Survey of an Australian general emergency department: estimated prevalence of mental health disorders

Abstract

Compared to the general population, people with mental health disorders have an increased risk of morbidity and mortality, and are associated with higher health-care costs and lost societal productivity. Evidence indicates that more people are presenting to emergency departments with mental health disorders and that this group represents a disproportionately large number of emergency department attendees. The study results indicate that around a third of people who attended the emergency department may have had a mental health disorder, which is more than that found in the general adult Australian population. The results also suggest that the majority of emergency department attendees that have a mental health disorder are not identified at this opportunistic point of contact. The emergency department is an ideal point of contact to screen people for mental health problems. If problems are identified early, and treatment is started early, then it is likely that more people would be helped before their mental health problem became severe. However, increased identification of mental health problems may have implications for mental health services in terms of workload and delivery. The aim of this study was to estimate the prevalence of mental health disorders in an Australian general emergency department. A cross-sectional survey was used to screen a sample of 708 patients, using the Kessler Psychological Distress Scale (K10). The mean age of participants was 50.2 years, and their mean K10 score was 19.96 (SD 7.83), with 24% categorized as having high or very high psychological distress. Seventeen per cent self-reported having a mental health issue. Post-probability calculations based on observed K10 scores estimated that 37% of participants had an actual mental health disorder. The results suggest the prevalence of mental health disorder is significantly higher in emergency department attendees than Australian population norms, supporting the contention that a substantial proportion of ED attendees has a mental health disorder that, in the majority of cases, is not investigated at this point of contact. There is potential to screen all emergency department attendees for the presence of mental health disorder; early identification of mental illness would enable early referral for treatment. However, if all patients are screened, then it is likely that more mental health conditions will be picked up. The implications for mental health nursing are that this may increase workload.

Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review

“…Nearly half (45%) of Australians aged 16–85 years will experience a common mental disorder . For someone with a mental health problem, a busy ED can be the first, and often frequent, place to seek care . The rate of presentations to public EDs resulting from a clinically diagnosable disorder that significantly interferes with an individual's cognitive, emotional or social abilities based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria is increasing at 3.8% per annum .…”

“…The rate of presentations to public EDs resulting from a clinically diagnosable disorder that significantly interferes with an individual's cognitive, emotional or social abilities based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria is increasing at 3.8% per annum . However, as many as one‐third of people who present to the ED might have a mental health problem without an associated diagnosis, and the poor health outcomes of this population maybe attributable to ineffectively treated mental health problems and/or to other chronic medical conditions . Diagnostic overshadowing, or the misattribution of physical symptoms to a mental health problem, is prevalent in ED settings, and so, the extent of poor physical health in people who present to the ED with mental health problems remains unclear …”

Protocol for a pragmatic randomised controlled trial to evaluate effects of a brief intervention for emergency department attendees who present with moderate or high levels of non-specific psychological distress: a pilot study

“…It was found that 37 % of all participants may have had an actual mental health disorder, which is higher than the population norm. Our data also showed that almost 40 % of ED attendees were affected by moderate/high non-specific psychological stress (identified using K10) [30]. This latter group is our target sample for the proposed study (moderate/high psychological distress).…”

“…A single-site cross-sectional study ( n  = 708) was conducted in 2011 to establish the prevalence of mental health issues of ED attendees [30]. Several mental health measures were employed, including the K10.…”

Improving care planning and coordination for service users with medical co‐morbidity transitioning between tertiary medical and primary care services

“…There is a strong association between mental disorder and medical co‐morbidity (Fagiolini & Goracci ). Medical co‐morbidity can exacerbate mental disorder, reduce quality of life and lead to premature mortality (Fagiolini & Goracci , Fulbrook & Lawrence , Lally et al . ).…”