National differences between ED and ambulatory visits for suicidal ideation and attempts and depression

Bharath Chakravarthy,Shannon Toohey,Yalda Rezaimehr,Craig L Anderson,Wirachin Hoonpongsimanont,Michael Menchine,Shahram Lotfipour

doi:10.1016/j.ajem.2013.12.044

Bharath Chakravarthy, Shannon Toohey + Show 5 more

Open Access

https://doi.org/10.1016/j.ajem.2013.12.044

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Abstract

BackgroundMany suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high. Study objectiveThe primary objective of the study is to determine a relationship between the incidence of suicidal and depressed patients presenting to EDs and the incidence of depressed patients presenting to outpatient clinics. The secondary objective is to analyze trends among suicidal patients. MethodsThe National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey were screened to provide a sampling of ED and outpatient visits, respectively. Suicidal and depressed patients presenting to EDs were compared with depressed patients presenting to outpatient clinics. Subgroup analyses included age, sex, race/ethnicity, method of payment, regional variation, and urban verses rural distribution. ResultsEmergency department visits for depression (1.16% of visits in 2002) and suicide attempts (0.51% of visits in 2002) remained stable over the years. Office visits for depression decreased from 3.14% of visits in 2002 to 2.65% of visits in 2008. Non-Latino whites had a higher percentage of ED visits for depression and suicide attempt and office visits for depression than other groups. The percentage of ED visits for suicide attempt resulting in hospital admission decreased by 2.06% per year. ConclusionFrom 2002 to 2008, the percentage of outpatient visits for depression decreased, whereas ED visits for depression and suicide remained stable. When examined in the context of a decreasing prevalence of depression among adults, we conclude that an increasing percentage of the total patients with depression are being evaluated in the ED, vs outpatient clinics.

Highlights

Data from 2002 to 2008 were obtained from both the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Survey (NAMCS) to compare trends between suicidal patients presenting to emergency departments (EDs) vs patients presenting to outpatient clinics for depression
Office visits for depression decreased from 3.1% of visits in 2002 to 2.6% of visits in 2008, a mean change of − 0.09% per year (P = .02)
There was no significant trend over the years in ED visits for depression or suicide attempt in either males or females

Summary

Introduction

In the United States, suicide ranked as the fourth leading cause of death between the ages of 10 and 65 years [3]. These statistics do not capture the full impact of the disease, as there are many unsuccessful suicide attempts with resulting injuries as well as visits to both the emergency department (ED) and psychiatric institutions for suicidal ideation. Many suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high. Results: Emergency department visits for depression (1.16% of visits in 2002) and suicide attempts (0.51% of visits in 2002) remained stable over the years. When examined in the context of a decreasing prevalence of depression among adults, we conclude that an increasing percentage of the total patients with depression are being evaluated in the ED, vs outpatient clinics

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