Indianapolis and Bloomington, IN — A new study by researchers from Indiana University finds that about 45 percent of patients who visit the emergency department for physical injuries and illnesses also have mental health and substance abuse problems that are often overlooked. It also found that patients who reported high levels of suicidal ideation and plans were more likely to have frequent emergency department visits.
That’s why IU researchers, expanding on previous studies, used a computer adaptive test to screen for mental health and substance use problems in patients with non-psychiatric complaints to examine whether emergency department visits were an important opportunity to screen for mental health issues.
Published in the Journal of the American College of Emergency PhysiciansThis is the most comprehensive study of the use of multidisciplinary mental health screening for non-psychiatric patients in the emergency department. The test, known as the Computerized Adjustment Test – Mental Health, modifies questions based on the respondents’ answers.with recent results
“The results of our study are really important for healthcare companies and health economists,” he said. Brian D’Onofrio, the study’s principal investigator and Professor of Psychological and Brain Sciences in the College of Arts and Sciences at IU Bloomington. “People who keep coming back to the emergency department are high-risk patients. It’s a place where screening can be very useful for identifying people who are at high risk — whether for suicidality, depression, anxiety, PTSD, or substance use problems — and getting them the care they need. they need.”
Besides follow-up care, mental health screening can also reduce the need for future visits, reducing burdens on emergency departments, he said.
To conduct the study, researchers asked randomly selected patients at an emergency department in Indianapolis to complete this computer-adaptive test that examines five conditions: depression, anxiety, post-traumatic stress disorder, suicidality, and substance use disorders. The aim of the study was to understand the prevalence of these problems through a sustained screening process in a large urban emergency department, where clinicians have competing and pressing concerns.
Of the 794 patients, the study showed that 24.1% were at moderate to severe risk for suicide, 8.3% for depression, 16.5% for anxiety, 12.3% for post-traumatic stress disorder, and 20.4% for substance use disorders. It also showed that people who had made two or more visits to the emergency department in the previous year were more likely to be in the medium-high suicide risk category compared to those who had never made one. Individuals who scored in the medium-high risk group had a 63% greater likelihood of visiting another emergency department within 30 days after the emergency department visit than those who scored low risk.
Previous research has also shown that many patients who die by suicide often visit the emergency department or enter the healthcare system for a non-psychiatric reason shortly before their suicide attempt.
The results of the study suggest that computer adaptive testing could be a viable option for quickly screening a large group of patients in the emergency department about their mental health because it provides results consistent with standard screening tests. It’s also faster than other screening methods, which makes it more practical for use in a crowded environment, said IU Ph.D. student Lauren O’Reillya researcher in D’Onofrio’s lab whose current research focuses on suicide.
Next, the researchers said, work is needed to understand the implications of this study, such as how emergency departments can incorporate screening into their procedures — as well as overcoming barriers to treating mental health conditions both inside and outside the emergency department.
“If emergency departments implement screening, it is critical that steps are taken post-screening to ensure adequate care, such as interventions, safety planning, or communication with providers,” O’Reilly said. “This is a particularly significant challenge given the global shortage of mental health care services.”
The study also opens up new avenues for improving the overall quality of emergency department care.
“I hope these findings provide an opportunity to discuss emergency department patients and intervention and link them to appropriate care,” he said. Paul Moses, senior author on the study and associate professor of emergency medicine at IU School of Medicine. “The emergency department is the place to go for anyone in crisis. I believe it is our duty to not only stabilize and treat patients in crisis, but also make sure we do everything we can to provide them with the resources they need to avoid a crisis in the future.”
This research was supported by a grant from IU responding to the great challenge of the addiction crisis.