Abstract
ObjectivesFrequent emergency department (ED) use is a growing problem that is associated with poor patient outcomes and increased health care costs. Our objective was to analyze the association between mood disorders and the incidence of frequent ED use.MethodsWe used the Canadian Community Health Survey conducted by Statistics Canada, 2015–2016. Mood disorder was defined as depression, bipolar disorder, mania, or dysthymia. Frequent ED use was defined as 4 or more visits in the year preceding the interview. Multivariable log-binomial regression models were used to determine the associations between mood disorders and frequent ED use.ResultsAmong the 99,009 participants, 8.4% had mood disorders, 80.3% were younger than 65, and 2.2% were frequent ED users. Mood disorders were significantly associated with the 1-year cumulative incidence of frequent ED use (RR = 2.5, 95% CI 2.2–2.7), after adjusting for several potential confounders.ConclusionsThis national survey showed that people with a mood disorder had a three-fold risk of frequent ED use, compared to people without mood disorder. These results can inform the development of policies and targeted interventions aimed at identifying and supporting ED patients with mood disorder.
Highlights
Frequent emergency department (ED) users, usually defined as patients with four or more emergency department visits per year, are a critical issue in emergency medicine
This association was persistent in our sensitivity analyses. This large national study, based on data collected through the Canadian Community Health Survey, showed that mood disorder was associated with frequent ED use
Our finding that patients with mood disorders were 2.5 times more likely to be frequent ED users is consistent with previous studies
Summary
Frequent emergency department (ED) users, usually defined as patients with four or more emergency department visits per year, are a critical issue in emergency medicine. They represent between 4 and 16% of all ED users and account for 15% to almost 50% of all ED visits. The number of frequent ED users is rising, with a 66% increase over 10 years. Known risk factors for frequent ED use include female sex, young age, low socioeconomic status, low education level, substance use, fair or poor self-reported health, increased number of chronic conditions and mental health conditions (depression, anxiety). Patients with depression or anxiety have a higher risk of hospitalization for non-psychiatric conditions, by affecting self-management and treatment adherence [3]
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