(PS9-2) Factors Associated with ED Recidivism for Youth with Acute Internalizing Mental Health Symptoms

Emergency department (ED) visits for youth with suicidal ideation (SI) and non-suicidal self-injury (NSSI) have continued to rise, with national trends nearly doubling. Suicide is the second leading cause of death for youth ages 10-18 years in the United States. Over 50% of youth seeking MH care use the ED without previously seeking community-based MH services. This surge in SI/NSSI rates coincides with a 60% increase in ED visits related to MH disorders, and a 329% increase in visits related to NSSI in individuals under 18 years. At-risk youth not utilizing the required level of MH care, at the required frequency (“dose”), often experience increases in symptoms and severity. Consequently, EDs have witnessed a 43% increase in MH readmissions. This cross-sectional study examined electronic health record (EHR) data from a Northeastern Level 1 Pediatric Trauma Center’s ED Psychiatric Services from January 2019 to March 2023 to explore factors associated with ED recidivism for youth aged 4-17 years presenting to the ED with acute internalizing symptoms (i.e., SI, NSSI, anxiety, depression). Patients were followed from their first identified ED encounter throughout the duration of the study period to assess the occurrence of ED recidivism. Descriptive statistics were conducted to characterize the sample. A Cox’s Proportional Hazard Model was performed to assess factors associated with ED recidivism. There were 4,887 ED encounters in our analytic sample coming from 3,700 unique patients. 50.03% of patients were older than 14 and 49.97% were 14 or younger. Nearly two-thirds (63.88%) of patients were White, 8.86% were Black and 27.26% were another race. Nearly three-quarters (74.1-%) of patients were non-Hispanic. 46.84% of patients had public insurance ad 53.16% had private insurance. 75.30% of patients had SI and/or NSSI, while 24.70% of patients did not have SI and/or NSSI. 62.49% of patients reported having MH treatment prior to ED presentation. 87.29% of patients had an internalizing factor diagnosis associated with their ED visits. 8.31% of patients had an externalizing factor diagnosis associated with their ED visit. 33.93% of patients were observed to have hopelessness and 31.23% to have aggressiveness as documented by the provider. The Cox’s Proportional Hazard Model indicated an increased risk of ED recidivism was significantly associated with having a different gender identity than sex at birth (Hazard Ratio (HR) = 1.31, 95% CI: 1.02, 1.69, p< .05), DCYF involvement (HR = 1.85, 95% CI: 1.49, 2.30, p< .001), residing in the RI urban core (HR = 1.57, 95% CI: 1.29, 1.92, p< .001), reporting MH treatment uptake (HR = 2.61, 95% CI: 2.13, 3.20, p< .001), being admitted to the ED (HR = 1.65, 95% CI: 1.33, 2.04, p< .001), having an externalizing factor diagnosis (HR = 1.40, 95% CI: 1.05, 1.85, p< .05) and provider report of patient aggressiveness (HR  = 1.61, 95% CI: 1.34, 1.95, p< .001). Findings revealed significant complex and multifaceted factors associated with ED recidivism for the diverse youth with acute internalizing symptoms who utilized the ED due to acute internalizing symptoms. Future studies need to consider these factors and develop targeted interventions for the prevention of youth ED recidivism.