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Barrio-Martínez S, Ruiz-Rodríguez P, Medrano LA, Priede A, Muñoz-Navarro R, Moriana JA, Carpallo-González M, Prieto-Vila M, Cano-Vindel A, González-Blanch C. Effect of Reliable Recovery on Health Care Costs and Productivity Losses in Emotional Disorders. Behav Ther 2024; 55:585-594. [PMID: 38670670 DOI: 10.1016/j.beth.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 04/28/2024]
Abstract
Despite the high economic costs associated with emotional disorders, relatively few studies have examined the variation in costs according to whether the patient has achieved a reliable recovery. The aim of this study was to explore differences in health care costs and productivity losses between primary care patients from a previous randomized controlled trial (RCT)-PsicAP-with emotional symptoms who achieved a reliable recovery and those who did not after transdiagnostic cognitive-behavioral therapy (TD-CBT) plus treatment as usual (TAU) or TAU alone. Sociodemographic and cost data were obtained for 134 participants treated at five primary care centers in Madrid for the 12-month posttreatment period. Reliable recovery rates were higher in the patients who received TD-CBT + TAU versus TAU alone (66% vs. 34%, respectively; chi-square = 13.78, df = 1, p < .001). Patients who did not achieve reliable recovery incurred more costs, especially associated with general practitioner consultations (t = 3.01, df = 132, p = .003), use of emergency departments (t = 2.20, df = 132, p = .030), total health care costs (t = 2.01, df = 132, p = .040), and sick leaves (t = 1.97, df = 132, p = .048). These findings underscore the societal importance of achieving a reliable recovery in patients with emotional disorders, and further support the value of adding TD-CBT to TAU in the primary care setting.
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Affiliation(s)
| | | | | | - Amador Priede
- Valdecilla Biomedical Research Institute and Mental Health Centre, Hospital de Laredo
| | | | - Juan Antonio Moriana
- Universidad de Córdoba and Maimónides Institute for Research in Biomedicine of Cordoba
| | | | | | | | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital and Universidad Europea del Atlántico
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2
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Austin EE, Cheek C, Richardson L, Testa L, Dominello A, Long JC, Carrigan A, Ellis LA, Norman A, Murphy M, Smith K, Gillies D, Clay-Williams R. Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance. Front Psychiatry 2024; 15:1368129. [PMID: 38487586 PMCID: PMC10937575 DOI: 10.3389/fpsyt.2024.1368129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Background Care delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness. Method We systematically reviewed the evidence regarding the effects of ED-based interventions for mental illness on patient outcomes, patient experience, and system performance, using a comprehensive search strategy designed to identify published empirical studies. Systematic searches in Scopus, Ovid Embase, CINAHL, and Medline were conducted in September 2023 (from inception; review protocol was prospectively registered in Prospero CRD42023466062). Eligibility criteria were as follows: (1) primary research study, published in English; and (2) (a) reported an implemented model of care or system change within the hospital ED context, (b) focused on adult mental illness presentations, and (c) evaluated system performance, patient outcomes, patient experience, or staff experience. Pairs of reviewers independently assessed study titles, abstracts, and full texts according to pre-established inclusion criteria with discrepancies resolved by a third reviewer. Independent reviewers extracted data from the included papers using Covidence (2023), and the quality of included studies was assessed using the Joanna Briggs Institute suite of critical appraisal tools. Results A narrative synthesis was performed on the included 46 studies, comprising pre-post (n = 23), quasi-experimental (n = 6), descriptive (n = 6), randomised controlled trial (RCT; n = 3), cohort (n = 2), cross-sectional (n = 2), qualitative (n = 2), realist evaluation (n = 1), and time series analysis studies (n = 1). Eleven articles focused on presentations related to substance use disorder presentation, 9 focused on suicide and deliberate self-harm presentations, and 26 reported mental illness presentations in general. Strategies reported include models of care (e.g., ED-initiated Medications for Opioid Use Disorder, ED-initiated social support, and deliberate self-harm), decision support tools, discharge and transfer refinements, case management, adjustments to liaison psychiatry services, telepsychiatry, changes to roles and rostering, environmental changes (e.g., specialised units within the ED), education, creation of multidisciplinary teams, and care standardisations. System performance measures were reported in 33 studies (72%), with fewer studies reporting measures of patient outcomes (n = 19, 41%), patient experience (n = 10, 22%), or staff experience (n = 14, 30%). Few interventions reported outcomes across all four domains. Heterogeneity in study samples, strategies, and evaluated outcomes makes adopting existing strategies challenging. Conclusion Care for mental illness is complex, particularly in the emergency setting. Strategies to provide care must align ED system goals with patient goals and staff experience.
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Affiliation(s)
- Elizabeth E. Austin
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Colleen Cheek
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Lieke Richardson
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Luke Testa
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Amanda Dominello
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Janet C. Long
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Ann Carrigan
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Louise A. Ellis
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Alicia Norman
- Centre for the Health Economy, Macquarie University Business School, Macquarie University, Macquarie, NSW, Australia
| | - Margaret Murphy
- Western Sydney Local Health District, New South Wales Health, Sydney, NSW, Australia
| | - Kylie Smith
- Emergency Care Institute, New South Wales Agency for Clinical Innovation, New South Wales Health, Sydney, NSW, Australia
| | - Donna Gillies
- Quality and Safeguards Commission, National Disability Insurance Scheme, Sydney, NSW, Australia
| | - Robyn Clay-Williams
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
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3
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Kirchner H, Ullrich H, Neu P, Hulsmans N, Juckel G, Brzoska P. The significance of nonurgent psychiatric emergencies in an ED: a retrospective study. BMC Emerg Med 2023; 23:131. [PMID: 37940880 PMCID: PMC10631003 DOI: 10.1186/s12873-023-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND In emergency departments, patients with mental health conditions are a major concern and make up the third or fourth of the most common diagnosis seen during all consultations. Over the past two decades, there has been a noticeable rise in the number of cases, particularly due to an increase in nonurgent visits for somatic medical issues. The significance of nonurgent visits for psychiatric patients is yet to be determined. This study aims to uncover the significance and identify the characteristics of this group. METHODS A retrospective analysis of psychiatric emergency visits at an interdisciplinary emergency department of a German general hospital in 2015 was conducted. For this purpose, patient records were reviewed and evaluated. An analysis was conducted based on the German definition of psychiatric emergencies according to the German guidelines for emergency psychiatry. RESULTS A total of 21,124 emergency patients visited the evaluated Emergency Department. Of this number, 1,735 psychiatric patient records were evaluated, representing 8.21% of the total population. Nearly 30% of these patients did not meet any emergency criteria according to German guidelines. Significant differences were observed between previously treated patients and those presenting for the first time. CONCLUSIONS The high proportion of nonurgent psychiatric patients in the total volume of psychiatric emergency contacts indicates a possible control and information deficit within the emergency system. Just as prior research has emphasized the importance of investigating nonurgent somatic medical visits, it is equally imperative to delve into studies centered around psychiatric nonurgent presentations.
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Affiliation(s)
- Heribert Kirchner
- Faculty of Health, School of Medicine, University Witten/Herdecke, Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Heiko Ullrich
- Center of Mental Health, Kreisklinikum Siegen, Weidenauer Str. 76, 57076, Siegen, Germany
| | - Peter Neu
- Department of Psychiatry and Psychotherapy, Jewish Hospital Berlin, Heinz-Galinski-Straße 1, 13347, Berlin, Germany
| | - Nik Hulsmans
- Department of Psychology, University of Siegen, Adolf-Reichwein-Straße 2a, 57076, Siegen, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1, 44791, Bochum, Germany
| | - Patrick Brzoska
- Faculty of Health, School of Medicine, University Witten/Herdecke, Herrhausen-Straße 50, 58455, Witten, Germany
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4
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Kim S, Chang H, Kim T, Cha WC. Patient Anxiety and Communication Experience in the Emergency Department: A Mobile, Web-Based, Mixed-Methods Study on Patient Isolation During the COVID-19 Pandemic. J Korean Med Sci 2023; 38:e303. [PMID: 37821083 PMCID: PMC10562183 DOI: 10.3346/jkms.2023.38.e303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Anxiety and communication difficulties in the emergency department (ED) may increase for various reasons, including isolation due to coronavirus disease 2019 (COVID-19). However, little research on anxiety and communication in EDs exists. This study explored the isolation-related anxiety and communication experiences of ED patients during the COVID-19 pandemic. METHODS A prospective mixed-methods study was conducted from May to August 2021 at the Samsung Medical Center ED, Seoul. There were two patient groups: isolation and control. Patients measured their anxiety using the State-Trait Anxiety Inventory (STAI X1) at two time points, and we surveyed patients at two time points about factors contributing to their anxiety and communication experiences. These were measured through a mobile web-based survey. Researchers interviewed patients after their discharge. RESULTS ED patients were not anxious regardless of isolation, and there was no statistical significance between each group at the two time points. STAI X1 was 48.4 (standard deviation [SD], 8.0) and 47.3 (SD, 10.9) for early follow-up and 46.3 (SD, 13.0) and 46.2 (SD, 13.6) for late follow-up for the isolation and control groups, respectively. The clinical process was the greatest factor contributing to anxiety as opposed to the physical environment or communication. Communication was satisfactory in 71.4% of the isolation group and 66.7% of the control group. The most important aspects of communication were information about the clinical process and patient status. CONCLUSION ED patients were not anxious and were generally satisfied with medical providers' communication regardless of their isolation status. However, patients need clinical process information for anxiety reduction and better communication.
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Affiliation(s)
- Sumin Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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5
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Oliveira J. e Silva L, Prakken SD, Meltzer AC, Broder JS, Gerberi DJ, Upadhye S, Carpenter CR, Bellolio F. Depression and anxiety screening in emergency department patients with recurrent abdominal pain: An evidence synthesis for a clinical practice guideline. Acad Emerg Med 2022; 29:615-629. [PMID: 34665903 DOI: 10.1111/acem.14394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recurrent abdominal pain in the emergency department (ED) might represent an opportunity for screening of depression and/or anxiety. METHODS We systematically searched five databases for studies evaluating the effect of screening for depression and/or anxiety in ED patients with recurrent and undifferentiated abdominal pain. Given paucity of direct evidence, we also searched for indirect evidence including studies that assessed prevalence of depression and/or anxiety in EDs (not necessarily recurrent abdominal pain), diagnostic accuracy of screening tools, effectiveness of screening in other settings, and outcomes such as repeat ED visits of patients with abdominal pain who were screened in the ED. Two methodologists evaluated certainty in the evidence using the GRADE approach. RESULTS A total of 4,337 citations were reviewed, and zero studies were found on the effect of screening in patients with recurrent and undifferentiated abdominal pain in the ED. A total of 35 studies were included as relevant indirect evidence. In studies of ED patients with abdominal pain, depression ranged from 10% to 29%, while anxiety ranged from 18% to 50%. False positives appear to be an issue given relatively low specificity of screening tools. One randomized trial including ED patients with vague symptoms evaluated the effect of depression screening on a composite outcome of depression recognition, psychiatric consultation, or referral by the emergency physician (risk ratio = 1.49, 95% confidence interval [CI] = 0.49 to 4.53, very low certainty). One study reported that patients with undifferentiated abdominal pain who screened positive for depression have had increased ED recidivism (odds ratio = 3.17, 95% CI = 1.14 to 8.85, very low certainty). CONCLUSIONS We were unable to identify any evidence that confirms that depression or anxiety screening in ED patients with recurrent and undifferentiated abdominal pain improves outcomes or changes management downstream.
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Affiliation(s)
| | - Steven D. Prakken
- Department of Psychiatry Duke University Health System Durham North Carolina USA
| | - Andrew C. Meltzer
- Department of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Joshua S. Broder
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
| | | | - Suneel Upadhye
- Department of Emergency Medicine McMaster University Hamilton Ontario Canada
| | - Christopher R. Carpenter
- Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis Missouri USA
| | - Fernanda Bellolio
- Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA
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6
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Quenneville AF, Kalogeropoulou E, Nicastro R, Weibel S, Chanut F, Perroud N. Anxiety disorders in adult ADHD: A frequent comorbidity and a risk factor for externalizing problems. Psychiatry Res 2022; 310:114423. [PMID: 35152068 DOI: 10.1016/j.psychres.2022.114423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION ADHD is a common neurodevelopmental disorder and is highly prevalent in adults. It is associated with several negative outcomes, impacting well-being and global functioning. ADHD is highly associated with comorbidities, anxiety disorders being probably the most frequent. The goal of our study is to assess the prevalence of anxiety disorders and their impact in adults with ADHD. METHOD 353 individuals diagnosed with ADHD were recruited. Severity of ADHD was assessed as well as lifetime anxiety disorders and other psychiatric comorbidities. We performed logistic and linear regressions to test the impact of lifetime anxiety disorders on demographic and clinical variables. RESULTS More than half of the patients had at least one anxiety disorder. The presence of comorbid anxiety disorders was associated with worse clinical presentation (positive history of suicide attempts, higher disposition toward anger, higher rate of hospitalization and psychotic symptoms) and with a lower level of education. CONCLUSION Anxiety disorders are highly prevalent in ADHD and are associated with higher levels of suicidality and disposition towards anger, more severe clinical presentation and lower functioning. Comorbid anxiety needs to be evaluated and treated by clinicians to limit distress, aggression towards self and others and to improve quality of life.
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Affiliation(s)
- Andréanne Filion Quenneville
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry and Addictology, Clinique des troubles relationnels et dépendances, Hôpital en Santé Mentale Albert-Prévost, University of Montreal, CIUSSS Nord-de-l'Ile-de-Montréal, 6555 Boulevard Gouin West, Montreal, QC H4K 1B3, Canada.
| | - Eleni Kalogeropoulou
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rosetta Nicastro
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, Strasbourg University Hospital, Strasbourg, France; Inserm U1114, Strasbourg, France
| | - Florence Chanut
- Department of Psychiatry and Addictology, Clinique des troubles relationnels et dépendances, Hôpital en Santé Mentale Albert-Prévost, University of Montreal, CIUSSS Nord-de-l'Ile-de-Montréal, 6555 Boulevard Gouin West, Montreal, QC H4K 1B3, Canada
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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7
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Au TY, Assavarittirong C. The overview of utilizing complementary therapy to relieve stress or anxiety in emergency department patients: animal-assisted therapy, art therapy, and music therapy. Ment Health (Lond) 2021. [DOI: 10.32437/mhgcj.v4i2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The Emergency Department could be a stressful environment for patients. Anxiety and depression may develop due to the atmosphere, in addition to patients’ concerns for their health conditions. The condition could potentially affect the experience of the patient in the Emergency Department and the quality of life after the visit. Pharmacological therapy could be administered to the patients. However, adverse effects may be associated with the treatment. Less aggressive complementary treatment approaches are presented in this article. Controlled clinical trials and randomized pilot studies of different complementary therapies, including animal-assisted therapy, art therapy, and music therapy, were conducted. The complementary therapies discussed in this article showed positive outcomes for patients with hospital-induced anxiety and has no adverse effect reported. Hence, hospitals may consider introducing complementary therapies, such as those mentioned in this study, to improve the patients’ experiences in the Emergency Department
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8
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Walker J, van Niekerk M, Hobbs H, Toynbee M, Magill N, Bold R, Hampsey E, Harriss E, Frost C, Sharpe M. The prevalence of anxiety in general hospital inpatients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 72:131-140. [PMID: 34454342 DOI: 10.1016/j.genhosppsych.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the prevalence of anxiety in general hospital inpatients by conducting a systematic review and meta-analysis of all relevant published studies. METHOD We searched Ovid Medline, Ovid Embase and Ovid PsycINFO from inception to December 2020. We included studies of the prevalence of anxiety symptoms of clinically significant severity (using cut-off scores on rating scales) and of the prevalence of anxiety disorders (using diagnostic interviews) in general hospital inpatients. Two independent reviewers assessed articles and extracted data. The review is registered with PROSPERO, number CRD42020189722. RESULTS We included 32 studies. Pooled prevalence estimates in random-effects meta-analyses were: anxiety symptoms 28% (95% CI 19% to 38%, 95% prediction interval 5% to 72%), any anxiety disorder 8% (95% CI 5% to 12%, 95% prediction interval 2% to 33%), panic disorder 3% (95% CI 2% to 4%, 95% prediction interval 1% to 8%), generalized anxiety disorder 5% (95% CI 3% to 8%, 95% prediction interval 1% to 23%). There was high heterogeneity in prevalence, little of which was explained in exploratory analyses of a limited number of potential determinants. CONCLUSION Anxiety symptoms of clinically significant severity affect more than one in four inpatients and anxiety disorders affect nearly one in ten.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
| | - Maike van Niekerk
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Harriet Hobbs
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Mark Toynbee
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Nicholas Magill
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhian Bold
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Elliot Hampsey
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
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9
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Foldes-Busque G, de Lafontaine MF, Turcotte S, Denis I. Are Patients at Risk for Developing Panic Disorder After an Emergency Department Visit With Noncardiac Chest Pain? J Acad Consult Liaison Psychiatry 2021; 63:23-31. [PMID: 34352451 DOI: 10.1016/j.jaclp.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Panic disorder (PD) is common in emergency department (ED) patients with noncardiac chest pain (NCCP). The literature suggests that initially PD-free patients may be at increased risk of developing PD in the months or years following an ED visit. OBJECTIVES This study aims to determine the incidence of PD in the 2 years following an ED visit with NCCP and to identify predictors of incident PD. METHODS This study was conducted using a longitudinal, observational design. Five hundred and eighty-five patients with NCCP (without PD) were recruited in two EDs. They underwent an interview and completed a series of questionnaires assessing anxiety disorders, perceived social support, psychological distress, anxiety sensitivity, comorbidities, and stressful life events. PD was assessed 6 months, 1 year, and 2 years after the initial interview. RESULTS PD incidence was 11.1% (95% confidence interval: 8.7-13.9) in the two years following the baseline assessment. Anxiety sensitivity (odds ratio = 1.08; 95% confidence interval: 1.04-1.11; P < .001) and stress related to life events (odds ratio = 1.14; 95% confidence interval: 1.06-1.24; P = .001) significantly predicted incident PD. CONCLUSIONS Patients with NCCP are at high risk for developing PD in the 2 years following an ED visit with NCCP. Anxiety sensitivity and stress related to life events may be promising clinical targets for preventive interventions.
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, QC, Canada; Research Centre of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada; Research Centre of the Quebec Heart and Lung Institute, Québec, QC, Canada.
| | - Marie-France de Lafontaine
- School of Psychology, Université Laval, Québec, QC, Canada; Research Centre of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada; Research Centre of the Quebec Heart and Lung Institute, Québec, QC, Canada
| | - Stéphane Turcotte
- Research Centre of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Québec, QC, Canada; Research Centre of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada; Centre de recherche universitaire sur les jeunes et les familles (CRUJeF), QC, Canada
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10
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Vorstellung psychiatrischer Notfallpatienten in der Notaufnahme durch Notarzt und Rettungsdienst – Charakterisierung, Versorgung und Verbleib. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00917-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Elhadi M, Khaled A, Malek AB, El-Azhari AEA, Gwea AZ, Zaid A, Elturki SM, Aburgegah A, Abu Ageila MAK, Alhadi A, Albashkar HA, Alshareef AM, Ben Nama AB, Sahboun NAM, Ahmed H. Prevalence of anxiety and depressive symptoms among emergency physicians in Libya after civil war: a cross-sectional study. BMJ Open 2020; 10:e039382. [PMID: 32859667 PMCID: PMC7454180 DOI: 10.1136/bmjopen-2020-039382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We aimed to identify the prevalence of depression and anxiety among physicians working in the emergency departments of nine tertiary care centres in Libya. DESIGN This was a cross-sectional study. SETTING Nine main tertiary centres in Libya PARTICIPANTS: Emergency department doctors were surveyed between December 2018 and February 2019. INTERVENTION The standardised Hospital Anxiety and Depression Scale (HADS) was selected as a measurement tool for analysing anxiety and depression symptoms; a HADS score of 8 indicated anxiety as well as depression symptoms. The primary outcomes were anxiety and depression, which were tabulated with independent sociodemographic variables. χ2 tests were conducted to compare the prevalence of anxiety and depression between the groups. Statistical analysis was performed using SPSS V.25. RESULTS A total of 108 out of 150 (72%) emergency physicians from all levels participated in the study and took the survey. The emergency physicians had a mean±SD age of 31.2±4.5 years, and were predominantly males (74 out of 108, 68.5%). Overall, 49 (45.4%) physicians reached the cut-off score to define both depression and anxiety (ie, a score ≥8). In terms of violence, 71 (65.7%) reported incidents of verbal violence, while 26 (24.1%) reported physical violence or abuse by militias. In addition, 28 reported being threatened by militias. CONCLUSION The high prevalence rate of anxiety and depression is of concern, and the high rate of physical and verbal abuse highlights the range of abuse endured by doctors in Libya. Therefore, screening for anxiety and depression at regular intervals is needed to avoid the deterioration of mental health, which can increase the risk of suicide and dropping out, and decrease the level of healthcare for patients.
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Affiliation(s)
| | - Ala Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | - Ahmed Zaid
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | | | | | | | | | | | - Hazem Ahmed
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
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Rajendran N, Mitra TP, Shahrestani S, Coggins A. Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department. Acad Emerg Med 2020; 27:92-99. [PMID: 31957143 DOI: 10.1111/acem.13838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/05/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anxiety and acute distress are significant concerns in the emergency department (ED). Adult coloring books are often utilized as an effective means of relaxation in waiting rooms and newsstands, but there are no reported randomized trials examining their effectiveness as a treatment for anxiety. METHODS We set out to examine the effectiveness of adult coloring books using a randomized placebo-controlled trial at a university-affiliated tertiary ED. Anxiety was measured using a validated self-reporting score, the Hospital Anxiety and Depression Scale (HADS-A), with a range of 0 to 21. Patients with HADS-A ≥ 7 were randomly assigned to either an adult coloring pack (n = 26) or placebo pack (n = 27). The primary outcome measure was the within-patient change in HADS-A scores following 2 hours of exposure. RESULTS A convenience sample of 117 patients were screened, and 53 patients were randomized. Characteristics of allocated groups were similar in terms of sex, diagnosis, and ethnicity. A higher proportion of intervention subjects spent ≥1 hour engaged with their activity (46.2% vs. 4.0%, p = 0.01). For the primary outcome measure, the mean within-patient decrease in HADS-A score at 2 hours for intervention subjects was 3.7 (95% confidence interval [CI] = 2.4 to 5.1, p < 0.001) versus a decrease of 0.3 (95% CI = -0.6 to 1.2, p = 0.51) in the placebo group. CONCLUSIONS Among ED patients, exposure to adult coloring books resulted in lower self-reported levels of anxiety at 2 hours compared to placebo.
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Affiliation(s)
| | | | | | - Andrew Coggins
- Sydney Medical School University of Sydney SydneyAustralia
- Emergency Department Westmead Hospital Sydney Australia
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Beiser DG, Ward CE, Vu M, Laiteerapong N, Gibbons RD. Depression in Emergency Department Patients and Association With Health Care Utilization. Acad Emerg Med 2019; 26:878-888. [PMID: 30884035 PMCID: PMC6690783 DOI: 10.1111/acem.13726] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Depression is one of the most common illnesses in the United States, with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the emergency department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a nonpsychiatric ED population and its association with subsequent ED visits and hospitalizations. METHODS This prospective cohort study enrolled a convenience sample of English-speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015, and September 21, 2015. Patients completed a computerized adaptive depression diagnostic screen (CAD-MDD) and dimensional depression severity measurement test (CAT-DI) via tablet computer. Primary outcomes included number of ED visits and hospitalizations assessed from index visit until January 1, 2016. Negative binomial regression modeling was performed to assess associations between depression, depression severity, clinical covariates, and utilization outcomes. RESULTS Of 999 enrolled patients, 27% screened positive for MDD. The presence of MDD conveyed a 61% increase in the rate of ED visits (incidence rate ratio [IRR] = 1.61, 95% confidence interval [CI] = 1.27 to 2.03) and a 49% increase in the rate of hospitalizations (IRR = 1.49, 95% CI = 1.06-2.09). For each 10% increase in MDD severity, there was a 10% increase in the relative rate of subsequent ED visits (IRR = 1.10, 95% CI = 1.04 to 1.16) and hospitalizations (IRR = 1.10, 95% CI = 1.02 to 1.18). Across the range of the severity scale there was over a 2.5-fold increase in the rate of ED visits and hospitalization rates. CONCLUSIONS Rates of depression were high among a convenience sample of English-speaking adult ED patients presenting with nonpsychiatric complaints and independently associated with increased risk of subsequent ED utilization and hospitalization. Standardized assessment tools that provide rapid, accurate, and precise classification of MDD severity have the potential to play an important role in identifying ED patients in need of urgent psychiatric resource referral.
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Affiliation(s)
- David G. Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - Charlotte E. Ward
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Milkie Vu
- Section of Emergency Medicine, Departments of Medicine, University of Chicago, Chicago, IL, presently at Rollins School of Public Health, Emory University, Atlanta, GA
| | - Neda Laiteerapong
- Section of General Internal Medicine, University of Chicago, Chicago, IL
| | - Robert D. Gibbons
- Center for Health Statistics, Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL
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Walker J, Burke K, Wanat M, Fisher R, Fielding J, Mulick A, Puntis S, Sharpe J, Esposti MD, Harriss E, Frost C, Sharpe M. The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies. Psychol Med 2018; 48:2285-2298. [PMID: 29576041 DOI: 10.1017/s0033291718000624] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comorbid depression in the medically ill is clinically important. Admission to a general hospital offers an opportunity to identify and initiate treatment for depression. However, we first need to know how common depression is in general hospital inpatients. We aimed to address this question by systematically reviewing the relevant literature. METHODS We reviewed published prevalence studies in any language which had used diagnostic interviews of general hospital inpatients and met basic methodological quality criteria. We focussed on interview-based studies in order to estimate the proportion of patients with a diagnosis of depressive illness. RESULTS Of 158 relevant articles, 65 (41%) describing 60 separate studies met our inclusion criteria. The 31 studies that focussed on general medical and surgical inpatients reported prevalence estimates ranging from 5% to 34%. There was substantial, highly statistically significant, heterogeneity between studies which was not materially explained by the covariates we were able to consider. The average of the reported prevalences was 12% (95% CI 10-15), with a 95% prediction interval of 4-32%. The remaining 29 studies, of a variety of specific clinical populations, are described. CONCLUSIONS The available evidence suggests a likely prevalence high enough to make it worthwhile screening hospital inpatients for depression and initiating treatment where appropriate. Further, higher quality, research is needed to clarify the prevalence of depression in specific settings and to further explore the reasons for the observed heterogeneity in estimates.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Katy Burke
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Marta Wanat
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Rebecca Fisher
- Department of Primary Care Health Sciences,University of Oxford, Oxford, UK
| | - Josephine Fielding
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Amy Mulick
- Department of Medical Statistics,London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Puntis
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Joseph Sharpe
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Michelle Degli Esposti
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford,Oxford,UK
| | - Chris Frost
- Department of Medical Statistics,London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
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Abstract
Aims and MethodTo determine the nature of current liaison psychiatry services in Wales, a structured telephone interview was conducted with representatives of all 11 National Health Service trusts.ResultsThree trusts (27%) had no dedicated liaison psychiatry service and only one of the eight (13%) with a service had a full-time consultant liaison psychiatrist. Only two services (25%) had a full-time junior doctor and three (37%) were not multidisciplinary, comprising nursing staff alone. No team had a clinical psychologist and only two (25%) provided a psychological treatment service.Clinical ImplicationsLiaison psychiatry services across Wales are fragmented, under-resourced and unlikely to meet patients' needs. They fall well short of the recommendations of the Royal Colleges of Physicians and Psychiatrists.
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Faessler L, Kutz A, Haubitz S, Mueller B, Perrig-Chiello P, Schuetz P. Psychological distress in medical patients 30 days following an emergency department admission: results from a prospective, observational study. BMC Emerg Med 2016; 16:33. [PMID: 27557531 PMCID: PMC4997757 DOI: 10.1186/s12873-016-0097-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Psychological distress in medical patients admitted to the emergency department (ED) is not well studied. Our aim was to investigate the extent of psychological distress in a broad and unselected medical patient sample 30 days after ED admission and its association with socio-demographic and clinical variables. Method We used data from a prospective observational cohort study including 1575 consecutive adult medical patients presenting to the ED with acute somatic conditions. Outcome variables were patient’s psychological distress measured by the 4-item Patient Health Questionnaire (PHQ–4) and self-rated health assessed 30 days after ED admission using telephone interviews. Risk factors included socio-demographic variables (e.g. gender, marital status), clinical presentation (e.g. illness severity, main initial diagnosis) and course of illness (e.g. rehospitalisation, length of hospital stay). Results A total of 38 % of patients had evidence for psychological distress 30 days after ED admission. Multivariate analysis found female gender (adjusted odds ratio [aOR] 1.35, 95 % confidence interval [CI] 1.02 to 1.78), comorbid psychiatric disorder (aOR 1.63, 95 % CI 1.08 to 2.62), discharge to a post-acute care institution (aOR 1.47, 95 % CI 1.03 to 2.09), unplanned rehospitalisation (aOR 2.38, 95 % CI 1.47 to 3.86), and unplanned visit at general practitioner (aOR 4.75, 95 % CI 2.57 to 8.80) to be associated with distress at day 30 following ED admission. Conclusions One month after ED admission a significant number of patients still show a moderate amount of psychophysical distress. Strongest related variables were course of illness, in particular unplanned general practitioner visits. Future interventional studies should assess possibilities to reduce distress in patients at increased risk. Trial registration NCT01768494, January 9, 2013 (registration date), February 25, 2013 (enrolment of first participant).
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Affiliation(s)
- Lukas Faessler
- Institute of Psychology, University of Berne, Berne, Switzerland. .,University Department of Internal Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Alexander Kutz
- University Department of Internal Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
| | - Sebastian Haubitz
- University Department of Internal Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
| | - Beat Mueller
- University Department of Internal Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
| | | | - Philipp Schuetz
- University Department of Internal Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
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Abstract
The impact of psychiatric emergencies for the care of patients in preclinical emergency medicine, in emergency departments and in psychiatric hospitals has been underestimated for a long time. There is still insufficient knowledge and a need for further research. There are, however, sufficient reasons to assume that annually approximately 500,000 patients with a psychiatric emergency receive treatment from a preclinical emergency physician and another 1.5 million in emergency departments in Germany. Further, approximately 500,000 patients are admitted to psychiatric hospitals as an emergency. The most frequent reasons are intoxication, agitation, aggressiveness and suicidal ideation, posing a threat of self-harm to the patient or to other persons and evoking other life-threatening conditions. Emergency psychiatry also plays a role in collective injuries, such as mass disasters, catastrophes and rampage situations. There is some evidence that the number of psychiatric emergencies is increasing. Reasons are, among others, changes in the services provided for inpatient and outpatient treatment, a reduction in stabilizing psychosocial factors and a general increase in the utilization of emergency healthcare services.
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Affiliation(s)
- F-G B Pajonk
- Praxis Isartal, Kloster Schäftlarn 8, 82067, Kloster Schäftlarn, Deutschland
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18
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Lawrence P, Fulbrook P. Protocol for a pragmatic randomised controlled trial to evaluate effects of a brief intervention for emergency department attendees who present with moderate or high levels of non-specific psychological distress: a pilot study. Pilot Feasibility Stud 2015; 1:33. [PMID: 27965811 PMCID: PMC5154032 DOI: 10.1186/s40814-015-0028-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening and brief intervention in the emergency department (ED) has almost exclusively focused on individuals with alcohol-use problems. The early detection of mental health problems before problems become severe will enable early intervention and support which may improve health and prevent further deterioration. The main aim of this pilot study is to provide evidence of the acceptance of a telephone intervention aimed at ED attendees with moderate or high psychological distress. This will be determined by recruitment rates, retention rates and participant satisfaction with the intervention. Secondary outcomes include whether socio-demographic variables have an impact on retention rates, and whether the intervention had any impact on psychological distress. METHODS/DESIGN This study will be a single-site pragmatic randomised controlled pilot study. Consenting ED attendees will be screened with the Kessler Psychological Distress Scales (K10). There will be three arms to the study: a moderate/high psychological distress group with or without intervention, and a low psychological distress group. Those with severe psychological distress will be excluded. All included participants will be followed-up at 1, 3, 6 and 12 months post-recruitment. Retention rates will be determined by successful completion of surveys at the follow-up time-points. Psychological distress will be measured by the K10 at all follow-up time-points. DISCUSSION This study will provide information regarding the potential for screening and recruitment at an opportunistic hospital presentation. It will provide data for a future larger study with regard to participants accepting to be included in this study. Participant acceptability will be measured in terms of recruitment rates and retention rates measured by successful follow-ups over the following 12 months post-recruitment. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12614000031662. Registered 10/01/2014.
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Affiliation(s)
- Petra Lawrence
- Nursing Research and Practice Development Centre, The Prince Charles Hospital and Australian Catholic University, Brisbane, Australia
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital and Australian Catholic University, Brisbane, Australia ; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
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Faessler L, Perrig-Chiello P, Mueller B, Schuetz P. Psychological distress in medical patients seeking ED care for somatic reasons: results of a systematic literature review. Emerg Med J 2015; 33:581-7. [PMID: 26362580 DOI: 10.1136/emermed-2014-204426] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 08/17/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this systematic literature review is to investigate (A) currently used instruments for assessing psychological distress, (B) the prevalence of psychological distress in medical emergency department (ED) patients with acute somatic conditions and (C) empirical evidence on how predictors are associated with psychological distress. METHODS We conducted an electronic literature search using three databases to identify studies that used validated instruments for detection of psychological distress in adult patients presented to the ED with somatic (non-psychiatric) complaints. From a total of 1688 potential articles, 18 studies were selected for in-depth review. RESULTS A total of 13 instruments have been applied for assessment of distress including screening questionnaires and briefly structured clinical interviews. Using these instruments, the prevalence of psychological distress detected in medical ED patients was between 4% and 47%. Psychological distress in general and particularly depression and anxiety have been found to be associated with demographic factors (eg, female gender, middle age) and illness-related variables (eg, urgency of triage category). Some studies reported that coexisting psychological distress of medical patients identified in the ED was associated with physical and psychological health status after ED discharge. Importantly, during routine clinical care, only few patients with psychological distress were diagnosed by their treating physicians. CONCLUSIONS There is strong evidence that psychological distress is an important and prevalent cofactor in medically ill patients presenting to the ED with harmful associations with (subjective) health outcomes. To prove causality, future research should investigate whether screening and lowering psychological distress with specific interventions would result in better patient outcomes.
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Affiliation(s)
- Lukas Faessler
- Institute of Psychology, University of Berne, Berne, Switzerland Medical University Department Kantonsspital Aarau, Aarau, Switzerland
| | | | - Beat Mueller
- Medical University Department Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Department Kantonsspital Aarau, Aarau, Switzerland
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Fulbrook P, Lawrence P. Survey of an Australian general emergency department: estimated prevalence of mental health disorders. J Psychiatr Ment Health Nurs 2015; 22:30-8. [PMID: 25524652 DOI: 10.1111/jpm.12191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2014] [Indexed: 11/29/2022]
Abstract
Compared to the general population, people with mental health disorders have an increased risk of morbidity and mortality, and are associated with higher health-care costs and lost societal productivity. Evidence indicates that more people are presenting to emergency departments with mental health disorders and that this group represents a disproportionately large number of emergency department attendees. The study results indicate that around a third of people who attended the emergency department may have had a mental health disorder, which is more than that found in the general adult Australian population. The results also suggest that the majority of emergency department attendees that have a mental health disorder are not identified at this opportunistic point of contact. The emergency department is an ideal point of contact to screen people for mental health problems. If problems are identified early, and treatment is started early, then it is likely that more people would be helped before their mental health problem became severe. However, increased identification of mental health problems may have implications for mental health services in terms of workload and delivery. The aim of this study was to estimate the prevalence of mental health disorders in an Australian general emergency department. A cross-sectional survey was used to screen a sample of 708 patients, using the Kessler Psychological Distress Scale (K10). The mean age of participants was 50.2 years, and their mean K10 score was 19.96 (SD 7.83), with 24% categorized as having high or very high psychological distress. Seventeen per cent self-reported having a mental health issue. Post-probability calculations based on observed K10 scores estimated that 37% of participants had an actual mental health disorder. The results suggest the prevalence of mental health disorder is significantly higher in emergency department attendees than Australian population norms, supporting the contention that a substantial proportion of ED attendees has a mental health disorder that, in the majority of cases, is not investigated at this point of contact. There is potential to screen all emergency department attendees for the presence of mental health disorder; early identification of mental illness would enable early referral for treatment. However, if all patients are screened, then it is likely that more mental health conditions will be picked up. The implications for mental health nursing are that this may increase workload.
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Affiliation(s)
- P Fulbrook
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, QLD, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
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Totten VY, Bryant TK, Chandar AK, Hoch WB, Hunter SL, Patel NJ, Brenner BE. Perspectives on visitors in the emergency department: their role and importance. J Emerg Med 2013; 46:113-9. [PMID: 24054883 DOI: 10.1016/j.jemermed.2013.04.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Visitors may play a significant role in patient care by interceding on patients' behalf and advocating proper care. STUDY OBJECTIVES The objectives of this study were to determine the percentage of emergency department (ED) patients with visitors, whether this varied by gender or race, and to compare patient and visitor perspectives on the role and importance of visitors. METHODS This cross-sectional study was done in a 46,035 adult-visit, urban ED during a consecutive 96-h period. A "visitor" was defined as any non-health-care provider present in a patient's room. Perspectives of visitors' role were assessed in five domains: transportation, emotional support, physical care, communication, and advocacy. RESULTS Forty-two percent of patients had at least one visitor during their ED stay. Visitor presence was unaffected by patients' age, gender, or triage score; however, 57% of white patients had at least one visitor during their stay, compared to 39% for non-Whites (p = 0.02). When patients had one or more visitors, gender and triage score did not influence the number of visitors; however, older patients and nonwhite patients had greater numbers of visitors (age ≥ 40 years, 1.5 ± 0.8 vs. age < 40, 1.2 ± 0.6 visitors/patient; p = 0.03 and nonwhite patients, 1.4 ± 0.7 vs. white patients, 1.1 ± 0.3 visitors/patient; p = 0.03). Seventy-eight percent of patients felt that visitors were important to their care. CONCLUSIONS Visitors represent a valuable resource for patients, and methods of partnering with visitors to improve outcomes merit further work.
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Affiliation(s)
- Vicken Y Totten
- Emergency Department, University Hospitals Case Medical Center, Cleveland, Ohio
| | | | | | - Wyatt B Hoch
- Case Western Reserve University, Cleveland, Ohio
| | - Stephanie L Hunter
- Emergency Department, University Hospitals Case Medical Center, Cleveland, Ohio
| | | | - Barry E Brenner
- Emergency Department, University Hospitals Case Medical Center, Cleveland, Ohio
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Benach J, Muntaner C, Tarafa G. El copago es inequitativo, injusto y evitable. GACETA SANITARIA 2012. [DOI: 10.1016/j.gaceta.2012.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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[Psychiatric care in emergency departments]. Anaesthesist 2012; 61:215-23. [PMID: 22430551 DOI: 10.1007/s00101-012-1991-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/10/2012] [Accepted: 01/15/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Psychiatric emergency situations (PES) are frequent in emergency departments (EDs). There are, however, only few investigations that focus on the prevalence of these patients or on diagnostic and therapeutic standards. These PESs in EDs should be treated according to standards comparable to medically disabled patients. Thus it is necessary to learn more about the diagnostic and therapeutic possibilities in EDs, about the procedures and the decision-making process whether these patients are transferred to further outpatient or inpatient treatment. MATERIALS AND METHODS A survey was conducted in EDs throughout Germany and 1,073 were contacted and asked to participate. The questionnaire consisted of questions concerning the size of the ED and of the hospital (e.g. number of patients and physicians), the prevalence of psychiatric disorders, the diagnostic and therapeutic possibilities, standard procedures for dealing with PES and the method of care in six typical case reports. RESULTS A total of 74 EDs participated (76% interdisciplinary EDs) with an average of 22,827 ± 12,303 patients per year in the ED. Psychiatry as a medical discipline was integrated into 10 EDs (14%) and psychiatric competence could be activated in 84% of EDs. Participating EDs reported prevalence rates of 15% mentally disordered patients and 9% of patients who required psychiatric diagnostic and therapeutic procedures. Of the patients 2% presented after suicide attempts and 3% were considered to be aggressive. Approximately 50% of all PESs were related to substance abuse disorders. An average of 2.5 ± 4.2 (range 0-25) members of the medical and nursing staff were injured during a 1-year period by violent patients. Legal actions against the will of patients were initiated in 81% of EDs. Standardized diagnostic screening instruments or self-rating questionnaires were used in only four EDs. As standard procedures for the diagnostic work-up of psychiatric patients (medical clearance) physical examination, measurement of heart rate and blood pressure and conducting of some laboratory tests (glucose, blood cell count, electrolytes and renal function) were named. Diazepam (91%), lorazepam (88%) and haloperidol (87%) were considered to be indispensable psychopharmacological agents in the ED. CONCLUSIONS In the majority of participating EDs, diagnostic standards for PES were known but were not routinely applied. It has to be assumed that many psychiatric disorders, in particular suicide attempts and suicidal ideation are not discovered. In many EDs psychiatric knowledge was available but a psychiatric consultation was only rarely requested. Physicians in the ED report a high degree of legal uncertainty with psychiatric patients. The use of screening instruments is recommended.
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Downey LVA, Zun LS, Burke T. Undiagnosed mental illness in the emergency department. J Emerg Med 2011; 43:876-82. [PMID: 21871769 DOI: 10.1016/j.jemermed.2011.06.055] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 04/05/2011] [Accepted: 06/04/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Mental illness affects 8% of the population. The early identification and treatment of mental illness can reduce the progression and complications of the illness. OBJECTIVE The objective of this study was to identify unsuspected psychiatric illness in patients presenting to the emergency department (ED) with non-psychiatric-related complaints. A comparison of the test results and the emergency physician assessments were then compared. METHODS All consenting and stable patients who presented to the ED with non-psychiatric complaints were given the Mini-International Neuropsychiatric Interview (MINI). It was administered to the patient by a trained research fellow before the patient was seen by the physician. Before the patient's departure from the ED, the research fellow notified the emergency physician of the results of the MINI interview. After the emergency physician was notified of the diagnosis of the MINI, any change in the treatment was reviewed. RESULTS A total of 211 patients were enrolled in the study. The majority of patients (55%) tested negative for all undiagnosed mental illnesses. The top diagnoses were as follows: major depression (24%), general anxiety (9%), and drug abuse (8%). Of all those patients who tested positive for an undiagnosed mental illness, only 2% were diagnosed by the ED attending. CONCLUSIONS The idea that the ED is a good place to identify undiagnosed mental health illnesses was confirmed. The use of an independent test such as the MINI was also shown to be useful to aid the emergency physician in identifying undetected mental illnesses.
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Affiliation(s)
- La Vonne A Downey
- Health Services/Public Administration, Roosevelt University, Chicago, Illinois 60605, USA
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Booth BM, Walton MA, Barry KL, Cunningham RM, Chermack ST, Blow FC. Substance use, depression, and mental health functioning in patients seeking acute medical care in an inner-city ED. J Behav Health Serv Res 2011; 38:358-72. [PMID: 21086057 PMCID: PMC3320727 DOI: 10.1007/s11414-010-9227-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The study investigated the behavioral health of a consecutive sample of 5,641 adult emergency department (ED) patients aged 19 through 60 presenting for medical care in a large, inner-city hospital ED. Twenty-three percent met the criteria for major depression; average mental health functioning, as measured by the mental health component of the SF-12, was half of a standard deviation lower than in the general population; 15% met the criteria for alcohol or drug abuse/dependence in the past year. Comorbidity was high. These behavioral health disorders may complicate treatment and diagnosis of the chief presenting complaint. These findings, coupled with the high rates of these disorders, suggest the importance of screening and either beginning appropriate treatment or offering appropriate referral for such disorders in ED settings.
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Affiliation(s)
- Brenda M. Booth
- Professor, Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences. address: 4301 W. Markham, Slot 755, Little Rock, AR 72205, Phone: (501) 526-8129, Fax: (501) 526-8199,
| | - Maureen A. Walton
- Research Assistant Professor, University of Michigan Department of Psychiatry and National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor VA Healthcare System, Department of Veterans Affairs. address: Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, Phone: (734) 232-0270, Fax: (734) 998-7992,
| | - Kristin L. Barry
- Research Associate Professor, University of Michigan Department of Psychiatry Addiction Research Center and Associate Director, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor VA Healthcare System, Department of Veterans Affairs. Mailing address: Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, Phone: (734) 232-0404, Fax: (734) 615-8739,
| | - Rebecca M. Cunningham
- Assistant Professor, University of Michigan Department of Emergency Medicine. Mailing address: Injury Research Center 300 NIB, Room 2C31G, Ann Arbor, Michigan 48109-0437, Phone: (734) 615-3704, Fax: 734-936-2706,
| | - Stephen T. Chermack
- Associate Professor, University of Michigan Department of Psychiatry, and Chief, Substance Abuse Clinic, Ann Arbor VA Healthcare System. Mailing address: Psychiatry Service (116C), VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, Phone: (734) 845-3908, Fax: (734) 845-3235,
| | - Frederic C. Blow
- Director, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor VA Healthcare System, Department of Veterans Affairs, and Associate Professor and Research Associate Professor, Department of Psychiatry, University of Michigan. Mailing address: Department of Veterans Affairs, Health Services Research and Development, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), PO Box 130170, Ann Arbor, MI 48113-0170, Phone: 734-761-2210, Fax: 734-761-2617,
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Ramsawh HJ, Chavira DA, Stein MB. Burden of anxiety disorders in pediatric medical settings: prevalence, phenomenology, and a research agenda. ACTA ACUST UNITED AC 2010; 164:965-72. [PMID: 20921356 DOI: 10.1001/archpediatrics.2010.170] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The current review describes the phenomenology of several common anxiety disorders in children and adolescents as they present in medical settings. Anxiety disorders and associated features in children are described, along with epidemiology, functional impairment, common somatic complaints, medical comorbidity, health care utilization, and presentation in general and in specialty pediatric medical settings. Recommendations for clinical management in pediatric settings are presented, and evidence-based interventions and emerging treatments for pediatric anxiety disorders are described. The review concludes with a discussion of future research directions that may lead to increased recognition and improved management of anxiety disorders in pediatric medical settings.
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Affiliation(s)
- Holly J Ramsawh
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0855, USA.
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Noorbala AA, Arbabi M, Shalbafan AR. Psychological Dimensions in Patients admitted in Imam Khomeini General Hospital in Tehran. IRANIAN JOURNAL OF PSYCHIATRY 2010; 5:51-4. [PMID: 22952491 PMCID: PMC3430494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to assess the mental health of patients admitted in Internal medicine, Surgery and Gynecology wards of Imam Khomeini Hospital of Tehran in 2009. METHOD The symptom checklist-90-R (SCL-90-R) questionnaire was administered for 93 patients in internal, surgical and gynecological wards of Imam Khomeini hospital in 2009. RESULTS In this study, the mean age was (32.89±12.69) with a range of 14 to 70 years old. 42 patients (44.7%) were male and 52 (59.6%) were female; 56 patients (59.6%) were married and 37 (40.4%) were single. There is a significant relationship between gender& marital status (P<0.04). According to cut of point of Global Severity Index (GSI) which was reported in a study (0.7), 58.1 percent of the patients have different levels of psychiatric problems (GSI>0.7). In psychiatric symptoms, somatization has the highest prevalence (90.5%), and depression (77.9%) and anxiety (71.6%) have a higher prevalence than other symptoms among patients who suffer from psychiatric problems. CONCLUSION According to the result of the current study, there is a high prevalence of psychiatric problems among the admitted patients in Internal medicine, Surgery and Gynecology wards of a general hospital according to SCL-90-R questionnaire. This study advises that more attention be given to mental health in general hospitals.
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Affiliation(s)
- Ahmad Ali Noorbala
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran,Psychosomatic ward, Imam Khomeini Hospital, Tehran, Iran,Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arbabi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran,Psychosomatic ward, Imam Khomeini Hospital, Tehran, Iran,Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Shalbafan
- Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Panic disorder (PD) is a disabling condition which appears in late adolescence or early adulthood and affects more frequently women than men. PD is frequently characterized by recurrences and sometimes by a chronic course and, therefore, most patients require long-term treatments to achieve remission, to prevent relapse and to reduce the risks associated with comorbidity. Pharmacotherapy is one of the most effective treatments of PD. In this paper, the pharmacological management of PD is reviewed. Many questions about this effective treatment need to be answered by the clinician and discussed with the patients to improve her/his collaboration to the treatment plan: which is the drug of choice; when does the drug become active; which is the effective dose; how to manage the side effects; how to manage nonresponse; and how long does the treatment last. Moreover, the clinical use of medication in women during pregnancy and breastfeeding or in children and adolescents was reviewed and its risk-benefit balance discussed.
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Affiliation(s)
- Carlo Marchesi
- Psychiatric Section, Department of Neuroscience, University of Parma Parma, Italy.
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Schriger DL, Gibbons PS, Nezami WA, Langone CA. Failure of a patient-centered intervention to substantially increase the identification and referral for-treatment of ambulatory emergency department patients with occult psychiatric conditions: a randomized trial [ISRCTN61514736]. BMC Emerg Med 2005; 5:2. [PMID: 15882462 PMCID: PMC1142309 DOI: 10.1186/1471-227x-5-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 05/09/2005] [Indexed: 11/29/2022] Open
Abstract
Background We previously demonstrated that a computerized psychiatric screening interview (the PRIME-MD) can be used in the Emergency Department (ED) waiting room to identify patients with mental illness. In that trial, however, informing the ED physician of the PRIME-MD results did not increase the frequency of psychiatric diagnosis, consultation or referral. We conducted this study to determine whether telling the patient and physician the PRIME-MD result would result in the majority of PRIME-MD-diagnosed patients being directed toward treatment for their mental illness. Methods In this single-site RCT, consenting patients with non-specific somatic chief complaints (e.g., fatigue, back pain, etc.) completed the computerized PRIME-MD in the waiting room and were randomly assigned to one of three groups: patient and physician told PRIME-MD results, patient told PRIME-MD results, and neither told PRIME-MD results. The main outcome measure was the percentage of patients with a PRIME-MD diagnosis who received a psychiatric consultation or referral from the ED. Results 183 (5% of all ED patients) were approached. 123 eligible patients consented to participate, completed the PRIME-MD and were randomized. 95 patients had outcomes recorded. 51 (54%) had a PRIME-MD diagnosis and 8 (16%) of them were given a psychiatric consultation or referral in the ED. While the frequency of consultation or referral increased as the intervention's intensity increased (tell neither = 11% (1/9), tell patient 15% (3/20), tell patient and physician 18% (4/22)), no group came close to the 50% threshold we sought. For this reason, we stopped the trial after an interim analysis. Conclusion Patients willingly completed the PRIME-MD and 54% had a PRIME-MD diagnosis. Unfortunately, at our institution, informing the patient (and physician) of the PRIME-MD results infrequently led to the patient being directed toward care for their psychiatric condition.
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Affiliation(s)
- David L Schriger
- University of California, Los Angeles Emergency Medicine Center, Los Angeles, CA, USA
- University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Patrick S Gibbons
- University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Wais A Nezami
- University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Carol A Langone
- Department of Clinical Social Work, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
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