Factors associated with emergency department use for mental health reasons among low, moderate and high users

Gen Hosp Psychiatry. 2019 Sep-Oct;60:111-119. doi: 10.1016/j.genhosppsych.2019.07.006. Epub 2019 Jul 11.


Objectives: This study identified factors associated with frequency of emergency department (ED) use for mental health (MH) reasons in Quebec during 2015-2016.

Methods: Participants (n = 115,066) were categorized as: 1) low (1 visit/year; 76%); 2) moderate (2 visits/year; 14%); and 3) high (3+ visits/year; 10%) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Variables significantly associated with frequency of ED use were entered into a multinomial logistic regression.

Results: Patients with mental illness (MI), especially substance-related disorders (SRD) and schizophrenia spectrum disorders; bipolar, depressive, anxiety or personality disorders; and those with severe chronic physical illness (needs factors) were more likely to use ED for MH reasons, as were male participants 18-64 years old, and those living in metropolitan areas with high social or material deprivation (predisposing factors). Regarding enabling factors, consultations with outpatient psychiatrists and not seeing a general practitioner (GP) in the year prior to ED visit were associated with high ED use.

Conclusion: The severity of MI/SRD contributed most to frequent ED use, while social and material deprivation in metropolitan areas, and intensity of medical care also influenced ED use for MH reasons.

Keywords: Emergency department users; Factors; High users; Mental illness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / therapy*
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Quebec / epidemiology
  • Severity of Illness Index
  • Young Adult