Anxiety and alcohol in the working‐age population are driving a rise in mental health‐related emergency department presentations: 15 year trends in emergency department presentations in Western Australia

Abstract

Objective To evaluate age, gender and disease‐specific trends in ED for mental health presentations over 15 years. Methods The study population consisted of residents of metropolitan Perth, Western Australia, presenting to Perth ED between 1 July 2002 and 30 June 2017. Population rates of mental health‐related ED presentations per year were calculated. Results Rates of mental health ED presentations are significantly increasing in the working‐age population for those with stress and anxiety‐related diagnoses, particularly in younger females, and also for alcohol‐related presentations for those aged 10–49 years, particularly in males. Conclusion The present study demonstrates that increased rates of mental health‐related ED presentations are driven by increased rates of presentation for stress and anxiety‐related and alcohol‐related presentations in both genders across the working‐age population.

Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004–05 to 2016–17

“…The largest diagnostic group in Australia and all jurisdictions throughout the study period was stress‐related disorders (F40–F49) with over a quarter of presentations, consistent with findings from WA (Perth) during the period 2002–03 to 2016–17, SA during the period 2004–11 and earlier findings from NSW (1999–2006) and the high prevalence of this condition in the community . However, low prevalence disorders, including psychotic disorders (F20–F29), comprised 13.6% of presentations on average, and experienced a 14.6% increase in the number of presentations per 10 000 population over the study period.…”

“…This finding is arguably reflecting the higher levels of risky alcohol consumption and illicit drug use in the NT compared to the other jurisdictions . In WA, which had the second highest increase in substance‐use related presentations, alcohol has been identified as the primary driver behind an increase in this diagnostic group among metropolitan Perth residents between 2002–03 and 2016–17 . However, increased alcohol‐related presentations have not been found in NSW or QLD, highlighting the importance of non‐alcohol related presentations for some jurisdictions.…”

“…33 In WA, which had the second highest increase in substance-use related presentations, alcohol has been identified as the primary driver behind an increase in this diagnostic group among metropolitan Perth residents between 2002-03 and 2016-17. 16 However, increased alcohol-related presentations have not been found in NSW 41 or QLD, 42 highlighting the importance of nonalcohol related presentations for some jurisdictions. We also note that in the Perth study, substance use presentations increased just over twofold, as compared with an almost three-fold increase across the entire state between 2004-05 and 2016-17 as assessed herein, supporting differences in presentation characteristics between urban and rural areas.…”

“…In the USA, mood disorders, anxiety and alcohol‐ and drug‐related mental disorders have been identified as the major diagnostic groups among MH‐related ED presentations between 1992 and 2001 . In Australia, neurotic, stress‐related and somatoform disorders predominated within MH‐related ED presentations in New South Wales (NSW) between 1999 and 2006 and South Australia (SA) between 2004 and 2011, with stress and anxiety‐related diagnoses and substance‐use, particularly alcohol‐related presentations driving an increase in presentations in metropolitan Perth, Western Australia (WA) between 2002–03 and 2016–17 . In Victoria (VIC), depression, self‐harm ideation, self‐harm overdose then psychosis were identified as the primary (non‐mutually exclusive) MH reasons for visit across five EDs in 2004 .…”

“…3 In Australia, neurotic, stress-related and somatoform disorders predominated within MHrelated ED presentations in New South Wales (NSW) between 1999 and 2006 7 and South Australia (SA) between 2004 and 2011, 15 with stress and anxiety-related diagnoses and substance-use, particularly alcohol-related presentations driving an increase in presentations in metropolitan Perth, Western Australia (WA) between 2002-03 and 2016-17. 16 In Victoria (VIC), depression, self-harm ideation, self-harm overdose then psychosis were identified as the primary (non-mutually exclusive) MH reasons for visit across five EDs in 2004. 17 Intentional selfharm and psychoactive substance use were the leading diagnoses of MHrelated presentations among Victorian children and youth (0-19 years), between 2008-09 and 2014-15, with intentional self-harm highest from 2012-13.…”