Article Figures & Data
- FIGURE 1
Age, race, and sex trends in psychiatric and suicide-related ED visits.
- TABLE 1
Age-Related Characteristics of Psychiatric ED Visits Among Youth in the United States
6–11 y 12–17 y 18–24 y Overall Count of total visits (weighted) 35 497 171 39 393 222 81 201 713 156 092 106 Count of psychiatric ED visits (weighted) 825 616 3 881 608 8 434 362 13 141 586 Estimated youth in the United States, 2011–2015 123 138 640 125 212 948 154 601 355 402 952 943 Psychiatric ED visits, % of all visits (count) 2011 2.0 (133 225) 9.0 (727 111) 9.4 (1 655 670) 7.8 (2 516 006) 2012 2.0 (132 235) 8.2 (607 112) 9.7 (1 575 440) 7.6 (2 314 787) 2013 2.8 (179 852) 9.4 (675 333) 9.8 (1 507 892) 8.1 (2 363 077) 2014 2.3 (181 471) 9.1 (755 863) 10.7 (1 770 647) 8.3 (2 707 981) 2015 2.5 (198 833) 13.2 (1 116 189) 12.5 (1 924 713) 10.1 (3 239 735) Psychiatric ED visits per 1000 US youth 2011 5.4 28.9 54.0 31.3 2012 5.4 24.2 50.9 28.7 2013 7.3 27.0 48.5 29.3 2014 7.3 30.2 57.0 33.5 2015 8.0 44.6 62.5 40.2 Region, % of psychiatric ED visits Northeast 29.6 20.6 18.8 20.0 Midwest 22.4 25.9 24.7 25.0 South 29.3 33.9 33.7 33.5 West 18.7 19.5 22.7 21.5 Sex,* % Female 28.4 56.7 49.7 50.0 Male 71.6 43.3 50.8 50.0 Race, % Non-Hispanic White 55.7 58.6 64.3 62.1 Non-Hispanic African American 22.9 19.4 19.7 19.8 Hispanic 16.5 19.8 13.8 15.8 Non-Hispanic other 4.9 2.1 2.1 2.3 Insurance,* % Private 32.2 38.6 32.5 34.3 Public 56.4 52.7 38.0 43.6 Self-pay 6.7 5.9 21.2 15.9 Other 4.6 2.8 8.3 6.4 Visit on a weekend,* % No 83.5 76.7 71.9 74.0 Yes 16.5 23.3 28.1 26.0 Arrival time,* % Morning (<11 am) 18.6 20.1 32.7 28.1 Afternoon (11 am–4 pm) 28.3 31.7 29.2 29.9 Evening (5 pm–12 am) 53.0 48.2 38.0 42.0 Urgent,* % No 34.3 21.9 33.5 30.1 Yes 65.7 78.1 66.5 69.9 Arrive by ambulance,*% No 85.9 78.7 71.2 25.6 Yes 14.1 21.3 28.8 74.4 Length of visit, % <90 min 18.5 17.4 21.9 20.4 90–179 min 25.7 28.3 28.9 28.5 180–359 min 36.9 30.5 28.3 29.4 ≥6 h 18.8 23.7 21.1 21.7 Mental health provider seen,* % No 84.5 75.1 87.4 83.5 Yes 15.4 24.9 12.6 16.5 Admit to hospital,* % No 81.6 74.6 84.3 81.3 Yes or transfer to another hospital 6.3 8.9 9.2 8.9 Transfer or admit to a psychiatric facility 12.1 16.4 6.5 9.8 Any psychiatric diagnosis or RFV,*,a % Mood* 45.4 62.7 48.5 52.5 Behavior* 42.3 19.7 8.2 13.7 SUD* 4.5 26.6 50.7 40.6 Psychosis 6.2 5.1 7.3 6.6 Suicide attempt or self-injury* 4.2 22.7 8.9 12.7 Other* 40.8 39.7 24.8 30.2 Count of psychiatric diagnoses or RFVs, mean 1.39 1.53 1.39 1.42 Primary diagnosis is psychiatric,* % No 37.9 23.3 38.9 34.2 Yes 62.1 76.7 61.1 65.8 Children Adolescents RRR 95% CI RRR 95% CI Year 1.04 0.89 to 1.22 1.04 0.94 to 1.14 Region Northeast Reference Reference Reference Reference Midwest 0.56 0.29 to 1.09 0.99 0.67 to 1.45 South 0.67 0.37 to 1.23 1.04 0.69 to 1.59 West 0.49* 0.27 to 0.90 0.74 0.49 to 1.12 Sex Female Reference Reference Reference Reference Male 2.65* 1.67 to 4.19 0.78 0.61 to 0.99 Race and/or ethnicity White, non-Hispanic Reference Reference Reference Reference African American, non-Hispanic 1.28 0.81 to 2.03 1.10 0.79 to 1.55 Hispanic 1.27 0.64 to 2.52 1.74* 1.22 to 2.47 Other 2.96 0.63 to 13.95 1.21 0.54 to 2.74 Insurance Private Reference Reference Reference Reference Public 1.42 0.79 to 2.57 1.03 0.74 to 1.43 Self-pay 0.30* 0.10 to 0.92 0.22* 0.14 to 0.34 Other 0.48 0.14 to 1.70 0.26* 0.12 to 0.54 Visit on a weekend No Reference Reference Reference Reference Yes 0.57* 0.15 to 0.94 0.86 0.63 to 1.18 Arrival time Morning (<11 am) Reference Reference Reference Reference Afternoon (11 am–4 pm) 1.74 0.91 to 3.14 1.69* 1.19 to 2.39 Evening (5 pm–12 am) 2.35* 1.34 to 4.12 2.04* 1.49 to 2.80 Urgent No Reference Reference Reference Reference Yes 0.85 0.50 to 1.44 1.76* 1.24 to 2.50 Length of visit 0.99 0.99 to 1.00 1.00 0.99 to 1.00 Arrive by ambulance No Reference Reference Reference Reference Yes 0.39* 0.21 to 0.75 0.71* 0.54 to 0.93 Mental health provider seen No Reference Reference Reference Reference Yes 1.06 0.32 to 2.11 2.08* 1.46 to 2.96 Admit to hospital No Reference Reference Reference Reference Yes or transfer to another hospital 0.58 0.31 to 1.11 1.06 0.67 to 1.69 Transfer or admit to a psychiatric facility 1.48 0.61 to 3.58 2.47* 1.49 to 4.11 Psychiatric diagnosis or RFVa Mood 0.83 0.50 to 1.37 1.57* 1.18 to 2.08 Behavior 7.64* 4.62 to 12.62 2.53* 1.79 to 3.56 SUDs 0.05* 0.02 to 0.13 0.41* 0.30 to 0.54 Psychosis 0.57 0.22 to 1.47 0.67 0.44 to 1.02 Suicide attempt or intentional self-injury 0.47 0.19 to 1.14 3.19* 2.27 to 4.48 Other 1.68* 1.12 to 2.53 1.87* 1.43 to 2.43 Count of diagnoses and/or RFVs 0.86 0.61 to 1.20 1.30* 1.09 to 1.54 Primary diagnosis is psychiatric No Reference Reference Reference Reference Yes 0.96 0.61 to 1.51 2.21* 1.66 to 2.93 - TABLE 3
Race- and Ethnicity-Related Characteristics of Psychiatric ED Visits Among Youth in the United States
Non-Hispanic White Non-Hispanic African American Hispanic Non-Hispanic Other Count of total visits (weighted) 75 572 719 35 939 326 27 564 070 3 874 405 Count of psychiatric ED visits (weighted) 8 162 101 2 607 369 2 074 122 297 994 Estimated youth in the United States, 2011–2015 217 594 589 56 413 412 92 679 177 36 265 765 Psychiatric ED visits, % of all visits (count)* 2011 9.3 (1 629 561) 6.3 (519 859) 5.7 (309 237) 6.2 (57 349) 2012 9.3 (1 499 311) 4.9 (342 599) 6.5 (411 193) 7.1 (61 684) 2013 9.8 (1 576 000) 5.9 (387 165) 6.1 (339 747) 7.9 (60 165) 2014 10.1 (1 682 520) 6.0 (562 364) 7.2 (423 844) 5.5 (39 253) 2015 10.3 (1 774 709) 10.8 (795 382) 9.1 (590 101) 8.9 (79 543) Psychiatric ED visits per 1000 US youth 2011 37.5 46.1 16.7 7.9 2012 34.5 30.4 22.2 8.5 2013 36.1 34.3 18.3 8.3 2014 38.5 49.7 22.8 5.4 2015 40.8 70.6 31.9 11.0 Region,* % of all psychiatric ED visits Northeast 19.8 19.4 21.1 24.1 Midwest 28.1 26.8 11.8 19.3 South 32.7 44.0 24.7 24.8 West 19.4 9.8 43.1 31.8 Youth, % 6–11 5.6 7.2 6.6 13.6 12–17 27.9 28.9 37.1 27.6 18–24 66.5 63.9 56.3 58.8 Sex, % Female 51.8 47.3 47.6 45.3 Male 48.2 52.7 52.4 54.6 Insurance,* % Private 41.7 18.6 22.6 40.4 Public 37.5 54.3 56.0 35.6 Self-pay 15.1 19.7 14.6 9.4 Other 5.7 7.4 6.8 14.5 Visit on a weekend,* % No 73.4 74.5 76.8 69.1 Yes 26.6 25.5 23.2 30.9 Arrival time,* % Morning (<11 am) 29.4 26.6 25.2 27.4 Afternoon (11 am–4 pm) 28.7 31.5 32.7 26.9 Evening (5 pm–12 am) 41.9 41.9 42.1 45.7 Urgent* No 28.3 37.5 27.8 32.4 Yes 71.7 62.4 72.2 67.6 Length of visit, % <90 min 20.9 20.5 17.3 25.7 90–179 min 30.6 25.9 25.0 16.5 180–359 min 28.3 28.4 35.6 27.9 ≥6 h 20.2 25.2 22.1 29.9 Arrive by ambulance,* % No 24.0 28.2 27.4 36.0 Yes 76.0 71.8 72.5 64.0 Mental health provider seen, % No 82.7 84.6 84.5 92.1 Yes 17.3 15.4 15.5 8.0 Admit to hospital, % No 80.5 81.8 84.0 80.3 Yes or transfer to another hospital 9.8 7.6 6.5 13.0 Transfer or admit to a psychiatric facility 9.7 10.6 9.5 6.8 Psychiatric diagnoses or RFV,*,a % Mood 54.0 47.4 51.6 63.4 Behavior* 11.9 18.6 16.9 6.7 SUD* 43.7 37.1 35.6 24.1 Psychosis 6.2 9.3 5.7 2.7 Suicide attempt or self-injury 12.9 11.4 12.8 20.2 Other 29.7 33.0 27.5 36.4 Count of psychiatric diagnoses or RFVs, mean* 1.45 1.45 1.37 1.33 Primary diagnosis is psychiatric,* % No 32.8 35.2 37.9 37.7 Yes 67.2 64.8 62.1 62.3 - TABLE 4
Sex-Related Characteristics of Psychiatric ED Visits Among Youth in the United States
Female Sex Male Sex Count of total visits (weighted) 87 687 560 68 404 546 Count of psychiatric ED visits (weighted) 6 582 345 6 559 241 Estimated youth in the United States, 2011–2015 196 847 905 206 105 038 Psychiatric ED visits*, % of all visits (count) 2011 6.9 (1 259 925) 8.9 (1 256 081) 2012 6.9 (1 184 067) 8.6 (1 130 720) 2013 6.7 (1 122 287) 10.0 (1 240 790) 2014 7.4 (1 320 195) 9.4 (1 387 786) 2015 9.5 (1 695 871) 11.0 (1 543 864) Psychiatric ED visits per 1000 US youth 2011 32.0 30.5 2012 30.1 27.4 2013 28.4 30.0 2014 33.4 33.6 2015 43.1 37.5 Region,* % of all psychiatric ED visits Northeast 18.8 21.3 Midwest 24.8 25.1 South 37.8 29.2 West 18.8 24.5 Youth,* y, % 6–11 3.6 9.0 12–17 33.4 25.6 18–24 63.0 65.4 Race, % Non-Hispanic white 64.2 60.0 Non-Hispanic African American 18.7 20.9 Hispanic 15.0 16.6 Non-Hispanic other 2.1 2.5 Insurance, % Private 34.1 34.5 Public 46.4 40.6 Self-pay 14.5 17.0 Other 5.0 7.9 Visit on a weekend, % No 73.4 74.6 Yes 26.5 25.4 Arrival time, % Morning (<11 am) 28.2 28.1 Afternoon (11 am–4 pm) 31.6 28.1 Evening (5 pm–12 am) 40.2 43.8 Urgent, % No 31.7 28.4 Yes 68.2 71.6 Length of visit, % <90 min 20.8 19.9 90–179 min 28.4 28.5 180–359 min 29.5 29.4 ≥6 h 21.2 22.2 Arrive by ambulance, % No 25.4 25.9 Yes 74.6 74.1 Mental health provider seen, % No 82.5 84.5 Yes 17.4 15.4 Admit to hospital, % No 81.9 80.7 Yes or transfer to another hospital 7.4 10.4 Transfer or admit to a psychiatric facility 10.7 8.9 Psychiatric diagnosis or RFV,*,a % Mood* 59.1 45.9 Behavior 12.1 15.3 SUD* 37.1 44.2 Psychosis* 5.1 8.2 Suicide attempt or self-injury 14.6 10.9 Other 30.1 30.3 Count of psychiatric diagnoses or RFVs, mean 1.44 1.44 Primary diagnosis is psychiatric, % No 35.1 33.4 Yes 64.9 66.6 - TABLE 5
Multivariate Analysis of Correlates of Psychiatric ED Visits Among Racial and Ethnic Groups
African American Hispanic Other RRR 95% CI RRR 95% CI RRR 95% CI Year 1.14* 1.03 to 1.27 1.10 0.98 to 1.24 1.00 0.77 to 1.30 Age group, y 6–11 Reference Reference Reference Reference Reference Reference 12–17 0.86 0.50 to 1.46 1.37 0.68 to 2.76 0.43 0.08 to 2.40 18–24 0.77 0.49 to 1.21 0.78 0.38 to 1.58 0.35 0.07 to 1.73 Region Northeast Reference Reference Reference Reference Reference Reference Midwest 0.93 0.52 to 1.69 0.35* 0.20 to 0.61 0.59 0.15 to 2.39 South 1.45 0.85 to 2.50 0.73 0.41 to 1.27 0.65 0.23 to 1.77 West 0.49* 0.26 to 0.95 2.11* 1.31 to 3.41 1.35 0.66 to 2.81 Sex Female Reference Reference Reference Reference Reference Reference Male 1.26 0.99 to 1.61 1.15 0.83 to 1.59 1.08 0.58 to 2.01 Insurance Private Reference Reference Reference Reference Reference Reference Public 3.36* 2.23 to 5.05 2.72* 1.85 to 4.00 0.97 0.35 to 2.72 Self-pay 2.99* 1.81 to 4.92 2.42* 1.48 to 3.93 0.77 0.28 to 2.07 Other 2.93* 1.56 to 5.50 1.84 0.91 to 5.02 2.68 0.98 to 4.53 Visit on a weekend No Reference Reference Reference Reference Reference Reference Yes 1.01 0.72 to 1.42 0.87 0.59 to 1.26 1.31 0.65 to 2.63 Arrival time Morning (<11 am) Reference Reference Reference Reference Reference Reference Afternoon (11 am–4 pm) 1.00 0.69 to 1.44 1.13 0.73 to 1.77 0.97 0.41 to 2.31 Evening (5 pm–12 am) 1.01 0.73 to 1.42 1.06 0.72 to 1.56 1.10 0.53 to 2.31 Urgent No Reference Reference Reference Reference Reference Reference Yes 0.67* 0.45 to 0.97 0.89 0.39 to 2.01 0.94 0.41 to 2.14 Length of visit 1.13 0.99 to 1.28 1.08 0.96 to 1.21 0.98 0.71 to 1.36 Arrive by ambulance No Reference Reference Reference Reference Reference Reference Yes 1.30 0.94 to 1.80 1.23 0.85 to 1.75 1.88 0.85 to 4.16 Mental health provider seen No Reference Reference Reference Reference Reference Reference Yes 0.87 0.61 to 1.23 0.81 0.55 to 1.19 0.38 0.13 to 1.13 Admit to hospital No Reference Reference Reference Reference Reference Reference Yes or transfer 0.80 0.52 to 1.24 0.69 0.40 to 1.20 1.35 0.50 to 3.64 Psychiatric facility 0.97 0.58 to 1.63 0.69 0.42 to 1.11 0.66 0.22 to 1.96 Psychiatric diagnosis or RFVa Mood 0.77 0.58 to 1.02 0.91 0.67 to 1.22 1.62 0.73 to 3.64 Behavior 1.60* 1.09 to 2.34 1.34 0.87 to 2.06 0.41 0.14 to 1.23 SUDs 0.74* 0.56 to 0.97 0.73 0.52 to 1.01 0.39* 0.20 to 0.69 Psychosis 1.38 0.89 to 2.50 0.78 0.44 to 1.41 0.42 0.15 to 1.13 Suicide attempt or self-injury 0.91 0.56 to 1.42 0.82 0.55 to 1.23 1.82 0.88 to 3.74 Other 1.17 0.87 to 1.57 0.80 0.55 to 1.16 1.33 0.68 to 2.62 Count of diagnoses and/or RFVs 0.94 0.78 to 1.15 0.75* 0.60 to 0.94 0.80 0.37 to 1.71 Primary diagnosis is psychiatric 0.93 0.69 to 1.27 0.76 0.52 to 1.11 1.44 −0.01 to 2.5 Female Sex Male Sex OR 95% CI Year Reference 0.97 0.91 to 1.05 Age group, y 6–11 Reference Reference Reference 12–17 Reference 0.29* 0.18 to 0.49 18–24 Reference 0.38* 0.54 to 0.60 Region Northeast Reference Reference Reference Midwest Reference 0.95 0.74 to 1.21 South Reference 0.67* 0.51 to 0.87 West Reference 1.20 0.92 to 1.80 Race and/or ethnicity White, non-Hispanic Reference Reference Reference African American, non-Hispanic Reference 1.26 0.99 to 1.61 Hispanic Reference 1.14 0.83 to 1.58 Other Reference 1.09 0.58 to 2.05 Insurance Private Reference Reference Reference Public Reference 0.81 0.62 to 1.06 Self-pay Reference 1.17 0.78 to 1.78 Other Reference 1.53 0.99 to 2.40 Visit on a weekend No Reference Reference Reference Yes Reference 0.94 0.77 to 1.67 Arrival time Morning (<11 am) Reference Reference Reference Afternoon (11 am–4 pm) Reference 0.89 0.67 to 1.19 Evening (5 pm–12 am) Reference 1.09 0.84 to 1.42 Urgent No Reference Reference Reference Yes Reference 1.25 0.97 to 1.61 Length of visit Reference 1.00 0.99 to 1.00 Arrive by ambulance No Reference Reference Reference Yes Reference 0.99 0.79 to 1.22 Mental health provider seen No Reference Reference Reference Yes Reference 0.89 0.70 to 1.13 Admit to hospital No Reference Reference Reference Yes or transfer to another hospital Reference 1.54 1.08 to 2.20 Transfer or admit to a psychiatric facility Reference 0.90 0.65 to 1.25 Psychiatric diagnosis or RFV Mood Reference 0.60 0.48 to 75 Behavior Reference 1.28 0.91 to 1.78 SUDs Reference 1.41* 1.13 to 1.75 Psychosis Reference 1.70* 1.11 to 2.61 Suicide attempt or intentional self-injury Reference 0.75 0.52 to 1.06 Other Reference 1.02 0.79 to 1.33 Count of diagnoses and/or RFVs Reference 1.03 0.89 to 1.20 Primary diagnosis is psychiatric No Reference Reference Reference Yes Reference 1.14 0.91 to 1.43 ↵* P < .05
2011 2012 2013 2014 2015 Overall All ED visits, % 6–11 y <0.1 <0.1 0.2 0.1 <0.1 <0.1 12–17 y* 1.4 1.3 2.7 2.3 3.5 2.2 18–24 y 1.3 1.0 0.7 0.8 1.1 0.9 Female patients 1.0 1.0 1.1 1.0 1.5 1.1 Male patients 0.9 0.7 1.1 1.1 1.5 1.0 Overall* 0.9 0.8 1.1 1.0 1.5 1.7 Psychiatric visits only, % 6–11 y 4.2 2.4 7.3 5.3 1.7 4.2 12–17 y* 15.8 15.5 28.7 24.8 26.2 22.7 18–24 y 10.9 9.9 7.1 7.6 9.1 8.9 Female patients 13.6 13.8 15.9 13.9 15.5 14.6 Male patients 10.4 7.9 11.0 10.6 13.5 10.9 Overall 12.0 10.9 13.3 12.2 14.5 12.7 Visits per 1000 US youth 6–11 y 0.2 0.1 0.5 0.4 0.1 0.3 12–17 y 4.6 3.7 7.7 7.5 11.7 7.1 18–24 y 5.9 5.0 3.5 4.3 5.7 4.8 Female patients 4.4 4.1 4.5 4.6 6.7 4.9 Male patients 3.2 2.2 3.3 3.6 5.1 3.5 Overall 3.7 3.2 3.9 4.1 5.8 4.2 ↵* P < .05.
In this issue
Trends in Psychiatric Emergency Department Visits Among Youth and Young Adults in the US
