Abstract

Recurrent out-of-Hour’s presentations among adolescents represent a high-risk group requiring targeted clinical attention. This study aimed to identify sociodemographic and clinical factors associated with repeated out-of-Hours psychiatric utilization. This retrospective study included adolescents aged 12-17 years who presented to the pediatric emergency department of a tertiary hospital between October 2022 and September 2024. Patients with three or more psychiatric visits were identified (n=50). Sociodemographic characteristics, psychiatric diagnoses, medication use, self-harm and suicide attempt history, and functional levels (CGAS) were extracted from electronic medical records. Of 1.355 psychiatric emergency evaluations, 15.64% (n=212) were recurrent visits, corresponding to 50 adolescents (32 girls, 18 boys). School non-attendance was significantly more common among boys (p=.018). Boys also had significantly higher numbers of admissions (Mann-Whitney U=348, p=.003). Although diagnostic distributions did not differ by sex, girls demonstrated a significantly higher rate of suicide attempts, consistent with global patterns of increased suicidal behavior among female adolescents. Short-acting intramuscular medications were administered more frequently to boys (55.6% vs. 31.3%; p=.016). No sex differences were found regarding inpatient referral or hospitalization outcomes. In regression analysis, a history of suicide attempt was a significant predictor of lower functioning, with an estimated 11-point decrease in CGAS scores (B=−11.22, p=.007). Adolescents with recurrent psychiatric visits represent a vulnerable subgroup with complex clinical and psychosocial needs. Beyond acute crises, repeated presentations appear to reflect broader difficulties including educational disengagement, family and socioeconomic factors, and gender-specific patterns of risk. The strong link between suicide attempts and impaired functioning highlights the need for thorough risk assessment and coordinated follow-up. Enhancing school support, family involvement, and access to mental health services may help reduce recurrent visits. Future multicenter prospective studies are required to further clarify contributing factors and guide effective interventions.

Key words: Child and Adolescent Psychiatry, Recurrent Psychiatric Presentations, Suicide Attempts, ADHD