Epidemiology of adult psychiatric visits to US emergency departments

Objectives: To characterize psychiatric-related emergency department visits (PREDVs) among adults in the United States for the year 2000 and to analyze PREDV trends from 1992 to 2000. Methods: Emergency department (ED) visit data from the National Hospital Ambulatory Medical Care Survey were used to estimate the number of PREDVs for adults aged 18 years and older. A PREDV was defined as any visit with a psychiatric discharge diagnosis (ICD N290-N312) or a suicide attempt (ICD E950-E959). Results: Approximately 4.3 million PREDVs occurred in the United States in the year 2000, yielding an annual rate of 21 visits per 1,000 adults. The PREDV rates increased 15% between 1992 and 2000. The PREDVs accounted for 5.4% of all ED visits. Substance abuse (27%), neuroses (26%), and psychoses (21%) were the most common conditions. African Americans had significantly higher visit rates (29/1,000; 95% CI = 27/ 1,000 to 31 / 1,000) compared with whites (23 / 1,000; 95% CI = 22 / 1,000 to 25 / 1,000). Persons with Medicaid (66 / 1,000; 95% CI = 64/1,000 to 68/1,000) had double the rate of PREDVs than the uninsured (33/1,000; 95% CI = 31/1,000 to 35/1,000) and almost eight times the rate of those privately insured (8/1,000; 95% CI = 7/1,000 to 10/1,000). Patients with psychiatric diagnoses had a higher admission rate (22%) than those with nonpsychiatric diagnoses (15%). The uninsured were the least likely to be admitted for all major psychiatric conditions except suicide (p < 0.0001). Conclusions: Psychiatric-related ED visits represent a substantial and growing number of ED visits each year. Patient characteristics influence the likelihood of a PREDV. Further research is needed to better understand the role that hospital EDs play in the delivery of health care services to those with mental illness.