Adolescent Urgent Psychiatric Consults: Prevalence of Substance Abuse and Comparison with Abstinent Peers

Aim: a) Examine the prevalence of substance abuse among adolescents referred for Urgent psychiatric consultation b) compare characteristics and outcome with abstinent peers.

Methods: This was a retrospective study of prevalence of substance abuse amongst adolescents assessed in a university hospital based urgent psychiatric consult service. Adolescents who had endorsed substance abuse in their assessment were than compared with age and gender matched peers who had denied any substance abuse. The clinic data base contains information on demographics and multiple clinical variables including presenting problem, diagnosis and outcome. Descriptive statistic was used for demographic and clinical variable. Logistic regression was used for group comparison.

Results: The prevalence of substance abuse was 22.7% amongst adolescents assessed for urgent psychiatric assessment (n=805). The average age was 15.5 years and females were overrepresented. The most frequent diagnosis was adjustment disorder followed by Substance Use disorder. Externalizing disorders were most frequent in abstinent peers. Adolescents with substance abuse were 3.502 (OR=3.502, 95% CI: 1.997, 6.141) times more likely to have a history of multiple forms of abuse, was 3.345 (OR=3.345, 95% CI: 1.472, 7.605) times more likely to have a family history of Antisocial disorders and 2.226 (OR=2.226, 95% CI: 1.099, 4.509) times of mood disorders. Almost 75% of substance abusing youth required follow-up and 17 % were admitted compared to 6% of abstinent youth.

Conclusion: Adolescents presenting to Emergency Departments for mental health crises may not volunteer a history of substance abuse. As substance abuse is a known risk factor for adolescent suicidal behaviors and carries high comorbidity with other psychiatric disorders, screening for abuse may assist triage decisions in the ED and improve detection and early intervention.