Kids Who Use the Emergency Room as Their Only Source of Health Care Are at Highest Risk For Sexual Abuse, Depression and Other Troubles

May 03, 1999

Adolescents who use the emergency room as their main source of health care are twice as likely to have a history of sexual and physical abuse and two and a half times more likely to suffer from depression, a new Children’s Hospital at Strong at the University of Rochester study suggests. The researchers say that emergency room doctors and nurses should look beyond these teens’ immediate injuries or health problems for signs of deeper matters like abuse or depression.

"Kids who use pediatricians or family doctors may also suffer from mental health problems or may have been abused," says Jonathan Klein, M.D., M.P.H., one of the authors of the study, "but kids without pediatricians, the ones who use only the emergency room for health care, are more likely to have serious underlying problems that may never get addressed."

This is one of the first studies to ask adolescents themselves where they get their care, rather than asking parents. It indicates that it is important to use the emergency room as a place to catch those teens who are falling through the cracks in the health care system. By designing a procedure to address the deeper problems an adolescent may have, or by persuading the teen to see a regular pediatrician, emergency room doctors can make sure that more adolescents receive proper preventive care.

"We know that people who don’t have health insurance are more likely to delay getting regular care, and wind up using the emergency room," says Karen Wilson, M.P.H., primary author of the study. "They usually don’t get the preventive care they need. What our study shows is that adolescents who use only the emergency room for care, regardless of whether they have insurance, are the people who need care the most, but aren’t getting it." Wilson explains that such people, and adolescents in particular, often go to the emergency room for injuries like a broken arm. The arm is treated, but the adolescent’s other problems – which may include depression, drug or sexual abuse – are not addressed.

The researchers also found that these adolescents were 10 percent more likely to use alcohol, 12 percent more likely to report using drugs in the previous month, and 13 percent more likely to report smoking. Boys, African-Americans, and those living in rural areas were all slightly more likely to use the emergency room as their source of primary care.

To compile this data, the authors analyzed written surveys of more than 6,000 5th-12th graders ranging in age from 12-18, from 294 schools across the country. The study was funded by the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls.

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