A new study by Indiana University researchers found that about 45 percent of patients who visit the emergency room for physical injuries and illnesses also have mental health and substance use problems that are often overlooked. Patients who reported high levels of suicidal thoughts and plans were also found to be more likely to make frequent emergency room visits.
Therefore, IU researchers, expanding on previous studies, used a computer-based adaptive screening test for mental health and substance use problems in patients with nonpsychiatric complaints to investigate whether emergency department visits are an important screening opportunity for mental health problems.
With findings recently published in Journal of the American College of Emergency Physicians, this is the largest study to use multidomain mental health screening in nonpsychiatric emergency department patients. The test, known as the Computerized Adaptive Mental Health Test, adjusts questions based on respondents’ answers.
“The results of our study are really important for health care companies and health economists,” said Brian D’Onofrio, the study’s principal investigator and professor of psychology and brain sciences in the College of Arts and Sciences at IU Bloomington. “The people who keep coming back to the emergency department are high-risk patients. This is where screening can be very helpful in identifying people who are at high risk — whether for suicide, depression, anxiety, post-traumatic stress disorder or substance use problems — and getting them care, from who are in need.”
Along with follow-up care, mental health screening can also reduce the need for future visits, reducing the burden on emergency departments, he said.
To conduct the study, researchers asked randomly selected patients in an Indianapolis emergency room to complete this computer-adaptive test that screens for five conditions: depression, anxiety, PTSD, suicidality, and substance use disorders. The purpose of the study was to understand the prevalence of these problems with a screening process that is sustainable in a large urban emergency department where physicians have competing and compelling interests.
Of the 794 patients, the study found that 24.1% were at moderate to severe risk for suicidality, 8.3% for depression, 16.5% for anxiety, 12.3% for PTSD, and 20.4% for substance use disorders. It also showed that people who had two or more emergency room visits in the previous year were 62 percent more likely to be in the medium-high risk category for suicide compared to those with no previous visits. Individuals who scored in the medium-high suicidal risk group had 63% greater odds of another ED visit within 30 days of their ED visit compared to those who scored as low risk.
Previous research has also shown that many suicidal patients often visit the emergency room or access the health care system for a non-psychiatric reason shortly before their suicide attempt.
The results of the study suggest that computerized adaptive testing may be a viable option for rapid screening of a large group of patients in the emergency department regarding their mental health, as it provides results that are consistent with standard screening tests. It’s also faster than other screening methods, making it more practical to use in a busy environment, said IU Ph.D. student Lauren O’Reilly, a researcher in D’Onofrio’s lab whose current research focuses on suicidality.
The researchers then said that work is needed to understand the implications of this study, such as how emergency departments can integrate screenings into their procedures — as well as overcome barriers to treating mental conditions both within the emergency care and beyond.
“If emergency departments are implementing screening, it is vital to take steps after screening to ensure adequate care, such as interventions, safety planning, or linkage to providers,” O’Reilly said. “This is a particularly big challenge given the global shortage of mental health services.”
The study also opens up new perspectives for improving the quality of care in emergency departments in general.
“I hope these results provide an opportunity to discuss, intervene and connect patients in the emergency department to appropriate care,” said Paul Musey, senior author of the study and associate professor of emergency medicine at the IU School of Medicine. “The emergency room is the right place for anyone in crisis. I believe we have a duty not only to stabilize and treat patients in crisis, but also to ensure that we have done everything we can to provide them with the resources they need to avoid future crisis.”
This research was supported by a grant from the IU Responding to the Addictions Crisis Grand Challenge.