1
|
Bull C, Goh JY, Warren N, Kisely S. Experiences of individuals presenting to the emergency department for mental health reasons: A systematic mixed studies review. Aust N Z J Psychiatry 2024; 58:839-856. [PMID: 38880783 PMCID: PMC11420598 DOI: 10.1177/00048674241259918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Emergency departments the world over have seen substantial increases in the number of individuals presenting for mental health reasons. However, we have a limited understanding of their experiences of care. The aim of this review was to systematically examine and synthesise literature relating to the experiences of individuals presenting to emergency department for mental health reasons. METHODS We followed Pluye and Hong's seven-step approach to conducting a systematic mixed studies review. Studies were included if they investigated adult mental health experiences in emergency department from the users' perspective. Studies describing proxy, carer/family or care provider experiences were excluded. RESULTS Sixteen studies were included. Thematic synthesis identified three themes and associated subthemes. Theme 1 - ED staff can make-or-break and ED experience - comprised: Feeling understood and heard; Engaging in judgement-free interactions; Receiving therapeutic support; Being actively and passively invalidated for presenting to the ED; and Once a psych patient, always a psych patient. Theme 2 - Being in the ED environment is counter-therapeutic - comprised: Waiting for an 'extremely' long time; and Lacking privacy. Theme 3 was Having nowhere else to go. CONCLUSIONS The experiences described by individuals presenting to emergency department for mental health reasons were mostly poor. The results illustrate a need for increased mental health education and training for all emergency department staff. Employment of specialist and lived experience workers should also be prioritised to support more therapeutic relationships and emergency department environments. In addition, greater investment in mental health systems is required to manage the current crisis and ensure future sustainability.
Collapse
Affiliation(s)
- Claudia Bull
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
| | - Jia Yin Goh
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
| | - Nicola Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
| | - Steve Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
2
|
Petruzzelli MG, Marzulli L, Colacicco G, Tarantino F, Furente F, Gabellone A, Margari L, Matera E. Adolescent Mental Health: A Focus on Psychiatric Counseling from the Emergency Room of an Italian University Hospital in the Five Years from 2019 to 2023. Eur J Investig Health Psychol Educ 2024; 14:1248-1259. [PMID: 38785580 PMCID: PMC11119817 DOI: 10.3390/ejihpe14050082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024] Open
Abstract
Recent studies have revealed increasingly worse and more complex mental health conditions in young people, which is reflected in a growing trend in emergency room (ER) visits for acute psychopathological symptoms (APSs). This phenomenon has become exacerbated in recent decades, with a peak in the post-pandemic period. To better characterize the phenomenon, we investigated the change in the rate and type of ER counseling requests provided at the Child Neuropsychiatry Unit of the University Hospital of Bari, Italy over the period between 2019 and 2023 for subjects younger than 18 years old. For this purpose, we retrospectively analyzed a total number of 1073 urgent consultation reports retrieved through the reporting computerized operating system of our hospital. The distribution of the counseling requests provided for APSs and, among these, the distribution of the numbers of APSs and of the male: female ratio were significantly different over the years, with an increasing linear trend identified for APSs (p = 3.095 × 10-7), the average number of APSs (p = 3.598 × 10-7), and female gender prevalence (p = 0.03908), as well as for the patients with a history of psychotropic drug assumption (p = 0.0006319). A significant change in the number of urgent counseling requests received for eating disorders (p = 0.0007408), depression (p = 7.92 × 10-8), somatization (p = 4.03 × 10-6), self-harm (SA) (p = 1.358 × 10-6), and non-suicidal self-injury (NSSI) (p = 8.965 × 10-6) was found, with a significant increasing trend for anxiety (p = 0.0444), depression (p = 8.06 × 10-6), somatization (p = 0.004616), SA (p = 3.998 × 10-8), and NSSI (p = 5.074 × 10-7). The findings of our study support the hypothesis of an alarming progressive worsening of the mental health of children and adolescents, with an overlapping effect of the pandemic exacerbating the process.
Collapse
Affiliation(s)
- Maria Giuseppina Petruzzelli
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy; (M.G.P.); (G.C.); (F.T.)
| | - Lucia Marzulli
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy; (M.G.P.); (G.C.); (F.T.)
| | - Giuseppe Colacicco
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy; (M.G.P.); (G.C.); (F.T.)
| | - Fabio Tarantino
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy; (M.G.P.); (G.C.); (F.T.)
| | - Flora Furente
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy; (M.G.P.); (G.C.); (F.T.)
| | - Alessandra Gabellone
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy; (M.G.P.); (G.C.); (F.T.)
| | - Lucia Margari
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy; (L.M.); (E.M.)
| | - Emilia Matera
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy; (L.M.); (E.M.)
| |
Collapse
|
3
|
Schneider PS, Pantis M, Preiser C, Hagmann D, Barth GM, Renner TJ, Allgaier K. SARS-CoV-2 and Adolescent Psychiatric Emergencies at the Tübingen University Hospital: Analyzing Trends, Diagnoses, and Contributing Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:216. [PMID: 38397705 PMCID: PMC10888620 DOI: 10.3390/ijerph21020216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Psychiatric emergencies have increased in recent decades, particularly with the onset of the SARS-CoV-2 pandemic, and far too little is known about the backgrounds of these emergencies. In this study, we investigated the extent to which the number of psychiatric emergencies changed during and in the aftermath of the SARS-CoV-2 pandemic at the Child and Adolescent Psychiatry (CAP) Tübingen. We considered age and psychiatric diagnoses. Additionally, we evaluated the backgrounds of the emergencies. We applied a mixed- (quantitative and qualitative) methods approach to data on emergency presentations at the CAP Tübingen from the pre-SARS-CoV-2 pandemic period (October 2019-January 2020) to Restriction Phase 1 (October 2020-January 2021), Restriction Phase 2 (October 2021-January 2022), and endemic phase (October 2022-January 2023). The total number of emergencies and those with eating disorders and affective disorders increased, while obsessive-compulsive disorders, expansive disorders and anxiety disorders decreased. The patients presenting in the pre-SARS-CoV-2 pandemic period were younger than those in the subsequent periods. We content-coded the reasons behind the emergency presentations. We also identified four areas of stressors and personality characteristics associated with the emergency presentations. In light of the increasing number of psychiatric emergencies, the long-term aim should be to meet the growing demands and create options for prevention.
Collapse
Affiliation(s)
- Priska S. Schneider
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, 72076 Tübingen, Germany; (M.P.); (G.M.B.); (T.J.R.); (K.A.)
- German Center for Mental Health (DZPG) Partner Site, 72076 Tübingen, Germany
| | - Michelle Pantis
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, 72076 Tübingen, Germany; (M.P.); (G.M.B.); (T.J.R.); (K.A.)
- German Center for Mental Health (DZPG) Partner Site, 72076 Tübingen, Germany
| | - Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, 72074 Tübingen, Germany;
- Centre for Public Health and Health Services Research, University Hospital Tübingen, 72016 Tübingen, Germany
| | - Daniela Hagmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, 72076 Tübingen, Germany; (M.P.); (G.M.B.); (T.J.R.); (K.A.)
- German Center for Mental Health (DZPG) Partner Site, 72076 Tübingen, Germany
| | - Gottfried M. Barth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, 72076 Tübingen, Germany; (M.P.); (G.M.B.); (T.J.R.); (K.A.)
- German Center for Mental Health (DZPG) Partner Site, 72076 Tübingen, Germany
| | - Tobias J. Renner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, 72076 Tübingen, Germany; (M.P.); (G.M.B.); (T.J.R.); (K.A.)
- German Center for Mental Health (DZPG) Partner Site, 72076 Tübingen, Germany
- LEAD Graduate School and Research Network, University Tübingen, 72072 Tübingen, Germany
| | - Katharina Allgaier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, 72076 Tübingen, Germany; (M.P.); (G.M.B.); (T.J.R.); (K.A.)
- German Center for Mental Health (DZPG) Partner Site, 72076 Tübingen, Germany
- LEAD Graduate School and Research Network, University Tübingen, 72072 Tübingen, Germany
| |
Collapse
|
4
|
Dobrin-De Grace R, Carvalho D, Courtney DB, Aitken M. Suicidal behaviour and ideation among adolescents during the COVID-19 pandemic. Curr Opin Psychol 2023; 52:101650. [PMID: 37423041 DOI: 10.1016/j.copsyc.2023.101650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023]
Abstract
Adolescence is a period of elevated risk for suicide, and mental health professionals expressed concerns that suicidal behaviours and suicide rates may increase among this age group during the COVID-19 pandemic. Adolescent suicide rates, attempts, and ideation during the pandemic varied depending on the country, data collection methodology, and population (e.g., general population vs. emergency department). Many pre-pandemic risk factors for suicidal behaviour or ideation were identified as risk factors during the pandemic; however, there was also some evidence that certain groups were disproportionately at risk, such as girls, and adolescents identifying as Black, Asian, American Indian/Alaska Native, or Asian/Pacific Islander. Given the trend of increased adolescent suicide in many countries over the past two decades, there is an ongoing need to direct resources toward prevention programs, screening, and evidence-based interventions for suicide risk.
Collapse
Affiliation(s)
- Roksana Dobrin-De Grace
- Department of Psychology, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada; Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
| | - Daniela Carvalho
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Darren B Courtney
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada; Department of Psychiatry, University of Toronto, Toronto, 250 College Street, 8th Floor Toronto, ON, M5T 1R8, Canada
| | - Madison Aitken
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada; Department of Psychiatry, University of Toronto, Toronto, 250 College Street, 8th Floor Toronto, ON, M5T 1R8, Canada
| |
Collapse
|