Emergency Departments May Under-Diagnose Mental Disorders -- MEDICA - World Forum for Medicine

Mark Olfson, M.D., M.P.H., of the Columbia University Medical Center, New York, and colleagues analysed data from a nationally representative sample of emergency department visits from 1997 to 2002 by young people, aged seven to 24 years, after deliberate self-harm. The researchers assessed the data to determine the frequency with which young people making such emergency visits are provided various medical and psychiatric treatments and are referred for inpatient and outpatient care.

The researchers found that the annual overall rate of emergency visits by persons seven to 24 years old for deliberate self-harm was 225.3 per 100,000 population. The rate was significantly higher for persons 15 to 19 and 20 to 24 years of age than for persons seven to 14. “Overall, roughly one-half (56.1 percent) of the patient visits resulted in a mental disorder diagnosis including 15.1 percent resulting in a depressive disorder diagnosis and 7.3 percent resulting in a substance use disorder diagnosis. Psychotropic medications were provided in 12.1 percent of the patient visits, most commonly anxiolytics (6.2 percent).”

“Slightly more than one-half of the patient visits (56.1 percent) resulted in inpatient admission,” the authors write. “In addition, 29.0 percent of the visits resulted in outpatient care referral; 5.8 percent resulted in referral to the emergency department for continuing care, 4.9 percent resulted in no follow-up care, and follow-up care was unspecified in 3.4 percent of the visits.” A diagnosis of depressive disorder, a well-known and powerful risk factor for youth suicide, was strongly associated with inpatient admission.

“Mental disorders were diagnosed in roughly one-half of emergency visits by young people treated for episodes of deliberate self-harm,” the authors conclude. “This suggests substantial underrecognition of mental illness and likely inadequate referral for follow-up mental health care”, the authors state.

MEDICA.de; Source: American Medical Association (AMA)