Reasons for Frequent Psychiatric Emergency Service Use in a Large Urban Center

Poremski, Daniel; Wang, Peizhi; Hendriks, Margaret; Tham, Josephine; Koh, Doris; Cheng, Lan

doi:10.1176/appi.ps.201800532

Cited by 9 publications

(5 citation statements)

References 35 publications

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“…Due to the relatively short lockdown period, we determined frequent PED visits as two and more visits during 2 months instead of four and more PED visits during 1 year, which is generally accepted for the determination of frequent emergency visit [ 50 , 51 ]. Frequent utilization of the PED was previously reported to be associated with anxiety, depressive and psychotic disorders, and suicidality [ 52 – 56 ]. The increased rate of frequent PED admission in the LP group could probably be explained by the increased rates of patients presenting with anxiety and depressive disorders in the LP.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown

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Bilici

et al. 2021

Soc Psychiatry Psychiatr Epidemiol

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Background We aimed to explore the impact of the preventive measures and partial lockdown to the psychiatric emergency department (PED) visits during COVID-19 pandemic in a mental health epicenter in Istanbul. Methods A total of 5839 patients admitted to PED during the lockdown period (LP) between March 30 and May 31, 2020, were enrolled in this retrospective cohort study. Data of these patients were compared to those of patients in the same period in 2019 between April 1 and June 2, 2019 (non-LP). We also investigated the monthly number of PED visits and hospitalizations between March 1 and December 31, 2020, and compared it to the same period in 2019. Results The volume of PED visits and hospitalizations in LP decreased by 12% and 41.6%, respectively. The rates of patients presenting anxiety and depressive disorders and bipolar disorders were found to significantly increase in LP than non-LP ( p < 0.001; p < 0.001; p < 0.01, respectively). Depressive disorders, prior history of mental illness, and aggressive behavior were found to predict frequent PED visits while decrease in age and male gender found to predict hospitalizations. Regarding suicide attempt, younger patients and those with new-onset mental disorders were found to be at high risk in LP. Patients diagnosed with COVID-19 in PED visits were mostly with psychotic and bipolar disorders. Conclusion Policy-makers should focus on studies on mental health services to reorganize and enhance such services, which are crucial to prevent and manage adverse mental health consequences of the pandemic and congestion in PEDs.

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Section: Discussionmentioning

confidence: 99%

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown

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Bilici

et al. 2021

Soc Psychiatry Psychiatr Epidemiol

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“…Though several quantitative studies have assessed determinants of unmet needs for care among patients with MD [7,8], few have examined these unmet needs in relation to high ED use [6,9]. Some qualitative studies that explored high ED use among patients with MD found that unmet care needs partly explained high ED use [10][11][12]. Previous quantitative investigations have found that, compared to patients with MD who have few or no needs, patients with unmet care needs were more likely to be women, younger, and have severe MD symptoms, co-occurring MD-SRD or poor physical health conditions [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…A recent study found three pro les of ED users with MD, one of which included high ED users with the greatest barriers to care; these patients also reported the lowest service satisfaction and the poorest perceived mental/physical health conditions [9]. Other qualitative investigations reported a combination of structural and motivational care barriers that justi ed high ED use, with structural barriers being most prevalent [12]. The structural care barriers most often reported in relation to high ED use included the long wait times to access services and the lack of outpatient care continuity and adequacy [12,15].…”

Section: Introductionmentioning

confidence: 99%

“…Other qualitative investigations reported a combination of structural and motivational care barriers that justi ed high ED use, with structural barriers being most prevalent [12]. The structural care barriers most often reported in relation to high ED use included the long wait times to access services and the lack of outpatient care continuity and adequacy [12,15]. The motivational barriers most often mentioned included: perceived stigma, wanting to self-manage care, and loss of con dence in outpatient services [16,17].…”

Section: Introductionmentioning

confidence: 99%

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Barriers to Care among High Emergency Department Users with Mental Disorders – A Mixed Methods Study

Chen,

Fleury

2024

Preprint

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Purpose The increasing number of high emergency department (ED) users is a growing concern worldwide. Patients with mental disorders (MD) are among the largest contributors to high ED use. As high ED use is often seen as an indicator of a healthcare system’s shortcomings, high ED users with MD may perceive unique barriers to care. Analyzing the associated patient characteristics and service use along with structural and motivational barriers to outpatient care use could help explain the high ED use among patients with MD, and help recommend more patient-centered interventions. Methods Data were extracted from a 2021–2022 survey and medical records of 182 high ED users with MD in four large ED networks from Quebec (Canada), including open-ended questions administered to 20 of these patients. A mixed methods approach (multivariable regression, thematic analysis) identified variables associated with the number of unmet care needs, and structural and motivational barriers to care explaining high ED use. Results The study partially confirmed its first hypothesis that patients with more health issues who were dissatisfied with services would have more barriers to care. The second hypothesis was also confirmed: structural barriers were more prevalent than motivational ones in relation to high ED use, and patients with high unmet needs had more care barriers than those with no unmet needs. Conclusions Findings suggest services could be greatly improved to reduce high ED use, and that unmet needs should be investigated further to better address the care barriers of this vulnerable population.

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“… 1 For many patients with severe psychopathology, PES has become their primary mental healthcare service. 2 – 5 Patients visiting PES are a highly heterogeneous group, all consulting in a context of crisis, but presenting with different needs. 6 – 8 Comorbidity between symptoms of depression, anxiety, drug/alcohol abuse, and psychosis is highly frequent among PES patients.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial Profiles of Patients Admitted to Psychiatric Emergency Services: Results from the Signature Biobank Project

et al. 2021

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Objectives: Patients admitted to psychiatric emergency services (PES) are highly heterogenous. New tools based on a transdiagnosis approach could help attending psychiatrists in their evaluation process and treatment planning. The goals of this study were to: (1) identify profiles of symptoms based on self-reported, dimensional outcomes in psychiatric patients upon their admission to PES, (2) link these profiles to developmental variables, that is, history of childhood abuse (CA) and trajectories of externalizing behaviours (EB), and (3) test whether this link between developmental variables and profiles was moderated by sex. Methods: In total, 402 patients were randomly selected from the Signature Biobank, a database of measures collected from patients admitted to the emergency of a psychiatric hospital. A comparison group of 92 healthy participants was also recruited from the community. Symptoms of anxiety, depression, alcohol and drug abuse, impulsivity, and psychosis as well as CA and EB were assessed using self-reported questionnaires. Symptom profiles were identified using cluster analysis. Prediction of profile membership by sex, CA, and EB was tested using structural equation modelling. Results: Among patients, four profiles were identified: (1) low level of symptoms on all outcomes, (2) high psychotic symptoms, (3) high anxio-depressive symptoms, and (4) elevated substance abuse and high levels of symptoms on all scales. An indirect effect of CA was found through EB trajectories: patients who experienced the most severe form of CA were more likely to develop chronic EB from childhood to adulthood, which in turn predicted membership to the most severe psychopathology profile. This indirect effect was not moderated by sex. Conclusion: Our results suggest that a transdiagnostic approach allows to highlight distinct clinical portraits of patients admitted to PES. Importantly, developmental factors were predictive of specific profiles. Such transdiagnostic approach is a first step towards precision medicine, which could lead to develop targeted interventions.

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Reasons for Frequent Psychiatric Emergency Service Use in a Large Urban Center

Cited by 9 publications

References 35 publications

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown

Barriers to Care among High Emergency Department Users with Mental Disorders – A Mixed Methods Study

Psychosocial Profiles of Patients Admitted to Psychiatric Emergency Services: Results from the Signature Biobank Project

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