Mental health in general, and undiagnosed psychiatric illness in particular, has been recognised as important concerns in emergency departments (EDs). They have been a focal point for acute healthcare services in Australia.1,2 This research examined the prevalence of non‐specific psychological distress among people admitted through ED, who had chronic and complex conditions, and were aged 50 years and over.3 Patients over 50 years were selected because of the increased likelihood of the onset of chronic conditions. A chronic patient was defined as an ED admission with two or more presenting comorbidities for at least 6 months prior to admission. This group was matched with people from the New South Wales (NSW) Health Survey who reported any of the following conditions: high blood pressure, diabetes, cancer, or heart problems. Psychological distress measured by Kessler 10 (K10)3 was used because this instrument has been validated in large population based surveys and allows valid comparisons with the 1997 NSW Health Survey data.4
The interviews took place in ED or shortly after in the general ward; therefore, it was not possible for the researchers to know whether a psychiatric consultation was conducted after admission to hospital or not.
Altogether, 524 ED patients were interviewed on admission in a principal referral hospital in Sydney, Australia. These were a representative sample of all ED attendees to this hospital. A total of 12.4% (95% CI: 9–15%) had a severe (very high) level, 21.4% (95% CI: 17–25%) had a high level, 31.3% (95% CI 27–35%) had a moderate level, and 34.9% (95% CI: 30%–39%) had a low level of psychological distress or no distress. Eight percent (95%CI: 5%–10%) of patients who completed the K10 had at least one mental health related condition (ICD‐9 codes: 290–319). More females than males reported non‐specific psychological distress but age differences were not large for the severe (very high) group.
Table 1 shows the demographic characteristics of admitted patients who completed K10 versus the total population of patients during the study period and data from age‐matched people in the NSW State Health survey. The differences in age, gender, or marital status were not statistically significant.
Table 1 K10 scores and demographic characteristics of admitted patients through ED.
| Kessler 10 | ||||
| Categories | Study sample | 1997 NSW Health Survey* | ||
| % (n = 524) | % With co‐morbidities | Chronic group (%) (n = 1121) | Non‐chronic group (%) (n = 789) | |
| Very high (30–50) | 12.4 | 7.7 | 6.1 | 4.1 |
| High (22–29) | 21.4 | 13.4 | 13.0 | 9.0 |
| Moderate (16–21) | 31.3 | 7.9 | 23.2 | 22.9 |
| Low (10–15) | 34.9 | 4.9 | 57.7 | 64.0 |
| Mean score (95% CI) | 19.6 (18.9–20.3) | 16.55 (16.1–16.9) | 15.48 (15.0–15.9) | |
| Demographic characteristics | ||||
| Characteristic | K10 sample in ED (%, n = 437) | Reference population†, all attendees to this ED (%) (6385) | Chronic diseased group (1144)§ % | Non‐chronic diseased group (797) % |
| Age | ||||
| 50–59 y | 16.9 | 24.5 | 27.3 | 46.9 |
| 60–69 y | 28.4 | 25.9 | 33.0 | 25.7 |
| 70–79 y | 35.7 | 28.2 | 28.8 | 18.6 |
| 80 y + | 19.0 | 21.5 | 10.8 | 8.8 |
| Sex | ||||
| Males | 54.5 | 52.1 | 44.9 | 45.3 |
| Females | 45.5 | 47.9 | 55.1 | 54.7 |
| Marital status | ||||
| Separated/divorced | 59.0 | 58.6 | 14.1 | 16.1 |
| Single | 25.5 | 23.1 | 5.2 | 5.4 |
| Widowed | 3.4 | 5.4 | 26.8 | 22.2 |
| Married | 6.4 | 6.2 | 53.9 | 56.2 |
| Unknown | 5.7 | 6.7 | – | – |
*People 50 years and older who reported to have attended emergency department at least once in the last 12 months.
†All emergency department attendees at this hospital between January 2002 and January 2003.
§Chronic disease group (those who reported high blood pressure, or diabetes, or cancer or heart problems).
In the comparison with the state wide survey,4 the rates of psychological distress from our study were higher than the population wide health survey estimates.
We acknowledge that the sample was drawn from a single geographical region and any generalisation to the broader NSW community cannot be made. Further, the findings of the study are based on self reported information provided by patients and some potential for reporting bias may have occurred because of respondents' interpretation of the questions or desire to report their emotions in a certain way or simply because of inaccuracies of responses because of recall bias.
In conclusion, these findings suggest that high levels of psychosocial distress in ED attendees pose additional challenges for “whole patient” health services delivery, given that ED services are frequently used as the gateway to the health system.
This suggests that when patients are admitted to hospitals through ED for clinical reasons not linked to obvious psychiatric problems, psychological distress in ED may be under reported (by patients) and not treated (in ED). The major finding is that psychological distress in ED is more common than population based estimates; therefore, it may require population health strategies to address mental health problems in ED, especially when it is associated with chronic illness.
Footnotes
Competing interests: none declared
References
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