180 Is Mental Health Treatment Associated With Decreased Emergency Department Utilization?

Abstract

Mental illness is known to be associated with increased emergency department utilization and tailored interventions have been created to reduce overuse. Little research, however, has examined the effect of standard care mental health treatment delivered in the community on ED utilization. This study aimed to determine the association of community mental health treatment with emergency department utilization among individuals with depression (MDD), generalized anxiety disorder (GAD), or panic disorder. Those with mental health diagnoses who reported receiving outpatient mental health treatment in the past year were hypothesized to be less likely to endorse utilizing the emergency department as one of their main providers of care. These data come from the MIDUS Refresher study, a publicly accessible data set of 2588 individuals from across the US. Participants were asked “where do you usually go if you are sick or need advice about your health?” and given the option of endorsing yes or no to “hospital emergency room” in addition to other primary care settings. MDD, GAD, and panic disorder were assessed using the WHO Composite International Diagnostic Interview. Number of chronic conditions was measured through participant report. Mental health treatment was measured through participant report of seeing a psychiatrist, general doctor, counselor, or religious leader for their mental health in the past 12 months, or of taking prescription medication for anxiety or depression over the past 30 days. 3.8% (N=135) of the sample qualified for GAD, 7.4% (N=263) qualified for panic disorder, and 13.3% (N=476) qualified for MDD. 11% (N=399) of the sample reported they would “usually go” to the ED, but only 1.3% (N=48) ranked the ED as health care setting they visited most often. Diagnosis of GAD, MDD, panic disorder, or a combination of the three was significantly associated with more chronic conditions (M=4.35, SD 3.66) than no diagnosis (M=2.69, SD=2.49), (t(-9.023), p<.001).As a whole, participants with at least one mood/anxiety diagnosis were more likely to report using the ED than those without, adjusting for race/ethnicity, education, age, sex and number of chronic symptoms (n=2518, AOR 1.584, 95% CI 1.204-2.084, p=.001). After propensity score matching by nearest neighbor, among participants with at least one mood/anxiety diagnosis, there was not a significant difference between those who did and did not receive mental health treatment in report of ED utilization when adjusting for race/ethnicity, education, age, sex and number of chronic symptoms (n=206, AOR .939, 95% CI .427-2.065, p=.876). This study found no association between mental health treatment and decreased ED utilization among individuals with mood/anxiety disorder. However, those with a mental health diagnosis had a significantly higher rate of chronic physical symptoms. As a result, future interventions that seek to decrease ED utilization among individuals with mood and anxiety disorders should target chronic physical conditions as well as mental health symptoms.