TOPLINE

Approximately half of the pediatric mental health-related emergency department (ED) visits occurred at low-volume facilities (< 10,000 annual pediatric visits); presentation to high-volume facilities was more common among non-Hispanic Black and Hispanic children and less common among Native American children than among non-Hispanic White children, a pattern also seen for suicide-related visits specifically.

METHODOLOGY

• In this retrospective cross-sectional exploratory analysis, researchers used the Nationwide Emergency Department Sample data collected during 2016-2022, focusing on children aged 5-17 years who had a mental health-related ED visit.
• The study included 5,369,821 weighted mental health-related ED visits, extrapolated from 1,224,951 unweighted visits, among children (49.2% aged 15-17 years; 58% girls).
• The primary outcome was the annual pediatric ED volume, categorized as low (< 1800 visits), medium (1800-4999 visits), medium-high (5000-9999 visits), or high (≥ 10,000 visits), and the high-volume category was compared with all other categories.
• Mental health-related visits were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code from the validated Child and Adolescent Mental Health Disorders Classification System. Suicide-related visits were identified as a distinct subgroup.
• For visits occurring during 2019-2022, when race and ethnicity data were available, researchers examined the potential association of patient characteristics (age, sex, race and ethnicity, insurance type, and quartile of median household income) and hospital characteristics (census region and urban-rural designation) with presentation to high vs low-, medium-, or medium-high-volume EDs; the association was examined for both mental health-related and suicide-related visits.

TAKEAWAY

• About half of all mental health-related visits occurred at low, medium, or medium-high-volume EDs, with 50.1% of visits occurring at high-volume EDs. Mental health-related visits increased by 24% during 2016-2022, whereas suicide-related visits increased by 74% over the same period.
• Among children with mental health-related visits overall, non-Hispanic Black children (adjusted odds ratio [aOR], 1.19; 95% CI, 1.05-1.35) and Hispanic children (aOR, 1.69; 95% CI, 1.44-1.98) were more likely to present to high-volume EDs than non-Hispanic White children.
• Among children with suicide-related visits, non-Hispanic Black children (aOR, 1.26; 95% CI, 1.12-1.42) and Hispanic children (aOR, 1.66; 95% CI, 1.41-1.96) were also more likely to present to high-volume EDs than non-Hispanic White children, whereas Native American children (aOR, 0.51; 95% CI, 0.32-0.81) were less likely to present to high-volume EDs than non-Hispanic White children.
• Native American children (aOR, 0.54; 95% CI, 0.35-0.83) were less likely to present to high-volume EDs than non-Hispanic White children, a finding consistent across all mental health-related visits. Children with private insurance were more likely to present to high-volume EDs, both for mental health visits overall (aOR, 1.15; 95% CI, 1.06-1.25) and suicide-related visits (aOR, 1.12; 95% CI, 1.03-1.22), than those with Medicaid. Children presenting for substance-related disorders (aOR, 0.79; 95% CI, 0.71-0.87) were less likely to present to high-volume EDs than those presenting for suicide or self-injury.

IN PRACTICE

"[A]pproximately half of mental health-related and suicide-related ED visits for children occurred in EDs with low, medium, or medium-high annual pediatric volume. Visit patterns varied by race, ethnicity, and diagnosis, with important implications for equitable delivery of high quality emergency behavioral health care," the authors wrote.

SOURCE

The study was led by Audrey G. Brewer, MD, MPH, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago. It was published online on September 3, 2026, in the Annals of Emergency Medicine.

LIMITATIONS

The study was limited by the lack of patient-level identifiers; the potential for administrative coding to cause the misclassification of demographic characteristics and diagnoses, including the severity and complexity of mental health-related concerns; the unavailability of race and ethnicity data for close to half the study period; and the inability to assess adverse childhood experiences, neighborhood-level factors, and the racial and ethnic makeup of areas surrounding the hospitals.

DISCLOSURES

The study was funded by the National Institute of Mental Health of the National Institutes of Health. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.