Temporal trends in pediatric mental health visits: using longitudinal data to inform emergency department health care planning.

OBJECTIVE: Understanding the temporality of mental health presentations to the emergency department (ED) during the 24-hour cycle, day of the week, and month of the year may facilitate strategic planning of ED-based mental health services.

METHODS: Data on 30,656 ED presentations for mental illness, substance use, or intentional self-harm by 20,956 patients (≤ 17 years) were examined. We studied patient demography, discharge diagnosis, and time and date of presentation.

RESULTS: Most pediatric mental health ED visits (66.0%) occurred after the average work and school day (after 5 PM). Presentations related to substance use and intentional self-harm steadily increased in the evening. Emergency department visits related to substance use peaked on Friday through Sunday (4723/7475; 63.2%), whereas visits for mood disorders (4127/5093; 81.0%), neurotic/stress-related disorders (5960/7989; 74.6%), and behavioral/emotional disorders (237/304; 78%) were highest during the work/school week (Monday to Friday). Visits for intentional self-harm peaked following the weekend (Monday: 771/4676; 16.5%). Summer months had fewer visits (6862/30,656; 22.4%), whereas March to May (range: 2752-2912 visits) and October to November (range: 2701-2751 visits) showed more steady peaks in volume. Most presentations by diagnostic group decreased in volume during the winter months (December to February) to increase again in the spring (March to May).

CONCLUSIONS: Peak times for pediatric mental health presentations to the ED are evenings throughout the week, suggesting that mental health services for children, adolescents, and their families should be available after work and school hours, 7 days a week.