Psychological Distress and Emergency Department Utilization in the United States: Evidence from the Medical Expenditure Panel Survey

Abstract

Objectives: Psychological distress not only has substantial health and social consequences, but is also associated with emergency department (ED) use. Previous studies have typically used cross-sectional data to focus on the relation between serious psychological distress and dichotomized ED utilization measures, without assessing the volume of ED use or examining nonserious levels of psychological distress. The objective of this study was to explore the association between ED utilization volume and the full spectrum of psychological distress. The K6 scores showed a dose-response relationship in terms of the adjusted odds of having one or more ED visits. The adjusted odds ratios (ORs) were 1.86 (95% CI = 1.37 to 2.54) for adults with K6 scores at or above 11, OR 1.76 (95% CI = 1.38 to 2.25) for adults with K6 scores between 6 and 10, OR 1.33 (95% CI = 1.05 to 1.68) for adults with K6 scores between 3 and 5, and OR 1.17 (95% CI = 0.92 to 1.48) for adults with K6 scores of 1 or 2. In addition, the adjusted odds of having one or more ED visits in 2010 significantly increased with increasing psychological distress in 2009 (OR = 1.04, 95% CI = 1.03 to 1.06). Each additional point added to the K6 scale results in an increase in the adjusted odds of an ED visit. Conclusions:Even a low level of psychological distress, and not just serious psychological distress, may be an early indicator of future ED use. These results highlight the need to develop novel responses to better manage or avert ED use not only for adults with serious psychological distress but also for those who are experiencing even mild symptoms of psychological distress.ACADEMIC EMERGENCY MEDICINE 2014;21:510-519

The Association between Psychological Distress and Self-Reported Sleep Duration in a Population-Based Sample of Women and Men

“…In addition to SPD, milder psychological distress has strong dose-response and positive linear associations with both emergency room department utilization and mortality among US adults in two previous, longitudinal studies, possibly indicating lasting effects of psychological distress [ 6 , 24 ]. Based on our findings, a corollary observation is that these previously reported prospective associations with emergency room department utilization and mortality may be partially mediated by the association between psychological distress and short sleep duration.…”

“…K6 scores of 13 or greater versus 12 or fewer were used as a cut-point to distinguish people with and without SPD. Additionally, the K6 scores were grouped into five categories (0, 1 to 2, 3 to 5, 6 to 10, and 11 or greater) as defined in previous studies [ 6 , 24 ]. There was approximately 30%, 30%, 20%, 15%, and 5% of the population in each category.…”

“…According to Healthy People 2020 , “mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges” [ 1 ]. Previous studies suggest that the prevalence of SPD (a nonspecific measure that incorporates symptoms of anxiety, depression, and other types of psychological distress) among US adults is between 3.2 and 5.4% [ 2 – 6 ]. Both inadequate sleep and poor mental health are major causes of employee absenteeism and impaired work productivity [ 7 , 8 ].…”

Childhood family wealth and mental health in a national cohort of young adults

“…The scale has been validated as a screening tool for clinically significant mental distress across different age groups (R. C. Kessler et al, 2003; Prochaska, Sung, Max, Shi, & Ong, 2012) and higher scores are related to poorer health behaviors, physical morbidity, emergency department use, and mortality (Pratt, 2009; Pratt, Dey, & Cohen, 2007; Stockbridge, Wilson, & Pagan, 2014). We categorized the measure using previously defined clinically relevant cut-offs of 5–12 as moderate psychological distress and ≥ 13 as severe psychological distress (R.…”

Improving Emergency Department Discharge Care with Telephone Follow‐Up. Does It Connect?

“…Given the critical role that caregivers play in the care of older adult family members, ED care interventions may benefit from greater family engagement in discharge planning, greater education for transition care needs, and general support of caregiver psychological needs. Individuals with comorbid mental health conditions with high‐level social needs (e.g., homelessness) experiencing high psychological distress are also at higher risk of ED visits and poorer postdischarge outcomes . More research regarding which individuals are at high risk of poor‐quality transitions and care fragmentation will help move the field forward.…”