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

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

Author information

1
Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Montréal, QC, Canada. Electronic address: flemar@douglas.mcgill.ca.
2
Insitut national de santé publique du Québec, Québec, QC, Canada.
3
Douglas Mental Health University Institute, Montréal, QC, Canada.
4
University Institute on Addictions, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada; Department of Psychiatry, University of Montreal, Montréal, QC, Canada; School of Psychoeducation, University of Montreal, Montréal, QC, Canada.
5
Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche Charles LeMoyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC, Canada.
6
Department of Psychiatry, University of Montreal, Montréal, QC, Canada; Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada.

Abstract

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

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