514 - Examining Associations between Child Opportunity Index and Mental Health Service Use among Pediatric Emergency Department Youth Screened for Suicide Risk
Monday, April 28, 2025
7:00am – 9:15am HST
Publication Number: 514.4783
Rachel Cafferty, University of Colorado School of Medicine, Denver, CO, United States; Charles Casper, University of Utah School of Medicine, Salt Lake City, UT, United States; Lilliam Ambroggio, Children's Hospital Colorado, Aurora, CO, United States; Sean T. O'Leary, University of Colorado School of Medicine, Denver, CO, United States; Cheryl A. King, University of Michigan Medical School, Ann Arbor, MI, United States; David A. Brent, UPMC/WPH/University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Jacqueline Grupp-Phelan, UCSF Benioff Children's Hospital San Francisco and Oakland, San Francisco, CA, United States
Assistant Professor University of Colorado School of Medicine Denver, Colorado, United States
Background: The Child Opportunity Index (COI) is an independent predictor of pediatric Emergency Department (ED) utilization and health outcomes, including adolescent depression and suicidality. Children with low COI (residing in low-opportunity areas) have lower levels of access to medical care. The relationship between COI and pediatric mental health service use (i.e., medication use, therapy, and acute crisis visits), as a proxy of mental health access, is not well-established. Objective: To examine associations between COI and mental health service use among pediatric ED patients screened for suicide risk. Design/Methods: This was a secondary analysis of the Emergency Department Screen for Teens At Risk for Suicide (ED-STARS) dataset. Participants were recruited from 13 pediatric ED sites between June 2015 and July 2016, were 12-17 years of age, completed a baseline suicide risk survey, and were reached for 3-month follow-up to collect interim mental health service use (Figure 1). Data were linked to the COI 3.0 scores for 2015. The primary predictor was nationally normed overall COI level (quintiles). The primary mental health service use outcome measures were medication use, therapy, and acute crisis services (i.e., ED mental health visit or psychiatric hospitalization). We performed multivariable logistic regression modeling, adjusting for demographic variables (age, sex, gender identity, sexual orientation) and baseline suicide risk (low, moderate, high). Odds ratios and 95% confidence intervals are reported. Results: Among 1,851 patients, most were female, White, not Hispanic, did not receive public assistance, and had no lifetime history of suicidal behavior. The mean COI score was 41.9 (SD 31.2). At 3 months, most participants did not use medications for a mental health diagnosis (n=1,266; 68.5%), did not engage in therapy (n=1,109; 60.0%) and did not report using acute crisis services (n=1,642; 88.7%) (Table 1). In adjusted models, a 10-point increase in COI was associated with a 10-14% increase in odds of each mental health service outcome. The very high COI quintile, compared to very low COI quintile, was associated with increased odds of all 3 outcomes: medication use (OR 2.73; 95% CI: 1.95, 3.84), therapy (OR 2.31; 95% CI: 1.67, 3.21), and acute crisis service use (OR 2.05; 95% CI: 1.29, 3.26) (Table 2).
Conclusion(s): In this cohort, higher COI was associated with increased post-ED interim mental health service use. Further work is needed to inform strategies that promote equitable mental health access for youth residing in low-COI areas.
