Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only.Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014–15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables.Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45–64- vs. 12–24-year age groups, and for men vs. women.Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.

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Psychotic experiences as precursors in schizophrenia? Findings from a population-based sample in Germany (DEGS1-MH)

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.912 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S48-S48

Author(s):

C. Schmidt-Kraepelin

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Psychotic Disorders ◽

Age Groups ◽

Population Based ◽

Care Utilization ◽

Psychotic Experiences ◽

German Health ◽

Wide Range

There are only a few studies that have studied the prevalence of psychotic experiences (PEs) in a representative population-based sample and a broad range of age. The association and predictive role of PEs in the context of psychotic and other mental disorders remains a subject of discussion. The Mental Health Module of the German Health Interview and Examination Survey for Adults is the first wave of a German health monitoring survey describing:– the distribution and frequency, the severity and the impairments of a wide range of mental disorders;– risk factors as well as patterns of help-seeking and health care utilization;– associations between mental and somatic disorders.A total of 4483 participants participated in the mental health section of the survey. The Composite International Diagnostic Interview, the Launay-Slade Hallucination Scale and the Peter's Delusion Inventory were used to assess PEs by clinically experienced interviewers. We can confirm and extend previous findings for younger age groups that PEs are very frequent psychopathological expressions in the general population across genders and all age groups. PEs rates were elevated among those with other mental disorders, particularly among possible psychotic disorders, PTSD and affective disorders. This points to the relevant role of PEs as a marker for psychopathology and mental disorders. Future prospective studies will have to focus on specific properties of psychotic experiences such as their appraisal or underlying social influences to determine their significance for the prediction of psychotic and other mental disorders.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00421-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Bahram Armoon ◽

Guy Grenier ◽

Zhirong Cao ◽

Christophe Huỳnh ◽

Marie-Josée Fleury

Keyword(s):

Emergency Department ◽

Urban Areas ◽

Addiction Treatment ◽

Service Use ◽

Negative Binomial ◽

Adverse Outcomes ◽

Community Healthcare ◽

Care Services ◽

Increased Risk ◽

Physician Care

Abstract Background This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables. Methods Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16). Results Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization. Conclusion Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services.

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Debt, common mental disorders and mental health service use

Journal of Mental Health ◽

10.1080/09638237.2018.1487541 ◽

2018 ◽

Vol 27 (6) ◽

pp. 520-528 ◽

Cited By ~ 5

Author(s):

Cerisse Gunasinghe ◽

Billy Gazard ◽

Lisa Aschan ◽

Shirlee MacCrimmon ◽

Matthew Hotopf ◽

...

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Mental Disorders ◽

Health Service ◽

Service Use ◽

Common Mental Disorders ◽

Mental Health Service Use ◽

Health Service Use

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Psychotic experiences and general medical conditions: a cross-national analysis based on 28 002 respondents from 16 countries in the WHO World Mental Health Surveys

Psychological Medicine ◽

10.1017/s0033291718000363 ◽

2018 ◽

Vol 48 (16) ◽

pp. 2730-2739 ◽

Cited By ~ 8

Author(s):

Kate M. Scott ◽

Sukanta Saha ◽

Carmen C.W. Lim ◽

Sergio Aguilar-Gaxiola ◽

Ali Al-Hamzawi ◽

...

Keyword(s):

Mental Health ◽

Chronic Pain ◽

Mental Disorders ◽

Severe Headache ◽

Medical Conditions ◽

Psychotic Experiences ◽

World Mental Health ◽

Wide Range ◽

Comorbid Mental Disorders ◽

Subsequent Onset

AbstractBackgroundPrevious work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.MethodsIn total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.ResultsAfter adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1–1.5] to 1.9 (95% CI 1.4–2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2–1.9) to 1.7 (95% CI 1.2–2.4).ConclusionsPEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.

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Twelve-month prevalence rates of mental disorders and service use in the Argentinean Study of Mental Health Epidemiology

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-017-1475-9 ◽

2018 ◽

Vol 53 (2) ◽

pp. 121-129 ◽

Cited By ~ 8

Author(s):

Juan Carlos Stagnaro ◽

Alfredo H. Cía ◽

Sergio Aguilar Gaxiola ◽

Néstor Vázquez ◽

Sebastián Sustas ◽

...

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Service Use ◽

Prevalence Rates

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Mental Disorder, Service Utilization, and GPA: Studying Mental Health of Former Child Welfare and Youth Experiencing Homelessness in a Campus Support Program

Families in Society The Journal of Contemporary Social Services ◽

10.1177/1044389419863177 ◽

2019 ◽

Vol 101 (1) ◽

pp. 54-70

Author(s):

Hui Huang ◽

Sofia B. Fernandez ◽

Michelle-Ann Rhoden ◽

Rigaud Joseph

Keyword(s):

Mental Health ◽

Academic Success ◽

Child Welfare ◽

Mental Disorders ◽

Service Use ◽

Mental Health Problems ◽

Support Program ◽

Mental Health Service Use ◽

Grade Point ◽

Social Work Research

Research has identified higher rates of mental disorders among former child welfare youth and youth experiencing homelessness when compared with their peers in the general population. Given the growing number of campus support programs serving these youth, research should focus on students in these programs to understand whether mental health problems interfere with these students’ receipt of program services, which can lead to unsatisfactory academic performance. This study collected both quantitative and qualitative data from students in a campus support program to examine the prevalence of mental disorders, mental health service use, receipt of program services, students’ grade point average, and their perceptions of obstacles and motivations to academic success. Implications for social work research and practice are discussed.

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Pacific models of mental health service delivery in New Zealand: Part I: What do we know about Pacific mental health in New Zealand? A narrative review

Australasian Psychiatry ◽

10.1177/1039856219859274 ◽

2019 ◽

Vol 28 (1) ◽

pp. 16-20

Author(s):

Roger Mulder ◽

Debbie Sorensen ◽

Staverton Kautoke ◽

Seini Jensen

Keyword(s):

Mental Health ◽

New Zealand ◽

Mental Disorders ◽

Psychotropic Drug ◽

Service Use ◽

Health Service Delivery ◽

Narrative Review ◽

Limited Evidence ◽

Mental Health Service Delivery ◽

Pacific People

Objective: To update measures of mental disorders and service use in Pacific people living in New Zealand. Method: A narrative review was conducted of available data on the prevalence of mental disorder, psychotropic drug prescribing and service use by Pacific people. Results: The 12-month prevalence of mental disorders in Pacific people was similar to European/Other in 2004. Currently Pacific people report high rates of psychological distress but lower levels of psychiatric disorders. Pacific adults have low rates of drinking but many who drink have a hazardous pattern. While Pacific people previously accessed services less than half the rate of European access, access rates in secondary care are now similar. Pacific people have relatively low rates of psychotropic drug use but these are increasing. Conclusion: There is limited evidence about Pacific people’s mental health in New Zealand. Patterns of psychopathology and service use may be different from other ethnic groups. Protective factors in Pacific culture should not be undermined when delivering mental health services.

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P077: The health inequalities among foreign patients visiting the emergency room with injury: a nationwide population-based study in South Korea, 2013-2015

CJEM ◽

10.1017/cem.2018.275 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S84-S84

Author(s):

S. Jung ◽

H. Lim ◽

J. Kwon ◽

N. Kim ◽

D. Seo

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Emergency Room ◽

Health Inequalities ◽

Personal Information ◽

Age Groups ◽

Population Based ◽

Emergency Rooms ◽

Wide Range ◽

Region Length

Introduction: Foreign patients often do not receive appropriate treatment in the emergency room as compared to locals. This is due to various causes such as language, insurance, and cultural differences. The purpose of this study was to investigate whether there is a wide range of health inequalities among foreigners who visited the emergency room with injury and to find out what causes it. Methods: We analyzed clinical data from the National Emergency Department Information System(NEDIS) database, which visited the emergency room from January 1, 2013 to December 31, 2015, in all age groups. Foreigners are classified based on the personal information described in the NEDIS. We analyzed the number of injuries, serious cases(death, operation, ICU admission), length of stay in ER, and transfer ratio. Results: A total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign patients. The incidence rate per 100,000 people per year was 2960.5 from locals and 1659.8 from foreigners. Serious outcomes were higher for foreigners than for locals(31.0% versus 23.2%, p<0.001). There was a further difference in the rural region. Length of stay was longer for foreigners(72 versus 69 minutes, median, p<0.001). The transfer rate was also higher for foreigners(1.9% versus 1.6%, p<0.001). Daegu had the highest ratio of foreigners’ injury compared to locals(ratio=0.998). Jeonnam(0.073) was the highest serious outcome rate in Korea, and Jeonbuk(0.070) was the second. The area with the longest length of stay in the Emergency department was the median 139 minutes for locals and 153 minutes for foreigners in Daegu. The more patients per day, the shorter the time spent in the emergency rooms(Spearman correlation coefficient=-0.388). This phenomenon was more prominent in locals(-0.624 versus -0.175). Multivariable logistic regression was used as a dependent variable for the serious outcomes of foreign patients. The foreign patients(OR=1.413, p<0.001), intention, no insurance, age, sex, urban area, low blood pressure, decreased consciousness, transfer, acuity, and length of stay were statistically significant. Conclusion: This study showed that there is a health inequality for foreigners who came to the emergency room due to injury in Korea. Also, serious outcomes from injury in foreigners have been shown to be related to various causes including factors of the foreigner.

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