Mental health and substance abuse issues common among non-psychiatric emergency room patients

INDIANAPOLIS and BLOOMINGTON, Ind. – A new study by researchers at Indiana University has found that about 45% of patients who go to the emergency department for physical injuries and ailments also have mental health and drug use issues. substances that are often overlooked. It also found that patients who reported high levels of suicidal thoughts and plans were more likely to have frequent emergency room visits.

That’s why UI researchers, expanding on previous studies, used a computer-adaptive test to screen for mental health and substance abuse problems in patients with non-psychiatric disorders to examine whether emergency department visits are an important opportunity to screen for mental health issues.

Brian D’OnofrioWith results recently published in the Journal of the American College of Emergency Physicians, this is the most comprehensive study to use multidomain mental health screening of non-psychiatric patients in an emergency department. The test, known as the Computerized Adaptive Test-Mental Health, adjusts questions based on respondents’ answers.

“The results of our study are really important to healthcare companies and health economists,” said Brian D’Onofrio, the study’s lead researcher and professor of psychological and brain sciences at the College of Arts and Sciences. science from IU Bloomington. “People who keep coming back to the emergency room are high-risk patients. It’s a place where screening could be very helpful in identifying people at high risk – whether for suicide, depression, anxiety, PTSD or substance use problems – and providing them with care. what they need.

Along with follow-up care, mental health screening could also reduce the need for future visits, thereby reducing the burden on emergency services, he said.

To conduct the study, researchers asked randomly selected patients at an Indianapolis emergency department to complete this computer-adaptive test that screens for five conditions: depression, anxiety, post-traumatic stress disorder, suicidality, and related to substance use. The aim of the study was to understand the prevalence of these problems with a sustainable screening process in a large urban emergency department, where physicians have competing and pressing interests.

Of 794 patients, the study showed that 24.1% were at moderate to severe risk for suicidality, 8.3% for depression, 16.5% for anxiety, 12.3% for PTSD and 20.4% for substance use disorders. It also showed that people who had two or more emergency room visits in the previous year had a 62% increased chance of being in the intermediate to high suicide risk category compared to those who had no no previous visits. People who scored in the intermediate-high suicide risk group were 63% more likely to have another ER visit within 30 days of their ER visit compared to those who scored at low risk.

Lauren O’ReillyPrevious research has also shown that many patients who die by suicide often visit the emergency room or access the health care system for a non-psychiatric reason shortly before their suicide attempt.

The study results suggest that computer-adaptive tests could be a viable option for rapidly screening a large group of emergency department patients about their mental health, as they provide results that match standard screening tests. It’s also faster than other screening methods, making it more convenient to use in a busy environment, said IU Ph.D. student Lauren O’Reilly, a researcher in D’Onofrio’s lab whose current research focuses on suicidality.

Next, the researchers said work was needed to understand the implications of this study, such as how emergency departments could incorporate screenings into their procedures – as well as to overcome barriers to treating mental health conditions. both within and beyond the emergency services setting.

“If emergency departments are implementing screening, it is essential that steps are taken after screening to ensure adequate care, such as interventions, safety planning or connecting with providers,” said O’Reilly. “This is a particularly significant challenge given the global shortage of mental health care services.”

Paul MuseyThe study also opens up new prospects for improving the overall quality of emergency care.

“I hope these results will provide an opportunity to discuss, intervene and connect emergency department patients to appropriate care,” said Paul Musey, lead study author and associate professor of medicine at emergency at the IU School of Medicine. “The emergency department is the right place for anyone in crisis. I believe we have a duty not only to stabilize and treat patients in crisis, but also to ensure that we have done everything we can to provide them with the resources they need to avoid a crisis at the coming.

This research was supported by a grant from the IU Responding to the Addictions Crisis Grand Challenge.