Abstract

The surge in pediatric psychiatric presentations to emergency departments has created a significant and underacknowledged toll on emergency physician well-being, leaving clinicians feeling depressed, frustrated, and helpless. This article addresses both dimensions of that challenge: the clinical factors driving adolescent mental health crises, and the physician wellness implications of frequent, high-acuity pediatric psychiatric exposure. Evidence-based contributing factors examined include sleep disruption from phone use, insufficient outdoor time, school-related stressors, coping deficits, medication effects and withdrawal, and emerging research on ketamine for treatment-resistant pediatric depression. The authors argue that physician wellness improves when clinicians feel equipped to help, and offer concrete, research-backed interventions emergency physicians can discuss with patients and families at the bedside.

• 📱 FACTOR 1
  Phone use and sleep disruption
  Phones in the bedroom, especially used through the night, disrupt adolescent sleep, a known risk factor for suicidality. Recommend that families have teens turn in phones to parents at bedtime.
  Curr Psychiatry Rep, 2015 · Nat Sci Sleep, 2020

• 🌿 FACTOR 2
  Insufficient outdoor ("green") time
  Reduced time in nature is independently linked to worse mental well-being in children and adolescents. Recommend a minimum of 120 minutes per week outdoors to produce measurable health benefit.
  Sci Rep, 2019 · PLoS One, 2020

• 🧠 FACTOR 3
  Coping deficits and school-related stressors
  Bullying, loneliness, perfectionism, and academic pressure are common triggers. Sharing personal stories of past failure and later success, and discussing healthy coping strategies, art, walking, calling a friend, can be meaningful bedside interventions.

• 💊 FACTOR 4
  Medication use, ADHD, and supplements
  Review all medications, including those prescribed for non-psychiatric conditions. Venlafaxine withdrawal can cause suicidal ideation. Undiagnosed or undertreated ADHD worsens impulsivity and emotional dysregulation. Omega-3, vitamins D and B complex, and magnesium show benefit for anxiety and depression.

• ⚗️ FACTOR 5
  Ketamine for treatment-resistant depression
  Ketamine infusion therapy is showing promise for adults and adolescents with suicidal ideation and treatment-resistant depression. Research in pediatric populations is ongoing; awareness of this emerging option is clinically relevant for ED disposition conversations.
  Am J Psychiatry, 2022

Why this matters for emergency physician wellness

Physician distress in pediatric psychiatric care is directly tied to feeling helpless. Equipping EPs with evidence-based interventions, even brief ones, restores a sense of agency and clinical effectiveness.

"We can feel better when we feel like we can help. Giving young patients coping strategies, sleep hygiene, green time, healthy stress outlets, can help emergency physicians too: restoring the sense of clinical agency that pediatric psychiatric presentations can erode."