{
  "abstract": "Objectives Paediatric mental health presentations to emergency departments (EDs) are rising. Rural/Regional mental health service users face structural barriers to accessing general and specialist treatment, including physical distance and local service capacity and funding constraints. However, differences in patient characteristics and treatment pathways between major city and rural/regional EDs remain unclear. This study aimed to compare demographic and clinical profiles of paediatric mental health patients within each location.Methods Retrospective cohort study of paediatric (aged 0–17 years) mental health presentations at 23 Australian EDs (metropolitan=18, rural/regional=five) from 1 January to 31 December 2018. At each site, up to 100 randomly selected unique patient medical records were included. Demographic and clinical characteristics were compared using logistic and linear mixed effects regression models.Results 2234 young people were recruited (metropolitan=1803, rural/regional=431). Mean age was 14.4 years (SD=2.6) and 59.4% were female. Frequent presentation reasons were suicidal ideation (853; 38.2%), self-harm (668; 29.9%) and behavioural disturbance (306; 13.7%). Of those with complete documentation, 703 (70.9%) had family history of mental illness and 933 (41.8%) reported recent interpersonal difficulties (eg, family/peer conflict). Three hundred and twenty-nine young people (14.7%) were admitted and 1024 (45.8%) were referred to public child and adolescent mental health services (CAMHS). Patients in rural/regional settings had shorter median waiting times for ED clinicians (24 vs 42 min) and mental health assessments (1.1 vs 2.5 hours), shorter median ED length of stay (2.9 vs 4 hours) and higher likelihood of referral to CAMHS on discharge (OR 2.19, 95% CI 1.22, 3.93).Conclusions Characteristics of children and adolescents presenting with mental health concerns are broadly similar between metropolitan and rural/regional EDs, but treatment characteristics differ. Frequency of family mental illness and interpersonal difficulties highlights the benefits of family focused interventions. Given similar patient profiles, equitable resourcing of rural/regional services is warranted.",
  "authors": [
    {
      "affiliations": [
        "Medicine, Dentistry and Health Sciences, The University of Melbourne School of Population and Global Health, Parkville, Victoria, Australia",
        "Centre for Adolescent Health, Murdoch Children’s Research Institute Population Health Theme, Parkville, Victoria, Australia"
      ],
      "name": "Jackson Newberry-Dupe"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Monash University, Melbourne, Victoria, Australia",
        "Paediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia"
      ],
      "name": "Marietta R John-White"
    },
    {
      "affiliations": [
        "Emergency Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia",
        "Department of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia"
      ],
      "name": "Franz E Babl"
    },
    {
      "affiliations": [
        "Emergency Department, Perth Children’s Hospital, Nedlands, Western Australia, Australia",
        "Divisions of Emergency Medicine and Paediatrics, School of Medicine, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia"
      ],
      "name": "Meredith L Borland"
    },
    {
      "affiliations": [
        "Emergency Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia",
        "Emergency Department, Grampians Health Ballarat, Ballarat, Victoria, Australia"
      ],
      "name": "Elyssia M Bourke"
    },
    {
      "affiliations": [
        "Emergency Department, Royal Darwin Hospital, Casuarina, Northern Territory, Australia"
      ],
      "name": "Sandra Brownlea"
    },
    {
      "affiliations": [
        "Emergency Medicine Research Group, Eastern Health, Box Hill, Victoria, Australia",
        "Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Paul Buntine"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia",
        "School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia"
      ],
      "name": "Brooke Charters"
    },
    {
      "affiliations": [
        "The University of Western Australia Rural Clinical School of WA, Albany, Western Australia, Australia",
        "WA Country Health Service, Albany, Western Australia, Australia"
      ],
      "name": "Mathew Coleman"
    },
    {
      "affiliations": [
        "Centre for Rural Emergency Medicine, Deakin University, Melbourne, Victoria, Australia",
        "Emergency Department, South West Healthcare, Warrnambool, Victoria, Australia"
      ],
      "name": "Tahnee Dunlop"
    },
    {
      "affiliations": [
        "Frankston Emergency Department, Peninsula Health, Frankston, Victoria, Australia"
      ],
      "name": "Olga Gaitsgory"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia",
        "School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia"
      ],
      "name": "Shane George"
    },
    {
      "affiliations": [
        "Paediatric Emergency Department, Women's and Children’s Hospital Adelaide Emergency Services, North Adelaide, South Australia, Australia"
      ],
      "name": "Amit Kochar"
    },
    {
      "affiliations": [
        "SEED Lifespan, Deakin University School of Psychology, Burwood, Victoria, Australia"
      ],
      "name": "Glenn A Melvin"
    },
    {
      "affiliations": [
        "Sunshine Hospital Emergency Department, Western Health, Footscray, Victoria, Australia"
      ],
      "name": "Doris Tham"
    },
    {
      "affiliations": [
        "Centre for Developmental Psychiatry and Psychology, Monash University Department of Psychiatry, Clayton, Victoria, Australia"
      ],
      "name": "Bruce Tonge"
    },
    {
      "affiliations": [
        "Royal Hobart Hospital, Tasmanian Health Service THS, Hobart, Tasmania, Australia",
        "Tasmanian Emergency Medicine Research Institute, Tasmania Department of Health, Hobart, Tasmania, Australia"
      ],
      "name": "Viet Tran"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia",
        "Paediatric Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia"
      ],
      "name": "Simon Craig"
    },
    {
      "affiliations": [
        "Centre for Mental Health and Community Wellbeing, The University of Melbourne School of Population and Global Health, Parkville, Victoria, Australia",
        "Centra for Adolescent Health, Murdoch Children’s Research Institute Population Health Theme, Parkville, Victoria, Australia"
      ],
      "name": "Rohan Borschmann"
    }
  ],
  "title": "Profile of paediatric mental health presentations to Australian emergency departments in 2018",
  "uid": "9e9bab6e-9738-54bd-bfaf-e72d21f75af3"
}