Clinical Question: Among adolescents with depression or suicidal ideation discharged from the emergency department (ED), what factors are associated with timely primary care follow-up?
Background: Timely outpatient follow-up after ED visits for adolescent mental health crises is recommended but inconsistently achieved. Prior studies show disparities in access to care. These disparities may be based on insurance and race, with structural barriers—including neighborhood-level disadvantage—playing an important role.
Study Design: Retrospective cohort study
Setting: Single tertiary children’s hospital in the mid-Atlantic U.S.
Synopsis: This retrospective cohort study included 3,362 adolescents (ages 12 through 19) who screened positive for moderate or severe depression or suicidal ideation (SI) in the ED and were discharged. The primary outcome was primary care follow-up within 30 days; the secondary outcome was follow-up within seven days. Only 21.2% completed the 30-day follow-up, and 11.1% completed follow-up within seven days. Adolescents from very high Child Opportunity Index (COI) neighborhoods were more likely to follow up than those from very low-opportunity areas. Privately insured patients had higher follow-up rates than their publicly insured peers, and Black adolescents were less likely to follow up than white adolescents. Notably, patients with current SI were less likely to complete follow-up. Limitations include single-center design, reliance on in-network follow-up data, and inability to confirm visit content. These findings align with prior literature demonstrating disparities in outpatient mental health care. However, this study places an emphasis on access and extends prior research by highlighting the impact of neighborhood opportunity on follow-up after ED visits.
Bottom Line: Most adolescents do not receive timely primary care follow-up after ED mental health visits, with disparities driven by neighborhood opportunity, insurance, and race.
Citation: Joshi P, et al. Follow-up after ED visits for teens with depression and suicidality: a retrospective cohort study. Pediatr Open Sci. 2025;1(4):1-7. doi:10.1542/pedsos.2025-000857.
Dr. Connelly
Dr. Connelly is trained in med-peds and is an academic hospitalist in the division of hospital medicine at MedStar Washington Hospital Center in Washington, D.C.