November 21, 2022 - Podcast

Episode 324 — Screening ER patients for mental health issues

A new study by Indiana University researchers suggests emergency department visits may be an important opportunity to screen patients for mental health issues.

The study found that about 45% of patients who visit the emergency department for physical injuries and ailments also have mental health and substance use problems that are often overlooked. It also found that patients who reported high levels of suicidal thinking 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 emergency department patients with nonpsychiatric complaints.

Brian D'Onofrio, a professor of psychological and brain sciences at IU, says the results of the study are important for health care companies and health economists. He says the people who keep coming back to the emergency department are high-risk patients, so the emergency department is a place where screening could be very helpful to identify people who are at high risk for suicide, depression, anxiety, PTSD or substance use problems and to get them the care they need.

Along with follow-up care, D'Onofrio says mental health screening could also lessen the need for future visits, reducing burdens on emergency departments.

To conduct the study, researchers asked randomly selected patients in an Indianapolis emergency department to complete this computer adaptive test that screens for five conditions: depression, anxiety, post-traumatic stress disorder, suicidality and substance use disorders.

Out of 794 patients, the study showed 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 department visits in the previous year had 62% increased odds of being in the intermediate-to-high suicide risk category compared to those with no prior visits.

Past research has also shown that many patients who die by suicide often visit the emergency department or access the health care system for a nonpsychiatric reason shortly before their suicide attempt.

The study’s results suggest that computer adaptive testing could be a viable option to quickly screen a large group of patients in the emergency department about their mental health because it provides results that match the standard screening tests. It is also faster than other screening methods, making it more practical for use in a busy environment.

The researchers said more work is needed to understand the implications of this study, such as how emergency departments might integrate screenings into their procedures — as well as overcome barriers to treating mental health conditions both within and beyond the emergency department setting.

The study also opens up new prospects for improving the quality of emergency department care overall.