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

Abstract

Background Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs. Aims To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model. Method Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons. Results Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners. Conclusions The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.

Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

“…Pronounced income gradients reflect the association between socioeconomic status and mental illness but may also suggest that EDs play a particularly important role as an access point for people living with low incomes (as indicated by low-income neighbourhoods and receiving drug coverage under public Pharmacare). This is consistent with patterns observed in cross-provincial Canadian data40 and elsewhere 2 10 41 42. We also observed regional variations in ED use that is likely due to differences in healthcare infrastructure and service provision.…”

Profiles of Individuals with Cannabis-Related Disorders

“…For Profile 2, both poor clinical conditions and low service use explained poor outcomes. Studies found that individuals with higher co-occurring MD-SRD and/or chronic physical illnesses were high ED users, [78][79][80] with frequent hospitalizations. 81,82 Homelessness 65,83 and unemployment, 84 both overrepresented in Profiles 2 and 6, were also associated with high ED use and hospitalizations in related studies.…”

Profiles of quality of life among patients using emergency departments for mental health reasons

“…A previous study [ 32 ] identified four QoL profiles among patients with MD; the profile with the best QoL was of older men with low education, serious MD, few important needs, and receiving a high level of help from health services; whereas the profile with the worst QoL included young women with co-occurring MD-SRD and important needs [ 32 ]. Yet another [ 33 ] reported four profiles of ED users with MD, with the one with the highest ED use also having the highest specialized service use among patients with multiple MD-SRD. Another recent study [ 34 ] showed three profiles of high ED users with MD: (1) 3-year recurrent very high ED users (10 + ED visits/year); (2) 2-year recurrent high ED users; (3) 1-year high ED users.…”