scholarly journals Use of Diagnosis Code in Mental Health Syndrome Definition

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Achintya N Dey ◽  
Deborah Gould ◽  
Nelson Adekoya ◽  
Peter Hicks ◽  
Girum S Ejigu ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Disorders ◽  
Substance Use Disorders ◽  
Syndromic Surveillance ◽  
Case Definition ◽  
Added Value ◽  
Icd 10 ◽  
Health Related ◽  
Ed Visits

Objective: The objectives of this study are to (1) create a mental health syndrome definition for syndromic surveillance to monitor mental health-related ED visits in near real time; (2) examine whether CC data alone can accurately detect mental health related ED visits; and (3) assess the added value of using Dx data to detect mental health-related ED visits.Introduction: Between 2006 and 2013, the rate of emergency department (ED) visits related to mental and substance use disorders increased substantially. This increase was higher for mental disorders visits (55 percent for depression, anxiety or stress reactions and 52 percent for psychoses or bipolar disorders) than for substance use disorders (37 percent) visits [1]. This increasing number of ED visits by patients with mental disorders indicates a growing burden on the health-care delivery system. New methods of surveillance are needed to identify and understand these changing trends in ED utilization and affected underlying populations.Syndromic surveillance can be leveraged to monitor mental health-related ED visits in near real-time. ED syndromic surveillance systems primarily rely on patient chief complaints (CC) to monitor and detect health events. Some studies suggest that the use of ED discharge diagnoses data (Dx), in addition to or instead of CC, may improve sensitivity and specificity of case identification [2].Methods: We extracted a de-identified random sample of 50,000 ED visits with CC from the National Syndromic Surveillance Program (NSSP) for the period January 1—June 30, 2017. NSSP’s BioSense Platform receives ED data from >4000 hospitals, representing about 55 percent of all ED visits in the country [3]. From this sample we extracted 22868 ED visits that included both CC and Dx data. We then applied our mental health syndrome case definition which comprised mental health-related keywords and ICD-9-CM and ICD-10-CM codes. We queried CC text for the words “stress,” “PTSD,” “anxiety,” “depression,” “clinical depression,” “manic depression,” “unipolar depression,” “agitated,” “nervousness,” “mental health,” “mental disorder,” “affective disorder,” “schizoaffective disorder,” “psycoaffective disorder,” “obsessive-compulsive disorder,” “mood disorder,” “bipolar disorder,” “schizotypal personality disorder,” “panic disorder,” “psychosis,” “paranoia,” “psych,” “manic,” “mania,” “hallucinating,” “hallucination,” “mental episode,” and “mental illness.” We queried Dx fields either for ICD-9- CM codes 295-296; 300, 311 or for ICD-10-CM codes F20-F48. The ICD-9- CM and ICD-10-CM codes used to identify mental health-related ED visits are based on the mental health disorders most frequently seen in EDs. Alcohol and substance use, suicide ideation, and suicide attempt were excluded from this study because they are included in alternate syndromes [2]. We manually reviewed the CC text to validate the search terms. Sensitivity, specificity, and positive predictive value will be calculated based on agreement of coding mental health against the human review of mental health visits.Based on our case definition, the sample of 22868 ED visits with CC and Dx data was further stratified into two groups: (1) mental health identified in either CC or Dx, and (2) no mental health identified in CC and Dx. Group 1 was further stratified into three groups: (a) mental health identified only in CC, (b) mental health identified in both CC and Dx, and (c) mental health identified only in Dx. The sample of 27132 ED visits with CC and no Dx data was further stratified into two groups: (1) mental health identified in CC, and (2) no mental health identified in CC (Figure).Results: Of the 50,000 sample of ED visits with CC data, 22868 visits had both CC and Dx data. Of the 22868 visits, we identified 1560 mental health-related ED visits using the mental health syndrome case definition. Of those visits, 241 were identified by a CC only, 226 were identified by both CC and Dx, and 1093 by a mental health-related Dx. Of the 27132 ED visits without Dx data, 421 had mental health identified in CC.Conclusions: Based on our preliminary analysis these findings suggest potential benefits of including Dx data in syndrome binning for mental health. Mental health terms are more likely to be found in Dx data than in the CC (1093 vs. 662). Using CC alone may underestimate the number of mental health-related ED visits. This study had several limitations. Not all facilities reporting to NSSP provide chief complaint data in the same manner, some provide CC as a drop down menu with predefined terms while others include the full text of CC. Not all records contained a Dx code which limited our ability to examine the added value of Dx code for that subset.

Frequent use of emergency departments for mental and substance use disorders

2018 ◽  
Vol 35 (4) ◽  
pp. 220-225 ◽  
Author(s):  
Karen Urbanoski ◽  
Joyce Cheng ◽  
Jürgen Rehm ◽  
Paul Kurdyak
Keyword(s):  
Substance Use ◽  
Mental Disorders ◽  
Substance Use Disorders ◽  
Service Use ◽  
Secondary Analysis ◽  
Mental Healthcare ◽  
Specialist Care ◽  
Ed Visits ◽  
Administrative Health Databases

ObjectivesWe described the population of people who frequently use ED for mental disorders, delineating differences by the number of visits for substance use disorders (SUDs), and predicted the receipt of follow-up services and 2-year mortality by the level of ED use for SUD.MethodsThis retrospective observational study included all Ontario residents 15 years and older who had five or more ED visits during any 12-month period from 2010 to 2012 (n=263 346). The study involved a secondary analysis of administrative health databases capturing emergency, hospital and ambulatory care. Frequent ED users for mental disorders (n=5416) were grouped into nested categories based on the number of ED visits for SUD. Logistic regression was used to examine group differences in the receipt of follow-up services and mortality, controlling for sociodemographics, comorbidities and past service use.ResultsThe majority of frequent ED users for mental disorders had at least one ED visit for SUD, most commonly involving alcohol. Relative to people with no visits for SUD, those with ED visits for SUD were older and more likely to be men (Ps <0.001). As the number of ED visits for SUD increased, the likelihood of receiving follow-up care, particularly specialist mental healthcare, declined while 2-year mortality steadily increased (Ps <0.001). These associations remained after controlling for comorbidities and past service use.ConclusionsFindings highlight disparities in the receipt of specialist care based on use of ED services for SUD, coupled with a greater mortality risk. There is a need for policies and procedures to help address unmet needs for care and to connect members of this vulnerable subgroup with services that are better able to support recovery and improve survival.

What is Comorbidity – Fact or Artefact?

1996 ◽  
Vol 168 (S30) ◽  
pp. 7-8 ◽  
Author(s):  
Hans-Ulrich Wittchen
Keyword(s):  
Substance Use ◽  
Mental Disorders ◽  
Personality Disorders ◽  
Mood Disorders ◽  
Diagnostic Criteria ◽  
Substance Use Disorders ◽  
Statistical Manual ◽  
Axis Ii ◽  
Diagnostic And Statistical Manual ◽  
Icd 10

Comorbidity can be described broadly as the presence of more than one disorder in a person in a defined period of time (Wittchen & Essau, 1993). Stimulated by the introduction of explicit diagnostic criteria and operationalised diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM–III; APA, 1980) and the Diagnostic Criteria for Research in ICD–10 (WHO, 1991), numerous studies in the 1980s and early 1990s, have assessed the extent, the nature, and more recently, the implications of comorbidity for a better understanding of mental disorders. Most studies investigated the association of anxiety and mood disorders, but increasingly there are also studies looking into the association of mood disorders with other disorders (such as somatoform and substance use disorders (Wittchen et al, 1993, 1996)) as well as with somatic conditions (axis II) and personality disorders (axis III).

scholarly journals Prevalence of Mental Disorders and Suicidality in Canadian Provinces

2019 ◽  
Vol 64 (11) ◽  
pp. 761-769
Author(s):  
Joshua Palay ◽  
Tamara L. Taillieu ◽  
Tracie O. Afifi ◽  
Sarah Turner ◽  
James M. Bolton ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Alcohol Use ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Substance Use Disorders ◽  
Alcohol Use Disorder ◽  
Service Providers ◽  
The Past ◽  
Canadian Provinces

Objective: There is limited information to guide health-care service providers and policy makers on the burden of mental disorders and addictions across the Canadian provinces. This study compares interprovincial prevalence of major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), alcohol use disorder, substance use disorders, and suicidality. Method: Data were extracted from the 2012 Canadian Community Health Survey—Mental Health ( n = 25,113), a representative sample of Canadians over the age of 15 years across all provinces. Cross tabulations and logistic regression were used to determine the prevalence and odds of the above disorders for each province. Adjustments for provincial sociodemographic factors were performed. Results: The past-year prevalence of all measured mental disorders and suicidality, excluding GAD, demonstrated significant interprovincial differences. Manitoba exhibited the highest prevalence of any mental disorder (13.6%), reflecting high prevalence of MDD and alcohol use disorder compared to the other provinces (7.0% and 3.8%, respectively). Nova Scotia exhibited the highest prevalence of substance use disorders (2.9%). Quebec and Prince Edward Island exhibited the lowest prevalence of any mental disorder (8.5% and 7.7%, respectively). Manitoba also exhibited the highest prevalence of suicidal ideation (5.1%); however, British Columbia and Ontario exhibited the highest prevalence of suicidal planning (1.4% and 1.3%, respectively), and Ontario alone exhibited the highest prevalence of suicide attempts (0.7%). Conclusions: Significant interprovincial differences were found in the past-year prevalence of mental disorders and suicidality in Canada. More research is necessary to explore these differences and how they impact the need for mental health services.

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

BJPsych Open ◽  
2020 ◽  
Vol 6 (4) ◽  
Author(s):  
Marie-Josée Fleury ◽  
Guy Grenier ◽  
Jean-Marie Bamvita ◽  
Francine Ferland
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Substance Use ◽  
Mental Disorders ◽  
Health Service ◽  
Substance Use Disorders ◽  
General Practitioners ◽  
Emergency Departments ◽  
Enabling Factors ◽  
Emergency Department Use

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.

scholarly journals Gender and the relationship between marital status and first onset of mood, anxiety and substance use disorders

2009 ◽  
Vol 40 (9) ◽  
pp. 1495-1505 ◽  
Author(s):  
K. M. Scott ◽  
J. E. Wells ◽  
M. Angermeyer ◽  
T. S. Brugha ◽  
E. Bromet ◽  
...  
Keyword(s):  
Mental Health ◽  
Gender Differences ◽  
Substance Use ◽  
Mental Disorders ◽  
Marital Status ◽  
Substance Use Disorders ◽  
Men And Women ◽  
Increased Risk ◽  
First Onset ◽  
Reduced Risk

BackgroundPrior research on whether marriage is equally beneficial to the mental health of men and women is inconsistent due to methodological variation. This study addresses some prior methodological limitations and investigates gender differences in the association of first marriage and being previously married, with subsequent first onset of a range of mental disorders.MethodCross-sectional household surveys in 15 countries from the WHO World Mental Health survey initiative (n=34493), with structured diagnostic assessment of mental disorders using the Composite International Diagnostic Interview 3.0. Discrete-time survival analyses assessed the interaction of gender and marital status in the association with first onset of mood, anxiety and substance use disorders.ResultsMarriage (versus never married) was associated with reduced risk of first onset of most mental disorders in both genders; but for substance use disorders this reduced risk was stronger among women, and for depression and panic disorder it was confined to men. Being previously married (versus stably married) was associated with increased risk of all disorders in both genders; but for substance use disorders, this increased risk was stronger among women and for depression it was stronger among men.ConclusionsMarriage was associated with reduced risk of the first onset of most mental disorders in both men and women but there were gender differences in the associations between marital status and onset of depressive and substance use disorders. These differences may be related to gender differences in the experience of multiple role demands within marriage, especially those concerning parenting.

scholarly journals Customizing ESSENCE Queries for Select Mental Health Sub-indicators

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Achintya N. Dey ◽  
Michael Coletta ◽  
Hong Zhou ◽  
Nelson Adekoya ◽  
Deborah Gould
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Anxiety Disorders ◽  
Syndromic Surveillance ◽  
Depressive Disorders ◽  
National Level ◽  
Chief Complaint ◽  
Co Morbidity ◽  
Icd 10 ◽  
Ed Visits

ObjectiveEmergency department (ED) visits related to mental health (MH) disorders have increased since 2006 (1), indicating a potential burden on the healthcare delivery system. Surveillance systems has been developed to identify and understand these changing trends in how EDs are used and to characterize populations seeking care. Many state and local health departments are using syndromic surveillance to monitor MH-related ED visits in near real-time. This presentation describes how queries can be created and customized to identify select MH sub-indicators (for adults) by using chief complaint text terms and diagnoses codes. The MH sub-indicators examined are mood and depressive disorders, schizophrenic disorders, and anxiety disorders. Wider adoption of syndromic surveillance for characterizing MH disorders can support long-term planning for healthcare resources and service delivery.IntroductionSyndromic surveillance systems, although initially developed in response to bioterrorist threats, are increasingly being used at the local, state, and national level to support early identification of infectious disease and other emerging threats to public health. To facilitate detection, one of the goals of CDC’s National Syndromic Surveillance Program (NSSP) is to develop and share new sets of syndrome codes with the syndromic surveillance Community of Practice. Before analysts, epidemiologists, and other practitioners begin customizing queries to meet local needs, especially monitoring ED visits in near-real time during public health emergencies, they need to understand how syndromes are developed.More than 4,000 hospital routinely send data to NSSP’s BioSense Platform, representing about 55 percent of ED visits in the United States (2). The platform’s surveillance component, ESSENCE,* is a web-based application for analyzing and visualizing prediagnostic hospital ED data. ESSENCE’s Chief Complaint Query Validation (CCQV) data source, which is a national-level data source with access to chief complaint (CC) and discharge diagnoses (DD) from reporting sites, was designed for testing new queries.MethodsWe used ESSENCE CCQV to query weekly data for the nine week period from the first quarter of 2018 and looked at three common MH sub-indicators: mood and depressive disorders, schizophrenic disorders, and anxiety disorders. We developed four query types for each MH sub-indicator. Query-1 focused on DD codes; query-2 focused on CC text terms; query-3 focused on a combination of CC, DD, and no exclusion for mental health co-morbidity; and query-4 focused on a combination of CC and DD and excluded mental health co-morbidity. We also examined the summary distribution of CC texts to identify keywords related to MH sub-indicators.For mood and depressive disorders, we queried ICD-9 codes 296, 311; ICD-10 codes F30–F39; CC text terms for words “depressive disorder,” bipolar disorder,” “mood disorder,” “depression,” “manic episodes,” and “psychotic.” For schizophrenic disorders, we queried ICD-9 codes 295; ICD-10 codes F20–F29; CC text terms for words “psychosis,” “psychotic,” “schizo,” “delusional,” “paranoid,” “auditory,” “hallucinations,” and “hearing voices.” For anxiety disorders, we queried ICD-9 codes 300, 306, 307, 308, 309; ICD-10 codes F40–F48; CC text terms for words “anxiety,” “anexiy,” “aniety,” “aniexty,” “ansiety,” “anxety,” “anxity,” “anxiety,” “phobia,” and “panic attack.”ResultsWe identified 2.3 million average weekly ED visits for the 9-week period queried. Table 1 shows average weekly ED visits of select MH sub-indicators from the four query types. Because query 4 focused on specific MH outcomes and excluded MH co-morbidities, the average weekly ED visit for all three sub-indicators was almost half that of query 3, which focused on broader concepts by including MH co-morbidities. Among mood and depressive disorders, query 4 identified on average 23,352 ED visits per week versus 45,504 visits per week for query 3. Similarly, for schizophrenic disorders and anxiety disorders, query 4 identified on average 4,988 and 32,790 visits per week compared with 9,816 and 53,868 visits, respectively, for query 3. Further, more MH-related visits were identified using the DD-coded query (query 1) than CC-based text terms (query 2).ConclusionsAnalysts can benefit from having queries on select sub-indicators readily available and can use these to facilitate routine MH-related monitoring of ED visits, or customize the queries by including local text terms. Consistent with our previous work (3), this analysis demonstrated that MH-related ED visits are more likely to be found in DD codes than in CC alone.* Electronic Surveillance for the Early Notification of Community-based EpidemicsReferences[1] Weiss AJ, Barrett ML, Heslin KC , Stocks C. Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006–2013. HCUP Statistical Brief #216 [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; 2016 Dec [cited 2018 Aug 14]. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-Visit-Trends.pdf.[2] Gould DW, Walker D, Yoon PW. The Evolution of BioSense: Lessons Learned and Future Directions. Public Health Reports. 2017 Jul/Aug;132(Suppl 1):S7–S11.[3] Dey AN, Gould D, Adekoya N, Hicks P, Ejigu GS, English R, Couse J, Zhou H. Use of Diagnosis Code in Mental Health Syndrome Definition. Online Journal of Public Health Informatics [Internet]. 2018 [cited 2018 Aug 14];10(1). Available from: https://doi.org/10.5210/ojphi.v10i1.8983

Prevalence of Mental Disorders in Abakaliki, Ebonyi State, Southeastern Nigeria

2020 ◽  
pp. 107839032095191
Author(s):  
Njaka Stanley ◽  
Ezeruigbo S. Chinwe
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Disorders ◽  
Substance Use Disorders ◽  
Significant Relationship ◽  
Well Being ◽  
Southeastern Nigeria ◽  
Economic Output ◽  
The People ◽  
Health Registry

Background: Increasing psychological stressors have posed challenges to the well-being of the people across the globe and greatly affected the functionality and economic output of the individuals and the society. Nigeria has no existing mental health registry. Data on the prevalence of mental disorders are not readily available owing to lack of mental health registry. Hence, this study assessed the prevalence of mental disorders in Abakaliki metropolis, Ebonyi State. Aim: To determine the prevalence of mental disorders and associated factors among the residents of Abakaliki metropolis, Ebonyi State. Method: This cross-sectional descriptive research study involved 400 participants. Questionnaires adapted from world mental health diagnostic interview and General Health Questionnaire 12 were used for data collection. Data were analyzed using descriptive statistics and hypotheses tested using chi-square test at significance level of .05. Results: The prevalence of mental disorders among the respondents was 70% depressive disorders and 52.3% substance use disorders—tranquilizers (34.9%) and stimulants (15.8%) were the commonly used, while 85.3% suffered anxiety disorders. These were common among age range of 19 to 28 years—those with higher education and the unemployed. More females had mental disorders except substance use disorders, which was higher in males (53.4%). There was no significant relationship between mental disorders and the demographic variables, but significant relationship was found to exist between individuals’ age and anxiety disorder. Conclusion: Mental disorders, such as depression, anxiety, and substance use disorders, are common among the respondents and, therefore, calls for urgent attention of the government to improve the mental health of the people.

scholarly journals Identifying mental health and substance use disorders using emergency department and hospital records: a population-based retrospective cohort study of diagnostic concordance and disease attribution

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e030530
Author(s):  
Linwei Wang ◽  
Fahmida Homayra ◽  
Lindsay A Pearce ◽  
Dimitra Panagiotoglou ◽  
Rachael McKendry ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Cohort Study ◽  
Substance Use Disorders ◽  
Retrospective Cohort ◽  
Population Based ◽  
Regression Analyses ◽  
Diagnosis Codes ◽  
Ed Visits ◽  
Positive Agreement

ObjectivesAdministrative data are increasingly being used for surveillance and monitoring of mental health and substance use disorders (MHSUD) across Canada. However, the validity of the diagnostic codes specific to MHSUD is unknown in emergency departments (EDs). Our objective was to determine the concordance, and individual-level and hospital-level factors associated with concordance, between diagnosis codes assigned in ED and at discharge from hospital for MHSUD-related conditions.DesignPopulation-based retrospective cohort study.SettingEDs and hospitals within Vancouver Coastal Health Authority (VCH), British Columbia, Canada.Participants16 926 individuals who were admitted into a VCH hospital following an ED visit from 1 April 2009 to 31 March 2017, contributing to 48 116 pairs of ED and hospital discharge diagnoses.Primary and secondary outcome measuresWe examined concordance in identifying MHSUD between the primary discharge diagnosis codes based on the International Statistical Classification of Diseases, 9th and 10th Revisions (Canada) assigned in the ED and those assigned in the hospital among all ED visits resulting in a hospital admission. We calculated the percent overall agreement, positive agreement, negative agreement and Cohen’s kappa coefficient. We performed multiple regression analyses to identify factors independently associated with discordance.ResultsWe found a high level of concordance for broad categories of MH conditions (overall agreement=0.89, positive agreement=0.74 and kappa=0.67), and a fair level of concordance for SUDs (overall agreement=0.89, positive agreement=0.31 and kappa=0.27). SUDs were less likely to be indicated as the primary cause in ED as opposed to in hospital (3.8% vs 11.7%). In multiple regression analyses, ED visits occurring during holidays, weekends and overnight (21:00–8:59 hours) were associated with increased odds of discordance in identifying MH conditions (adjusted OR 1.47, 95% CI 1.11 to 1.93; 1.27, 95% CI 1.16 to 1.40; 1.30, 95% CI 1.19 to 1.42, respectively).ConclusionsED data could be used to improve surveillance and monitoring of MHSUD. Future efforts are needed to improve screening for individuals with MHSUD and subsequently connect them to treatment and follow-up care.

scholarly journals Monitoring child mental health related emergency department visits in New York City

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Don Olson ◽  
Willem Van der Mei ◽  
Sungwoo Lim ◽  
Carol Yoon ◽  
Melissa Kull ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
New York ◽  
New York City ◽  
York City ◽  
Syndromic Surveillance ◽  
Surveillance Data ◽  
Age Group ◽  
Health Related ◽  
Ed Visits

ObjectiveTo assess the use of syndromic surveillance to assess trends inmental health-related emergency department (ED) visits amongschool-aged children and adolescents in New York City (NYC).IntroductionFrom 2001-2011, mental health-related hospitalizations and EDvisits increased among United States children nationwide [1]. Duringthis period, mental health-related hospitalizations among NYCchildren increased nearly 23% [2]. To estimate mental health-relatedED visits in NYC and assess the use of syndromic surveillance chiefcomplaint data to monitor these visits, we compared trends from anear real-time syndromic system with those from a less timely, codedED visit database.MethodsThe NYC ED syndromic surveillance system receives anonymizedpatient chief complaint and basic demographic data for nearly everyED visit citywide to provide timely surveillance information tohealth authorities. Using NYC ED syndromic surveillance datafrom 2003-2015, we applied previously developed definitions forgeneral psychiatric syndromes. We aggregated ED visits by agegroup (5-12 years, 13-17 years, and 18-20 years), geography, andtemporality. Syndromic data were compared with Statewide Planningand Research Collaborative System (SPARCS) data from 2006-2014which reported mental health diagnosis (ICD-9), treatment, service,and basic demographics for patients visiting facilities in NYC. Usingthese two data sources, we compared daily visit patterns and annualtrends overall as well as stratified by age group, area-based poverty(ZIP code), and time of visit.ResultsBoth syndromic surveillance and SPARCS data for NYC showedan increasing trend during the period. While both showed relativeincreases with similar slopes, mental health-related chief complaintdata captured fewer overall visits than the ICD-9 coded SPARCSdata. Trends in syndromic data during 2003-2015 differed by age-group and area-based poverty, e.g., among children ages 5-12 yearsthe annual proportion of mental health-related ED visits increasedroughly 3-fold from 1.2% to 3.8% in the poorest areas, which wasgreater than the increase in the richest areas (1.7% to 2.6%). Seasonal,day-of-week, and school holiday patterns found far fewer visits duringthe periods of NYC public school breaks (Figure).ConclusionsWe conclude that syndromic surveillance data can provide areliable indicator of mental health-related ED visit trends. Thesefindings suggest potential benefit of syndromic surveillance data asthey may help capture temporal and spatial clustering of events in amuch more timely manner than the >1 year delay in availability ofED discharge data. Next steps include a qualitative study exploringthe causes of these patterns and the role of various factors drivingthem, as well as use of patient disposition and matched data to bettercharacterize ED visit patient outcomes.

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