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Sociodemographic Influences of Emergency Department Care for Anxiety Disorders

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Abstract

This study examines variations in content of care for anxiety-related emergency department (ED) visits in the USA across various sociodemographic strata. The 2009–2012 National Hospital Ambulatory Medical Care Survey was used to identify all visits to general hospital EDs in which an anxiety diagnosis was recorded (n = 1930). Content and equitability of care was assessed utilizing logistic regression models. There were an estimated 1,856,000 ED visits with anxiety-related discharge diagnoses in the USA annually. Content of care and disposition varied by age, race/ethnicity, and insurance status. Visits by Medicaid patients were more likely than visits by privately insured patients to include a toxicology screen (OR = 1.67, p < .05) and visits by patients with either Medicaid or Medicare were less likely to include an EKG (OR = 0.53, p < .05 and OR = 0.52, p < .05, respectively). Understanding variations in ED care for anxiety can identify opportunities for intervention, both in the ED and upstream in appropriate healthcare settings.

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References

  1. Smith RP, Larkin GL, Southwick SM. Trends in U.S. Emergency Department Visits for Anxiety-Related Mental Health Conditions, 1992-2001. Journal of Clinical Psychiatry. 2008;69(2):286–294.

    Article  Google Scholar 

  2. Dark T, Flynn HA, Rust G, et al. Epidemiology of Emergency Department Visits for Anxiety in the United States: 2009-2011. Psychiatric Services. 2017;68(3):238–244.

    Article  Google Scholar 

  3. Sills MR, Bland SD. Summary Statistics for Pediatric Psychiatric Visits to US Emergency Departments, 1993-1999. Pediatrics. 2002;110(4):e40.

    Article  Google Scholar 

  4. Snowden LR, Cheung FK. Use of Inpatient Mental Health Services by Members of Ethnic Minority Groups. American Psychologist. 1990;45(3):347–355.

    Article  CAS  Google Scholar 

  5. Hu TW, Snowden LR, Jerrell JM, et al. Ethnic Populations in Public Mental Health: Services Choice and Level of Use. American Journal of Public Health. 1991;81(11):1429–1434.

    Article  CAS  Google Scholar 

  6. Newton AS, Ali S, Johnson DW, et al. A 4-year Review of Pediatric Mental Health Emergencies in Alberta. Canadian Journal of Emergency Medicine. 2009;11(5):447–454.

    PubMed  Google Scholar 

  7. Elster A, Jarosik J, VanGeest J, et al. Racial and Ethnic Disparities in Health Care for Adolescents: A Systematic Review of the Literature. Archives of Pediatrics and Adolescent Medicine. 2003;157(9):867–874.

    Article  Google Scholar 

  8. Newton AS, Rosychuk RJ, Niu X, et al. Emergency Department Use and Post-Visit Care for Anxiety and Stress Disorders among Children: A Population-Based Cohort Study in Alberta, Canada. Pediatric Emergency Care. 2016;32(10):658–663.

    Article  Google Scholar 

  9. Onoye J, Helm S, Koyanagi C, et al. Proportional Differences in Emergency Room Adult Patients with PTSD, Mood Disorders, and Anxiety for a Large Ethnically Diverse Geographic Sample. Journal of Health Care for the Poor and Underserved. 2013;24(2):928–942.

    Article  Google Scholar 

  10. Institute of Medicine. Future of Emergency Care: Hospital Based Emergency Care at the Breaking Point. Washington, DC: National Academies Press, 2007.

    Google Scholar 

  11. National Center for Health Statistics. 2012 NHAMCS Micro Data File Documentation. Centers for Disease Control and Prevention. Available online at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc12_ed.pdf. Accessed on July 24, 2017.

  12. Marson DC, McGovern MP, Pomp HC. Psychiatric Decision Making in the Emergency Room: A Research Overview. American Journal of Psychiatry. 1988;145(8):918–925.

    Article  CAS  Google Scholar 

  13. Faessler L, Perrig-Chiello P, Mueller B, et al. Psychological Distress in Medical Patients Seeking ED Care for Somatic Reasons: Results of a Systematic Literature Review. Emergency Medicine Journal. 2016;33(8):581–587.

    Article  Google Scholar 

  14. Mehl-Madrona LE. Prevalence of Psychiatric Diagnoses among Frequent Users of Rural Emergency Medical Services. Canadian Journal of Rural Medicine. 2008;13(1):22–30.

    PubMed  Google Scholar 

  15. Brown AM, Clarke DE. Reducing Uncertainty in Triaging Mental Health Presentations: Examining Triage Decision-Making. International Emergency Nursing. 2014;22:47–51

    Article  Google Scholar 

  16. Bullard MJ, Unger B, Spence J, et al. Revisions to the Canadian Triage and Acuity Scale Adult Guidelines. Canadian Journal of Emergency Medicine. 2008;10:136–142.

    PubMed  Google Scholar 

  17. Triage Training Resources. Canadian Triage and Acuity Scale Combined Adult/Pediatric Educational Program: Participant’s Manual. Canadian Association of Emergency Physicians. Available online at http://caep.ca/sites/caep.ca/files/caep/participant_manual_v2.5b_november_2013_0.pdf. Accessed on July 17, 2017.

  18. Kolbasovsky A, Reich L, Futterman R, et al. Reducing the Number of Emergency Department Visits and Costs Associated with Anxiety: A Randomized Controlled Study. American Journal of Managed Care. 2007;13(2):95–102.

    PubMed  Google Scholar 

  19. Miley KL. Cardiac or Anxiety: A Literature Review of the Young Adult Patient Who Presents to the Emergency Department with Chest Pain. Journal of Emergency Nursing. 2016;42(2):108–113.

    Article  Google Scholar 

  20. Webster R, Thompson AR, Norman P, et al. The Acceptability and Feasibility of an Anxiety Reduction Intervention for Emergency Department Patients with Non-Cardiac Chest Pain. Psychology, Health, and Medicine. 2016;29:1–11.

    Google Scholar 

  21. Choi NG, DiNitto DM, Marti CN, et al. Associations of Mental Health and Substance Use Disorders with Presenting Problems and Outcomes in Older Adults’ Emergency Department Visits. Academic Emergency Medicine. 2015;22(11):1316–1326.

    Article  Google Scholar 

  22. Marra EM, Mazer-Amirshahi M, Brooks G, et al. Benzodiazepine Prescribing in Older Adults in U.S. Ambulatory Clinics and Emergency Departments (2001-2010). Journal of the American Geriatric Society. 2015;63(10):2074–2081.

    Article  Google Scholar 

  23. Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press, 2003.

    Google Scholar 

  24. Beasley GM, Ostbye T, Muhlbaier LH, et al. Age and Gender Differences in Substance Screening May Underestimate Injury Severity: A Study of 9,793 Patients at Level 1 Trauma Center from 2006 to 2010. Journal of Surgical Research. 2014;188(1):190–197.

    Article  Google Scholar 

  25. Substance Abuse and Mental Health Services Administration. Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville: Department of Health and Human Services, 2001.

    Book  Google Scholar 

  26. Donovan RA, West LM. Stress and Mental Health Moderating Role of the Strong Black Woman Stereotype. Journal of Black Psychology. 2015;41(4):384–396.

    Article  Google Scholar 

  27. Ham N. High Rates of Depression among African American Women, Low Rates of Treatment. The Huffington Post. Available online at http://www.huffingtonpost.com/nia-hamm/depression-african-american-women_b_5836320.html. Accessed on May 12, 2016.

  28. Baker TA, Buchanan NT, Mingo CA, et al. Reconceptualizing Successful Aging among Black Women and the Relevance of the Strong Black Woman Archetype. Gerontologist. 2015;55(1):51–57.

    Article  Google Scholar 

  29. Strothers HS 3rd, Rust G, Minor P, et al. Disparities in Antidepressant Treatment in Medicaid Elderly Diagnosed with Depression. Journal of American Geriatrics Society. 2005;53(3):456–461.

    Article  Google Scholar 

  30. Abreu JM. Conscious and Nonconscious African American Stereotypes: Impact on First Impression and Diagnostic Ratings by Therapists. Journal of Consulting and Clinical Psychiatry. 1999;67(3):387–393.

    Article  CAS  Google Scholar 

  31. Wu CH, Erickson SR, Piette JD, et al. Mental Health Resource Utilization and Health Care Costs Associated with Race and Comorbid Anxiety among Medicaid Enrollees with Major Depressive Disorder. Journal of the National Medical Association. 2012;104(1–2):78–88.

    Article  Google Scholar 

  32. Stockdale SE, Lagomasino IT, Siddique J, et al. Racial and Ethnic Disparities in Detection and Treatment of Depression and Anxiety among Psychiatric and Primary Health Care Visits, 1995-2005. Medical Care. 2008;46(7):668–677.

    Article  Google Scholar 

  33. Patel R, Biros MH, Moore J, et al. Gender Differences in Patient-Described Pain, Stress, and Anxiety among Patients Undergoing Treatment for Painful Conditions in the Emergency Department. Academic Emergency Medicine. 2014;21(12):1478–1484.

    Article  Google Scholar 

  34. Bekker MH, van Mens-Verhulst J. Anxiety Disorders: Sex Differences in Prevalence, Degree, and Background, but Gender-Neutral Treatment. Gender Medicine. 2007;4(Suppl B):S178–193.

    Article  Google Scholar 

  35. Grubbs KM, Cheney AM, Fortney JC, et al. The Role of Gender in Moderating Treatment Outcome in Collaborative Care for Anxiety. Psychiatric Services. 2015;66(3):265–271.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA

    Tyra Dark PhD, George Rust MD, Heather A. Flynn PhD, Heidi Kinsell PhD & Jeffrey S. Harman PhD

Authors
  1. Tyra Dark PhD
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  2. George Rust MD
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  3. Heather A. Flynn PhD
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  4. Heidi Kinsell PhD
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  5. Jeffrey S. Harman PhD
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Correspondence to Tyra Dark PhD.

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Dark, T., Rust, G., Flynn, H.A. et al. Sociodemographic Influences of Emergency Department Care for Anxiety Disorders. J Behav Health Serv Res 45, 593–604 (2018). https://doi.org/10.1007/s11414-018-9598-7

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  • DOI: https://doi.org/10.1007/s11414-018-9598-7

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