Trends of emergency department presentations with a mental health diagnosis by age, Australia, 2004–05 to 2016–17: A secondary data analysis

Abstract

Objectives: The present study aims to explore for Australia: (i) the trends of ED presentations with a mental health (MH) diagnosis by age group; and (ii) whether those trends differ from all ED presentations. Methods: ED presentations to Australian public hospitals, 2004-05 to 2016-17 were captured in the National Non-Admitted Patient Emergency Department Care Database. We assessed total change and annual rate of change in the number and rates of presentations per 10 000 population for all presentations and those with a MH principal diagnosis (ICD-10-AM F00 to F99, MH dx ). Multivariable regression was used to assess the trend of the proportion of MH dx presentations. Results: Between 2004-05 and 2016-17, children (0-14 years), followed by older persons (≥65 years) had the highest ED utilisation; while youth (15-24 years) and younger adults (25-34 years) predominated for MH dx overlook the growing impact of these sub-groups.

Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004–05 to 2016–17

“…If this situation also exists in Australia, as we believe we have identified for WA, the exclusion of rural hospitals (with and without designated EDs) may lead to an underestimation of rates of MH dx presentations. However, as the significant upturn in rates of MH dx presentations in NSW occurred from 2011–12, and thus prior to the change in data collection, the impact at the jurisdictional level, we believe, is minimal.…”

“…We present the most robust and comprehensive evidence available on MH dx presentations in EDs in Australia and its jurisdictions by MH diagnostic group over time, using data from the national collection. While these data are limited by the absence of a national agreement and standards on data collection within EDs and different coding systems across jurisdictions, the use of broad diagnostic groups and size of the individual state collections should maximise the robustness of the intra‐ and inter‐jurisdictional comparisons. Even so, the marked increase in presentations for unspecified mental disorder (F99) in NSW warrants further investigation.…”

“…Before 2013–14, the NNAPEDCD included only public hospitals classified as peer group A and B, leaving the majority of small hospitals, especially those in rural areas, out of scope . Since 2013–14, all public hospitals with a designated ED have been included in the NNAPEDCD, leading to a marked change in hospitals included for NSW . Even so, many rural and remote hospitals without a designated ED continue to be excluded, and thus not all emergency occasions of service are captured within the NNAPEDCD dataset .…”

“…Data on ED presentations with a MH diagnosis (MH dx ) were extracted from Mental Health Services in Australia (MHSA) series which reports on presentations from the National Non‐Admitted Patient Emergency Department Care Database (NNAPEDCD) with an ICD‐10‐AM principal diagnosis falling within Chapter 5, Mental and Behavioural Disorders (F00–F99) . Additional information on the NNAPEDCD and the MHSA series is detailed in our companion paper . The most recently published data on number of MH dx presentations by diagnostic group were extracted for Australia and all jurisdictions, except 2013–14, which were unavailable.…”

“…Mental health (MH)‐related ED presentations are increasingly being identified as a burden in EDs in the USA, Australia and Canada . In the USA, mood disorders, anxiety and alcohol‐ and drug‐related mental disorders have been identified as the major diagnostic groups among MH‐related ED presentations between 1992 and 2001 .…”