{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:21:49Z","timestamp":1790144509100,"version":"4.0.1"},"reference-count":25,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T00:00:00Z","timestamp":1665619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems than adults. The study at hand aimed to characterise those adolescents presenting to the ED triaged with a chief complaint regarding mental health. Furthermore, the goal was to assess sex differences in terms of diagnosis, suicidal ideation, substance use, as well as social impact. Methods: We conducted a single-centre, retrospective review of presentations to our adult ED related to the mental health of adolescents aged 16 to 18 years, covering the period from January 2013 to July 2017. Anonymised data were extracted from medical reports referring to the ED visits that were triaged as mental-health-related, and we assessed these for diagnosis, acute and previous suicidal ideation, history of self-harm, external aggression, substance use and social problems. We focused on patient characterisation and defining sex differences. Results: Data were analysed for a total of 612 consultations by adolescents who presented to our ED with problems related to mental health. Women accounted for 61.1% of cases. The most frequent diagnoses were reactions to severe stress and adjustment disorders (19.1%), followed by alcohol use disorders (17.6%), intentional self-harm (17.3%), and affective disorders (13.7%). Males had lower odds for intentional self-harm (OR 0.10, 95% 0.05\u20130.21, p &lt; 0.001) as well as disorders of personality and behaviour (OR 0.09, 95% 0.21\u20130.37, p &lt; 0.001), whereas they had higher odds of being admitted due to use of alcohol (OR 2.51, 95% 1.65\u20133.83, p &lt; 0.001). Of all cases, 31.7% reported acute suicidal ideation, with a significantly lower odds ratio in males (OR 0.58, 95% 0.41\u20130.84, p = 0.004). The most common source for referral to the ED was family members (25.2%). Males had twice the odds of reporting alcohol consumption as well as use of cannabis (in both cases p &lt; 0.001). In 27.9% of all cases, familial problems were reported, with males having significantly lower odds of being exposed to these (OR 0.64, 95% 0.44\u20130.94, p = 0.021), whereas they had higher odds of reporting educational problems (OR 1.68, 95% 1.04\u20132.72, p = 0.035). Conclusions: Adolescents aged sixteen to eighteen years presenting to the ED with problems related to mental health are an important subgroup of ED presentations and should be thoroughly assessed for suicidal ideation, substance use, as well as familial and educational problems. Assessment and establishment of post-ED care are of particular importance in this vulnerable patient group.<\/jats:p>","DOI":"10.3390\/ijerph192013196","type":"journal-article","created":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T20:55:11Z","timestamp":1665694511000},"page":"13196","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents"],"prefix":"10.3390","volume":"19","author":[{"given":"Raffaela M.","family":"Flury","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Brockhus","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4067-7174","authenticated-orcid":false,"given":"Martin","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Henssler","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University of Cologne Medical School, DE-50937 Cologne, Germany"},{"name":"Charit\u00e9 University Medicine, St Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, DE-10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristomenis K.","family":"Exadaktylos","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7956-2724","authenticated-orcid":false,"given":"Jolanta","family":"Klukowska-R\u00f6tzler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Brockhus, L.A., B\u00e4rtsch, M., Exadaktylos, A.K., Keitel, K., Klukowska-R\u00f6tzler, J., and M\u00fcller, M. (2021). Clinical Presentations of Adolescents Aged 16\u201318 Years in the Adult Emergency Department. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18189578"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"651530","DOI":"10.1155\/2013\/651530","article-title":"Mental Disorders among Children and Adolescents Admitted to a French Psychiatric Emergency Service","volume":"2013","author":"Boyer","year":"2013","journal-title":"Emerg. Med. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e20191536","DOI":"10.1542\/peds.2019-1536","article-title":"Children\u2019s Mental Health Emergency Department Visits: 2007\u20132016","volume":"145","author":"Lo","year":"2020","journal-title":"Pediatrics"},{"key":"ref_4","unstructured":"WHO (2021, April 22). Adolescent Mental Health. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/adolescent-mental-health."},{"key":"ref_5","unstructured":"WHO (2021, December 04). Global Health Estimates: Leading Causes of Death. Available online: https:\/\/www.who.int\/data\/gho\/data\/themes\/mortality-and-global-health-estimates\/ghe-leading-causes-of-death."},{"key":"ref_6","unstructured":"WHO (2021, December 04). Global Health Estimates: Leading Causes of DALYs. Available online: https:\/\/www.who.int\/data\/gho\/data\/themes\/mortality-and-global-health-estimates\/global-health-estimates-leading-causes-of-dalys."},{"key":"ref_7","unstructured":"Von Wyl, A., Chew Howard, E., Wade-Bohleber, L.M., Passalacqua, S., Haemmerle, P., and Andreae, A. (2020). Station\u00e4re und tagesklinische Angebote der psychiatrischen Gesundheitsversorgung an der Schnittstelle des Jugend- und Erwachsenenalters in der Schweiz: Eine Bestandesaufnahme bestehender Angebote im Auftrag des BAG. ZHAW Z\u00fcrcher Hochschule f\u00fcr Angewandte Wissenschaften, Z\u00fcricher Fachhochschule."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/S0140-6736(07)60368-7","article-title":"Mental health of young people: A global public-health challenge","volume":"369","author":"Patel","year":"2007","journal-title":"Lancet"},{"key":"ref_9","unstructured":"B\u00fcrli Ch, A.F., Duetz, M., and Schibli, D. (2015). Psychische Gesundheit in der Schweiz\u2013Bestands-aufnahme und Handlungsfelder, Bericht im Auftrag des Dialogs Nationale Gesundheitspolitik, Bundesamt f\u00fcr Gesundheit (BAG)."},{"key":"ref_10","unstructured":"WHO (2021, April 22). International Statistical Classification of Diseases and Related Health Problems 10th Revision. Available online: https:\/\/icd.who.int\/browse10\/2019\/en."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"343","DOI":"10.5694\/mja17.00434","article-title":"Paediatric mental and physical health presentations to emergency departments, Victoria, 2008\u20132015","volume":"208","author":"Hiscock","year":"2018","journal-title":"Med. J. Aust."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.jadohealth.2016.07.011","article-title":"Characterization of Young Adult Emergency Department Users: Evidence to Guide Policy","volume":"59","author":"Burns","year":"2016","journal-title":"J. Adolesc. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.jpeds.2015.07.004","article-title":"Trends in Pediatric Emergency Department Utilization for Mental Health-Related Visits","volume":"167","author":"Mapelli","year":"2015","journal-title":"J. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1542\/hpeds.2016-0120","article-title":"Child and Adolescent Mental Health Repeat Visits to the Emergency Department: A Systematic Review","volume":"7","author":"Leon","year":"2017","journal-title":"Hosp. Pediatr."},{"key":"ref_15","unstructured":"Healthy London Partnership\u2019s Children and Young People\u2019s Programme (2016). Improving Care for Children and Young People with Mental Health Crisis in London. Recommendations for Transformation in Delivering High-Quality Accessible Care, NHS England."},{"key":"ref_16","unstructured":"Schuler, D.T.A., and Peter, C. (2016). Psychische Gesundheit in der Schweiz. Monitoring 2020. Kennzahlen mit Fokus COVID-19 (Obsan Bulletin 2\/2022)., Schweizerisches Gesundheitsobservatorium."},{"key":"ref_17","unstructured":"Lieberherr, R. (2017). BfSB: Alkoholkonsum 2017. BFS Neuch\u00e2tel 2019, Schweizerisches Gesundheitsobservatorium (Obsan)."},{"key":"ref_18","unstructured":"Gmel, G.K.H., Notari, L., and Gmel, C. (2017). Suchtmonitoring Schweiz\u2014Konsum von Alkohol, Tabak und illegalen Drogen in der Schweiz im Jahr 2016. Sucht Schweiz, Bundesamt f\u00fcr Gesundheit, Direktionsbereich \u00d6ffentliche Gesundheit, Nationale Pr\u00e4ventionsprogramme."},{"key":"ref_19","first-page":"289","article-title":"Emergency Department Visits for Non-suicidal Self-harm, Suicidal Ideation, and Suicide Attempts in Children and Adolescents","volume":"53","year":"2021","journal-title":"Child Psychiatry Hum. Dev."},{"key":"ref_20","unstructured":"Parton, D. (2013). National confidential inquiry into suicide and homicide by people with mental illness (NCI). Ment. Health Today, 5."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.psc.2016.07.003","article-title":"Violence in the Emergency Department","volume":"39","author":"Stowell","year":"2016","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1016\/S0140-6736(16)00648-6","article-title":"Global burden of diseases, injuries, and risk factors for young people\u2019s health during 1990\u20132013: A systematic analysis for the Global Burden of Disease Study 2013","volume":"387","author":"Mokdad","year":"2016","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1007\/s10578-017-0719-y","article-title":"Mental Health Visits: Examining Socio-demographic and Diagnosis Trends in the Emergency Department by the Pediatric Population","volume":"48","author":"Holder","year":"2017","journal-title":"Child Psychiatry Hum. Dev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40211-016-0213-y","article-title":"Psychiatric emergencies of minors with and without migration background","volume":"31","author":"Popow","year":"2017","journal-title":"Neuropsychiatrie"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1007\/s00115-018-0549-6","article-title":"Suicidal tendencies in adolescence: Dysfunctional familiar communication as risk factor","volume":"89","author":"Radde","year":"2018","journal-title":"Nervenarzt"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13196\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:53:31Z","timestamp":1760144011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,13]]},"references-count":25,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph192013196"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192013196","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,13]]}}}