The Use of an Emergency Ward by Patients with Depressive or Anxiety Disorders: A One Year Follow-up Study

Abstract

Objective:

The present study examined patients during the year after the index hospitalization in an Emergency Ward (ED) to determine whether patients with depressive or anxiety disorders have a higher rate of readmission than patients without these conditions.

Method:

For this purpose, 165 subjects (85 diagnosed with DSM-IV depressive or anxiety disorders and 80 controls) were evaluated with the Hospital Anxiety and Depression Scale (HADS) and with the Duke Severity of Illness Scale both during the index hospitalization and one year later. Hospitalizations during the follow-up period were determined using the hospital database.

Results:

During the follow-up period, depressed and anxious patients were more frequently rehospitalized in ED wards than controls (p = 0.006), after controlling for the effect of medical illnesses severity, marital status, living arrangement, and employment status. No difference was found regarding the admissions to wards different from ED.

Conclusions:

Patients with depressive or anxiety disorders use the ED ward more frequently than controls for the diagnosis and treatment of somatic symptoms.

Keywords

depressive disorders anxiety disorders emergency department hospitalization

Get full access to this article

View all access options for this article.

References

Barsky

Wyshak

, and Klerman

. Medical and psychiatric determinants of outpatient medical utilization. Medical Care 1986; 24: 548–560.

Klerman

. Depressive disorders. Further evidence for increased medical morbidity and impairment of social functioning. Archives of General Psychiatry 1989; 46: 856–858.

House

. Psychiatric disorders, inappropriate health service utilization and the role of consultation-liaison psychiatry. Journal of Psychosomatic Research 1995; 39: 799–802.

Ballanger

. Panic disorder in the medical setting. Journal of Clinical Psychiatry 1997; 58(suppl 2):13–17.

Hankin

Steinwachs

Regier

. Use of general medical care services by persons with mental disorders. Archives of General Psychiatry 1982; 39: 225–231.

Mayou

Hawton

. Psychiatric disorders in the general hospital. British Journal of Psychiatry 1986; 149: 172–190.

Salkovskis

Storer

Atha

. Psychiatric morbidity in an accident and emergency department. Characteristics of patients at presentation and one month follow-up. British Journal of Psychiatry 1990; 156: 483–487.

Levenson

Hamer

Rossiter

. Relation of psychopathology in generalmedical inpatients to use and cost of services. American Journal of Psychiatry 1990; 147: 1498–1503.

Mayou

Hawton

Feldman

. Psychiatric problems among medical admissions. International Journal of Psychiatry in Medicine 1991; 21: 71–84.

10.

Saravay

Pollack

Steinberg

. Four-year follow-up of the influence of psychological comorbidity on medical rehospitalization. American Journal of Psychiatry 1996; 153: 397–403.

11.

Katon

Von Korff

Lin

Lipscomb

Russo

Wagner

Polk

. Distressed high utilizers of medical care DSM-III-R diagnoses and treatment needs. General Hospital of Psychiatry 1990; 12: 355–362.

12.

Davison

Hildrey

Floyer

. Use and misuse of an accident and emergency department in the East End of London. Journal of the Royal Society of Medicine 1983; 76: 37–40.

13.

Katerndahl

Realini

. Where do panic sufferers seek care? Journal of Family Practice 1995; 40: 237–243.

14.

Johnson

Weissman

Klerman

. Service utilization and social morbidity associated with depressive symptoms in the community. Journal of the American Medical Association 1992; 267: 1478–1483.

15.

Narrow

Regier

Rae

Manderscheid

Locke

. Use of services by persons with mental and addictive disorders. Findings from the National Institute of Mental Health Epidemiological Catchment Area Program. Archives of General Psychiatry 1993; 50: 95–107.

16.

Hirschfeld

RMA

. Panic disorder: Diagnosis, epidemiology, and clinical course. Journal of Clinical Psychiatry 1996; 57(Suppl 10): 3–8.

17.

Bonora

Conti

Piccinelli

. Mini International Neuropsychiatric Interview (MINI) Versione 4. Versione Italiana. In: Conti

, editor. Compendio di Psichiatria e Igiene Mentale. Firenze, SEE, 1995: 125–145.

18.

Sheehan

Lecrubier

Janavs

. Mini International Neuropsychiatric Interview (MINI) Release 4.4. University South Florida Institute of Research in Psychiatry, Tampa, Florida and Inserm U302, Hopital de la Salpétrière, Paris, France, 1994.

19.

American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders 4th Edition (DSM-IV). Washington, DC: APA Press Inc, 1994.

20.

Zigmond

Snaith

. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983; 67: 361–370.

21.

Parkerson

Broadhead

Chiu-Kit

. The Duke Severity of Illness (DUSOI) for measurement of severity and comorbidity. Journal of Clinical Epidemiology 1993; 46: 379–393.

22.

Borgquist

Hansson

Nettelbladt

Nordstrom

Lindelöw

. Perceived health and high consumers of care: A study of mental health problems in a Swedish primary health care district. Psychological Medicine 1993; 23: 763–770.

23.

Klein

Linn

Colin

Lang

Pollack

Lenox

. Anxiety disorders in a general emergency service in Israel. Psychiatric Services 1995; 46: 488–492.

24.

Katon

. Panic disorder: Relationship to high medical utilization, unexplained physical symptoms, and medical costs. Journal of Clinical Psychiatry 1996; 57(Suppl 10): 11–18.

25.

Reiss

Peterson

Gursky

McNally

. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behavioral Research Therapy 1986; 24: 1–8.

26.

Bridges

Goldberg

. Somatic presentation of DSM III psychiatric disorders in primary care. Journal of Psychosomatic Research 1985; 29: 563–569.

27.

Lloyd

. Psychiatric syndromes with a somatic presentation. Journal of Psychosomatic Research 1986; 30: 113–120.

28.

Parker

Taylor

. Relations between alexithymia, personality and affects. In: Taylor

Bagby

Parker

JDA

, editors. Disorder of affect regulation. Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press, 1997: 67–92.

29.

Tueth

. Managing recurrent nonischemic chest pain in the emergency department. American Journal of Emergency Medicine 1997; 15: 170–172.

30.

Leon

Portera

Weissman

. The social costs of anxiety disorders. British Journal of Psychiatry 1995; 166(Suppl 27): 19–22.

31.

Fisch

. Alexithymia, masked depression and loss in a holocaust survivor. British Journal of Psychiatry 1989; 154: 708–710.

32.

Parker

JDA

Bagby

Taylor

. Alexithymia and depression: Distinct or overlapping constructs? Comprehensive Psychiatry 1991; 32: 387–394.

33.

Katon

Kleinman

Rosen

. Depression and somatization: A review. Part I. American Journal of Medicine 1982; 72: 127–135.

34.

Katon

Kleinman

Rosen

. Depression and somatization: A review. Part II. American Journal of Medicine 1982; 72: 241–247.