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Reasons for Emergency Department Use among Patients with Mental Disorders

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Abstract

Disproportionate use of emergency departments (EDs) by patients with mental disorders suggests the need to evaluate factors associated with ED use. Based on the Andersen Behavioral model, this mixed-method study identified the contributions of predisposing, enabling and needs factors in ED use among 328 patients with mental disorders. We hypothesised that ED use for mental health (MH) reasons would be most strongly associated with need factors. The study was conducted in four EDs located in different territories of Quebec (Canada). ED teams assisted with patient recruitment. Participants completed a questionnaire including a qualitative component on reasons for using the ED and assessments of ED and MH services. Data were organised according to the Andersen model, and analysed thematically. ED users were generally single, with low socioeconomic status and inadequate knowledge of MH services (predisposing factors). Most had a regular source of care which facilitated ED referrals (enabling factors); although inadequate access to outpatient care contributed to ED use. Needs factors were the primary motivators in ED use among patients with mental disorders, especially self-rated importance of problems, and MH diagnoses including suicidal ideation/attempts, depression, anxiety, and substance use disorders. Results confirmed our hypothesis that ED visits were more strongly related to needs factors. The mixed methodology reinforced the importance of predisposing and enabling factors in ED use, particularly in more complex cases. Various strategies (e.g. shared care, recruitment of addiction liaison nurses for SUD screening) are suggested for improving access to other resources and reducing non-urgent ED use.

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Acknowledgments

This study was funded by the Fonds de la recherche en santé du Québec (FRSQ), grant number 3082. We thank the ED users who participated in this research. We are also grateful to Judith Sabetti for her assistance.

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Authors and Affiliations

  1. Department of Psychiatry, McGill University, Montreal, Quebec, Canada

    Marie-Josée Fleury

  2. Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada

    Marie-Josée Fleury & Guy Grenier

  3. Douglas Hospital Research Centre, 6875 LaSalle Blvd. Montreal, Quebec, H4H 1R3, Canada

    Marie-Josée Fleury

  4. Department of Health Administration, Policy and Evaluation, School of Public Health, University of Montreal, Montreal, Quebec, Canada

    Lambert Farand

  5. School of Social Work, Addiction Rehabilitation Center, National Capital University Integrated Health and Social Services Center, Laval University, Quebec City, Quebec, Canada

    Francine Ferland

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  1. Marie-Josée Fleury
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Correspondence to Marie-Josée Fleury.

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Fleury, MJ., Grenier, G., Farand, L. et al. Reasons for Emergency Department Use among Patients with Mental Disorders. Psychiatr Q 90, 703–716 (2019). https://doi.org/10.1007/s11126-019-09657-w

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