The Association Between Deprivation, Mental Health and Repeat Attendance in Adolescents presenting to the Emergency Department: A UK retrospective Cohort Study

Background

Adolescent mental health presentations to emergency departments (EDs) are increasing across the UK. Socioeconomic deprivation is a recognised determinant of health outcomes, yet its relationship with mental health (MH) ED attendance, repeat attendance and medication burden in adolescents remains poorly characterised. This study aimed to examine these associations in a UK adolescent ED population.

Methods

A retrospective observational cohort study was conducted using ED attendance data from St. George’s Hospital (SGH) from 2024, linked with pharmacy prescription data from 2023 onwards. Patients aged 12–17 were included. The primary outcome was the association between Index of Multiple Deprivation (IMD) decile and any MH-related ED attendance per patient. Secondary outcomes included repeat attendance and polypharmacy (defined as ≥3 medication orders). Chi-Squared tests and Spearman’s Rank Correlation were used to assess statistical significance and direction of association.

Results

In total, 5,544 unique patients were included, comprising 7,439 attendances. MH-related attendance was highest in the most deprived group (11.3%) and lowest in the least deprived group (7.5%), with a statistically significant association across IMD groups (p<0.001; Spearman’s Rank = -0.77). A dose–response relationship was observed between repeat attendance and MH presentations, rising from 8.1% in single attenders to 23.4% in those attending four or more times (p<0.001; Spearman’s Rank =+0.98). Polypharmacy was present in around 35% of patients across all deprivation groups, with a modest but significant deprivation gradient (p<0.001; Spearman’s Rank = -0.47).

Conclusion

Socioeconomic deprivation is significantly associated with MH ED attendances in adolescents. Repeat attenders represent a high-risk group, with nearly one in four having a mental health presentation, highlighting the need for targeted mental health intervention and closer monitoring of frequent ED attenders. This study is limited by its observational, single-centre design and lack of confounder adjustment; further multi-centre studies incorporating multivariable regression are warranted.