Screening of mental health and substance users in frequent users of a general Swiss emergency department

Abstract

BackgroundThe objectives of this study were to determine the proportions of psychiatric and substance use disorders suffered by emergency departments’ (EDs’) frequent users compared to the mainstream ED population, to evaluate how effectively these disorders were diagnosed in both groups of patients by ED physicians, and to determine if these disorders were predictive of a frequent use of ED services.MethodsThis study is a cross-sectional study with concurrent and retrospective data collection. Between November 2009 and June 2010, patients’ mental health and substance use disorders were identified prospectively in face-to-face research interviews using a screening questionnaire (i.e. researcher screening). These data were compared to the data obtained from a retrospective medical chart review performed in August 2011, searching for mental health and substance use disorders diagnosed by ED physicians and recorded in the patients’ ED medical files (i.e. ED physician diagnosis). The sample consisted of 399 eligible adult patients (≥18 years old) admitted to the urban, general ED of a University Hospital. Among them, 389 patients completed the researcher screening. Two hundred and twenty frequent users defined by >4 ED visits in the previous twelve months were included and compared to 169 patients with ≤4 ED visits in the same period (control group).ResultsResearcher screening showed that ED frequent users were more likely than members of the control group to have an anxiety, depressive disorder, post-traumatic stress disorder (PTSD), or suffer from alcohol, illicit drug abuse/addiction. Reviewing the ED physician diagnosis, we found that the proportions of mental health and substance use disorders diagnosed by ED physicians were low both among ED frequent users and in the control group. Using multiple logistic regression analyses to predict frequent ED use, we found that ED patients who screened positive for psychiatric disorders only and those who screened positive for both psychiatric and substance use disorders were more likely to be ED frequent users compared to ED patients with no disorder.ConclusionsThis study found high proportions of screened mental health and/or substance use disorders in ED frequent users, but it showed low rates of detection of such disorders in day-to-day ED activities which can be a cause for concern. Active screening for these disorders in this population, followed by an intervention and/or a referral for treatment by a case-management team may constitute a relevant intervention for integration into a general ED setting.

Combined impacts of multimorbidity and mental disorders on frequent emergency department visits: a retrospective cohort study in Quebec, Canada

“…Previous research showed independent associations between frequent visits to the emergency department and physical multimorbidity 7,[9][10][11][12] or mental disorders. 10,11,[13][14][15][16]37 These studies did not distinguish common and serious mental disorders. However, the greater effect of serious mental disorders is consistent with the greater functional disability associated with psychotic and bipolar disorders.…”

Typology of patients who use emergency departments for mental and substance use disorders

“…Individuals with multiple co-occurring MDs and SUDs, similar to our class 2, were more likely to have high emergency department use. 22,32,56 Studies also found associations between high emergency department use and specific diagnoses, such as schizophrenia, [22][23][24] bipolar disorder, 33 depression, 33,59 personality disorder, 22,25,26,28 anxiety 23,24,26,33 and alcohol and drug use disorders. 4,22,23,29 Moreover, individuals from class 2 were frequently admitted to hospital and made more frequent visits to psychiatrists than others (enabling factors).…”

“…age, gender, education, employment and household income); and enabling factors refer to variables that facilitate access or continuity in health services, such as having a regular source of care. 21 The main needs factors identified in association with higher frequency of emergency department use for mental health reasons are mental health diagnoses, including schizophrenia, [22][23][24] personality disorder 22,[24][25][26][27][28] and SUDs, 4,22,23,29 as well as co-occurring MD-SUD and/or chronic physical illnesses. 22,[30][31][32] Regarding predisposing factors, an association was found between higher frequency of emergency department use and male gender, 18,29,30 whereas the association between emergency department use and age categories was not consistent.…”

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

“…3 Common reasons for such frequent use include pain, chronic physical and mental illness, and substance abuse. 1,2,4,5 Frequent ED users are mainly men, are between 40 and 50 years of age, are sicker and have higher rates of mortality than occasional ED users. 1,2,6 As such, they merit focused attention, and research on interventions to meet their needs is needed.…”