There are very few epidemiological studies of children and adolescents referred for emergency or crisis. In a study carried out in Ontario, (2) a retrospective chart review was carried out over an 18-month period of 319 children and adolescents who visited the emergency room of a children's hospital and who were referred for emergency psychiatric consultation. Of these, 63 per cent were female; 58 per cent were between 10 and 15 years of age and 42 per cent between 16 and 19. Around 42 per cent were in care. The majority (72 per cent) presented between 17.00 and 21.00—36 per cent were admitted to hospital and 50 per cent were receiving outpatient treatment. The main diagnoses were conduct/oppositional defiant disorder in 38 per cent and adjustment disorder in 41 per cent; 60 per cent presented with threats of self-harm, and 24 per cent with threats of harming others.

A study carried out in a hospital in New Haven described 1436 emergencies seen by child psychiatry personnel. (3.) About 56 per cent of the children were female. Examining the presenting problems, 17 per cent were classified as suicidal attempt, 30 per cent as suicidal ideation, 17 per cent as physically aggressive behaviour, and 24 per cent as oppositional-defiant behaviour.

In summary, the majority of child and adolescent emergency problems are related to suicidal behaviour, physical violence, and oppositional defiant behaviour. More females than males presented, and generally after 17.00.

Emergencies do present to other settings (such as an inpatient unit, a general practitioner's office, a school, or other community service), but epidemiological information about emergencies in these settings is lacking.

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