This study showed that mental health problems are a leading cause of urgent hospitalization in adolescence. In this series, adolescent patients accounted for nearly a quarter of patients who accessed the PED, and this percentage was in line with that of a previous study. (7)
The principal cause of adolescents’ access to PED was trauma, but the presentation of mental health problems was considerably high: 6.4% of adolescents received a diagnosis related to mental health, with anxiety and behavioral disorders as the most common diagnoses. Comparing our results with those of a previous study, performed in a similar setting in 1990’s, a rise in the prevalence of visits for mental health problems is evident, 6.4% vs. 1.6%, respectively. (11) We found that adolescent girls were more prone to present with a mental health problem than male peers, and this data was in line with previous studies. (6, 11, 12)
Aside from traumas, among adolescents, 1 in 8 visits was related to a mental health problem, and a third of the hospitalized adolescents were referred to the neuropsychiatric ward. Admission to this ward was significantly more frequent in adolescents than in younger patients accessing the PED (p < 0.001).
Evidence shows that near 20% of adolescents present with a mental health problem. (13) Patients with these diseases often seek help, with an increasing trend in recent years, in the emergency services, (14–18) which for most of them are the first contact with the health care system. Therefore, pediatricians working in the emergency room should be prepared to receive and perform an appropriate investigation in these patients. In order to better evaluate these subjects, specific screening tools have been developed, (16) recommending the need for routine assessment of the family and social functioning, substance abuse, emotional and behavioral distress, with particular attention to suicidal thoughts. We want to emphasize that, in our series, nearly 25% of adolescents diagnosed with a mental health problem, presented with physical symptoms such as headache, abdominal pain, chest pain, respiratory distress, or dizziness. Thus, confirming that in adolescence, mental health problems frequently hide behind physical complaints. Besides, in just one year, six adolescents presented for a suicide attempt, confirming the high risk of suicide and self-harm in this age group. (19)
The few available studies performed in a PED setting focused on adolescents showing that the main reasons for the PED access were injuries or exacerbations of chronic diseases such as asthma or diabetes. (7, 8) On the contrary, this study revealed the significant burden of mental health problems in patients’ populations, further raising awareness of these disorders in adolescence. In our setting, these diseases are the first cause of urgent hospitalization in this age group. These data can contribute to highlight the need for an implementation of specially equipped staff and wards to support these patients, across Institutions.
Our study has some limitations. It was a single-center study, referring to a tertiary-level children’s hospital in a medium-sized city, so our results cannot be generalized; however, the substantial number of visits recorded strengthened our findings. Our Institution doesn’t have a psychiatric emergency clinic, but we highlight that it has a neuropsychiatric ward. In Italy, many PED don't have the possibility to admit patients with mental health problems to a neuropsychiatric ward because this specific ward is absent in many Institutions. This was a retrospective study, so we cannot rule out misclassification of patients, and, finally, patients who access our PED are aged 0 to 17 years old, therefore, we cannot provide data for late adolescence, 18 to 25 years of age.
In conclusion, this study described the features of a cohort of adolescents accessing the PED for a whole year. It highlighted the remarkable burden of mental health problems in this cohort of patients, showing that it is the first cause of urgent hospitalization in this age group.