The association between serious psychological distress and emergency department utilization among young adults in the USA.
ABSTRACT Psychological problems could lead to several adverse health outcomes and were strongly correlated with cigarette smoking and alcohol consumption. In addition, patients treated in EDs were vulnerable to psychological problems. We therefore examined the population-level association between serious psychological distress (SPD) and emergency department (ED) use among young adults in the USA. We also studied the additive effects of SPD, cigarette smoking, and alcohol consumption on the ED presentation.
The study sample contains 16,873 individuals, using data from the National Health Interview Survey, from 2004 to 2006. Bivariate analyses with chi-square tests and logistic regression analyses are performed.
Young adults having SPD were 2.05 times more likely to go to an ED. People having SPD and being a current smoker were 2.52 times more likely to use services in an ED. However, people having SPD and being a heavy drinker did not have a significantly elevated risk of ED use.
An association between SPD and ED use among US young adults is established in this study. Attempts to decrease excess ED use and the development of strategies to improve mental health among young adults are needed to improve patient health and reduce the health-care burden of high costs and deteriorating ED care quality.
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ABSTRACT: Objective Individuals with both physical and mental health problems may have elevated levels of emergency department (ED) service utilization either for index conditions or for associated comorbidities. This study examines the use of ED services by Medicaid beneficiaries with comorbid diabetes and schizophrenia, a dyad with particularly high levels of clinical complexity. Methods Retrospective cohort analysis of claims data for Medicaid beneficiaries with both schizophrenia and diabetes from fourteen Southern states was compared with patients with diabetes only, schizophrenia only, and patients with any diagnosis other than schizophrenia and diabetes. Key outcome variables for individuals with comorbid schizophrenia and diabetes were ED visits for diabetes, mental health-related conditions, and other causes. Results Medicaid patients with comorbid diabetes and schizophrenia had an average number of 7.5 ED visits per year, compared to the sample Medicaid population with neither diabetes nor schizophrenia (1.9 ED visits per year), diabetes only (4.7 ED visits per year), and schizophrenia only (5.3 ED visits per year). Greater numbers of comorbidities (over and above diabetes and schizophrenia) were associated with substantial increases in diabetes-related, mental health-related and all-cause ED visits. Most ED visits in all patients, but especially in patients with more comorbidities, were for causes other than diabetes or mental health-related conditions. Conclusion Most ED utilization by individuals with diabetes and schizophrenia is for increasing numbers of comorbidities rather than the index conditions. Improving care in this population will require management of both index conditions as well as comorbid ones.Schizophrenia Research 01/2013; DOI:10.1016/j.schres.2013.12.002 · 4.43 Impact Factor
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ABSTRACT: OBJECTIVE The purpose of this study was to examine racial-ethnic and gender differences in return visits to emergency services among transition-age youths (aged 17 to 24 years) with mental health needs. METHODS Data were from the California Emergency Department and Ambulatory Surgery Data. Logistic regression was used to examine the odds of returning to an emergency department among youths who had a psychiatric diagnosis (N=33,588). RESULTS About 41% of the sample returned to the emergency department within a year. Compared with white males, the odds of returning were lower for Hispanic males (odds ratio [OR]=.89) and Asian males (OR=.59) and higher for white females (OR=1.21), African-American females (OR=1.49), Hispanic females (OR=1.24), and Native American females (OR=2.09). CONCLUSIONS Repeat visits to emergency departments among transition-age youths with psychiatric diagnoses may indicate limited access to or lack of high-quality care. The disparities indicate a need for culturally sensitive and gender-specific services for this vulnerable population.Psychiatric services (Washington, D.C.) 03/2014; 65(5). DOI:10.1176/appi.ps.201300012 · 2.81 Impact Factor
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ABSTRACT: 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.Academic Emergency Medicine 05/2014; 21(5):510-519. DOI:10.1111/acem.12369 · 2.20 Impact Factor