Study reveals gender and racial differences in youth psychiatric admissions
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Study reveals gender and racial differences in youth psychiatric admissions

According to new research published in CAVITYThere are troubling disparities in the number of children and adolescents visiting emergency departments for serious mental health symptoms. These results illustrate the significant need for targeted resources that reduce the number of children and adolescents visiting emergency departments while promoting equitable access to care.1,2

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Study reveals gender and racial differences in youth psychiatric admissions

This cross-sectional analysis used data from May 2020 to June 2022 that included youth ages 5 to 17 years who stayed in emergency departments in Massachusetts for 3 or more nights while waiting for inpatient mental health care. The purpose of this study, according to the researchers, is to summarize characteristics of youth — including age, gender, race or ethnicity, insurance, diagnosis, and barriers to placement — who stayed in emergency departments to examine any disparities in length of stay and rates of hospital admission after admission. Additionally, the researchers also assessed whether statewide demand for inpatient mental health care had any associations with individual outcomes.2

A total of 4,942 boarding episodes were identified from this data set. Of these events, 2,648 involved cisgender women (54%), 1,958 (40%) cisgender men, and 336 (7%) transgender or nonbinary youth. Additionally, researchers observed that 1,337 youth (27%) were under the age of 13, with the most common diagnosis being depression (n = 2,138, 43%).2

Results showed that of the total number of events, approximately 56% (n = 2748) resulted in hospital admission, with 171 transgender and non-binary young people (51%) and 1558 cisgender women (59%) receiving inpatient care (-9.1%; 95% CI, -14.7% to -3.6%). Transgender and non-binary young people also stayed in the facility for a mean (SD) of 10.4 (8.3) midnights compared with cisgender women, who stayed in the facility for 8.6 (6.9) midnights (adjusted difference: 2.2 midnights; 95% CI, 1.2 to 3.2 midnights). In addition, fewer black youth were admitted to residential care compared with their white counterparts (n = 382, ​​51% and n = 1,231, 56%, respectively; adjusted difference: -4.3%; 95% CI, -8.4% to -0.2%). The authors also observed that for every additional 100 youth in residential care statewide on the assessment date, the proportion of youth admitted was approximately 19.4% lower (95% CI, -23.6% to -15.2%) and the length of stay was 3.0 nights longer (95% CI, 2.4-3.7 nights).2

“The experience of being in a boarding facility—staying in a single emergency room, under 24-hour, one-on-one supervision, for days or weeks, with little definitive mental health treatment, and not knowing how long you’ll be stuck there—is detrimental to children’s well-being,” Lindsay Overhage, a doctoral candidate and researcher in the department of health care policy at Harvard Medical School, said in a press release. “In fields other than psychiatry, the most seriously ill person in the emergency department is the first to be admitted for inpatient treatment. However, many hospital departments don’t feel equipped to handle the children who have the most severe psychiatric symptoms, so by default, these children end up in the emergency department.”1

According to the authors, limitations of the study include the potential lack of generalizability of the data to other U.S. states, changes in the health care system resulting from the COVID-19 pandemic, and the study only included youth whose classes lasted 3 or more nights and excluded all other youth who visited a mental health emergency department. Despite the limitations, the researchers note that the results could inform further research and policy development that could help reduce boarding while ensuring equity in access to inpatient care.2

“Our study found that several nonclinical factors, including the nationwide demand for residential care, appear to play a role in the decision to enroll, and that racial and gender differences permeate the process,” senior author Nicole M. Benson, M.B.I., associate director of medical information at McLean Hospital and assistant professor of psychiatry at Harvard Medical School, said in a press release. “The boarding facility is a culmination of problems and lack of access across the entire mental health care system, not just residential care. Addressing this problem will require resources and interventions at multiple levels.”1

1. McLean Hospital. Study identifies racial and gender disparities in the emergency department boarding facility for adolescent psychiatric patients. Press release. July 8, 2024. Accessed July 9, 2024.
2. Overhage LN, Lê Cook B, Rosenthal MB, McDowell A, Benson NM. Differences in admission to psychiatric emergency departments between children and adolescents. JAMA Pediatrician Published online July 8, 2024. doi:10.1001/jamapediatrics.2024.1991