For children presenting to the emergency department with a mental health disorder, the likelihood of transfer is increased for those without insurance, according to a study published online in Pediatric Emergency Care.

Jamie L. Kissee, from the University of California Davis in Sacramento, and colleagues conducted a cross-sectional study of pediatric mental health emergency department admission and transfer events using the Healthcare Cost and Utilization Project 2014 Nationwide Emergency Department Sample. The analyses included 9,081 acute mental health emergency department events among children.

The researchers found that compared with patients with private insurance, children without insurance had higher odds of transfer relative to admission (odds ratio, 3.30; 95 percent confidence interval, 1.73 to 6.31). Similar odds of transfer were seen for children with Medicaid versus those with private insurance (odds ratio, 1.23; 95 percent confidence interval, 0.80 to 1.88). There was also variation in transfer rates across categories of mental health diagnosis. For patients presenting with depressive disorder, bipolar disorder, attention-deficit/conduct disorders, and schizophrenia, the odds of transfer were higher for patients without insurance than those with private insurance.

"This study provides evidence of existing disparities in treatment that raise concern for differential care for children presenting to emergency departments with mental health emergencies," the authors write.

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