Epidemiology of Adult Psychiatric Visits to US Emergency Departments

Acad Emerg Med. 2004 Feb;11(2):193-5.

Abstract

Objectives: To characterize psychiatric-related emergency department visits (PREDVs) among adults in the United States for the year 2000 and to analyze PREDV trends from 1992 to 2000.

Methods: Emergency department (ED) visit data from the National Hospital Ambulatory Medical Care Survey were used to estimate the number of PREDVs for adults aged 18 years and older. A PREDV was defined as any visit with a psychiatric discharge diagnosis (ICD N290- N312) or a suicide attempt (ICD E950-E959).

Results: Approximately 4.3 million PREDVs occurred in the United States in the year 2000, yielding an annual rate of 21 visits per 1000 adults. The PREDV rates increased 15% between 1992 and 2000. The PREDVs accounted for 5.4% of all ED visits. Substance abuse (27%), neuroses (26%), and psychoses (21%) were the most common conditions. African Americans had significantly higher visit rates (29/1000; 95% CI = 27/1000 to 31/1000) compared with whites (23/1000; 95% CI = 22/1000 to 25/1000). Persons with Medicaid (66/1000; 95% CI = 64/1000 to 68/1000) had double the rate of PREDVs than the uninsured (33/1000; 95% CI = 31/1000 to 35/1000) and almost eight times the rate of those privately insured (8/1000; 95% CI = 7/1000 to 10/1000). Patients with psychiatric diagnoses had a higher admission rate (22%) than those with nonpsychiatric diagnoses (15%). The uninsured were the least likely to be admitted for all major psychiatric conditions except suicide (p < 0.0001).

Conclusions: Psychiatric-related ED visits represent a substantial and growing number of ED visits each year. Patient characteristics influence the likelihood of a PREDV. Further research is needed to better understand the role that hospital EDs play in the delivery of health care services to those with mental illness.

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data
  • Age Distribution
  • Aged
  • Emergency Service, Hospital / statistics & numerical data*
  • Emergency Services, Psychiatric / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Humans
  • Insurance, Health / statistics & numerical data
  • Male
  • Medically Uninsured / statistics & numerical data
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Patient Admission / statistics & numerical data
  • Prevalence
  • Psychoses, Substance-Induced / epidemiology
  • Sex Distribution
  • United States / epidemiology