Structural influences on psychiatric emergency department visits among racial and ethnic minority youth in North Carolina: A neighborhood-level analysis.

Mental health continues to be a growing crisis for children, adolescents, and young adults. Yet, increasing trends in subgroups are not uniform, and key differences exist across geographic, racial, and age groups. Few studies examine structural factors like economic and racial inequality, important upstream structural inequities that impact mental health. This study examines the association between individual drivers and structural factors like neighborhood privilege and youth mental health (i.e., depression, schizophrenia, suicide ideation, anxiety) and associated racial and ethnic disparities. Data on mental health were obtained from psychiatric emergency department (ED) visits for the state of North Carolina from 2012 to 2021 for residents under age 24. Multilevel logistic regressions were employed to examine trends and drivers of psychiatric ED visits compared to non-psychiatric ED visits. Results show an increase in psychiatric ED visits from 2012 to 2021 across all races and ethnicities. Although white youth represent the majority of psychiatric ED visits, increasing trends among minorities, including Black and Hispanic youth, were notable, particularly for severe mental health conditions like schizophrenia and suicide-related outcomes and for urban neighborhoods with greater segregation. Findings underscore the need for policies addressing economic and racial inequalities at the neighborhood level to mitigate youth mental health disparities.