Mental Disorders, Substance Abuse Linked to Increased Emergency Department Visits

Deborah Brauser

July 21, 2010

July 20, 2010 — Almost 12 million of the 95 million total emergency department (ED) visits (1 in 8) made by adults in the United States in 2007 were due to a mental health and/or substance abuse (MHSA) problem, according to a new report from the Agency for Healthcare Research and Quality (AHRQ).

The findings also found that the most common MHSA-related reason for these visits was a mood disorder (42.7%), followed by anxiety disorders (26.1%), alcohol-related problems (22.9%), and drug disorders (17.6%). Nearly 41% of the total MHSA visits led to hospitalization.

"The number of patients with [MHSA] conditions treated in EDs has been on the rise for more than a decade," write lead study author Pamela L. Owens, PhD, from the AHRQ in Rockville, Maryland, and colleagues.

"Not only is this of concern to members of the mental health community but also to the members of the emergency medicine community who are concerned that ED overcrowding results in decreased quality of care and increased likelihood of medical error," they add.

The findings were reported July 2010 in a Healthcare Cost and Utilization Project (HCUP) statistical brief from the AHRQ.

Increased MHSA-Related Visits

For this project, data were examined from the HCUP 2007 Nationwide ED Sample, an AHRQ database of community hospitals in the United States.

Results showed that 12.5% of all ED visits during that year were related to an MHSA condition. These visits were also "2½ times more likely to result in hospital admission than ED visits related to non-MHSA conditions," write the study authors.

In addition, 63.7% of all MHSA-related visits were due to mental health conditions, 24.4% were for substance abuse conditions, and 11.9% were for co-occurring conditions.

Women had more of the overall MHSA visits (at 53.9%) and more of the visits due to mental health conditions (65.4%), whereas men had more of the visits related to substance abuse (29.3%) and co-occurring MHSA conditions (43%).

When looking at age range, adults between 18 and 44 years old had the largest percentage of overall MHSA-related ED visits (at 46.6%), followed by those between 45 and 64 years old (34.5%) and those older than 65 years (18.9%).

The patients 18 to 44 years of age were more likely to have visits due to co-occurring MHSA conditions (58.8% vs 42.7% and 50.7% for mental conditions only and substance abuse only, respectively), whereas those older than 65 years were more likely to have mental health conditions only (25.3% vs 9.1% for substance abuse and 5.2% for co-occurring conditions).

Finally, hospital admissions were most related to co-occurring MHSA conditions (57.1%), followed by mental health conditions only (39.3%) and substance abuse (36.6%). The group most likely to be admitted to the hospital was patients 65 years and older with co-occurring conditions, and those least likely to be admitted were between the ages of 18 and 44 years with mental health problems only.

The study authors have disclosed no relevant financial relationships.

AHRQ-HCUP Statistical Brief 92. Mental Health and Substance Abuse-Related Emergency Department Visits Among Adults, 2007. Released July 2010.

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