B2.02 - Oral: Neighborhood Factors Influence Primary Care Follow-up for Adolescents with Depression or Suicidality After ED Visits

Brief Abstract Summary: Gain insight into the disparities in mental health care follow-up for adolescents in crisis. With depression and suicidality on the rise, timely follow-up after an ED visit for mental health crisis is critical but achieved by less than two-thirds of adolescents. This study examines how neighborhood conditions, assessed via the Child Opportunity Index (COI), affect primary care follow-up rates for adolescents screened for depression or suicidality. Analyzing data from over 4,000 adolescents, we found that only 24.5% received follow-up within 30 days, with stark differences based on insurance type, race, and neighborhood COI. Black youth and those from "very low" COI neighborhoods had significantly lower follow-up rates, underscoring the urgent need to address socioeconomic and structural barriers to equitable health care access.

Detailed abstract description: Background
With rising rates of adolescent depression and suicidality, exacerbated by the COVID-19 pandemic, it is critical for acute care systems to connect youth in mental health crises to timely follow-up care. Socioeconomic and structural barriers may hinder these connections, contributing to inequities in mental health care access. Despite National Committee for Quality Assurance standards recommending follow-up within 30 days after an Emergency Department (ED) visit for mental health concerns, fewer than two-thirds of adolescents receive timely outpatient care. We examine how neighborhood conditions, as measured by the Child Opportunity Index (COI), impact primary care follow-up for adolescents who screened positive for moderate/severe depression or suicidality on a routine behavioral health screen (BHS-ED) during an ED visit.

Methods/Approach
We conducted a retrospective cohort study of adolescents in our primary care network aged 12-19 years who presented to our ED between June 2015 to June 2023, and screened positive for moderate/severe depression or suicidality using the BHS-ED. Logistic regression analyses examined associations between COI quintile and primary care follow-up within 30 days, adjusting for patient- and neighborhood-level factors.

Results
Our cohort of 4,208 adolescents had a mean age of 15.7 (SD 1.6) years and predominantly self-identified as female (71.7%) and Black (55.5%). Most were publicly insured (54.6%) with 56.2% residing in "very low" COI quintile neighborhoods. Only 24.5% completed a primary care follow-up visit within 30 days of the index ED visit with privately insured youth more likely to follow-up compared to publicly insured youth (OR 1.30, 95% CI 1.12–1.49, p< 0.001). Black youth had lower odds of follow-up compared to white youth (OR 0.72, 95% CI 0.61–0.85, p< 0.001). In multivariate analysis, adolescents from "very high" COI quintile neighborhoods were more likely to follow up than those from "very low" quintile COI neighborhoods (OR 1.33, CI 1.08-1.64, p< 0.01).

Conclusion
Our findings highlight significant disparities in primary care follow-up for adolescents with symptoms of depression or suicidality, with lower follow-up rates among those from disadvantaged neighborhoods.