Who's getting care? Acute treatment utilization following an emergency department visit among adults with major psychiatric disorders and suicidal thoughts and behaviors.

introductionPeople with major psychiatric disorders (e.g., major depressive disorder [MDD], bipolar disorder [BD], and schizophrenia-spectrum disorders [SSD]) utilize acute treatment at high rates, while struggling to engage in outpatient care. There is limited longitudinal research on differences in treatment utilization among people with different psychiatric diagnoses and concurrent suicidal thoughts and/or behaviors (STBs). The current study aimed to examine patterns of and factors associated with treatment utilization (outpatient treatment, psychiatric inpatient hospitalization, emergency department [ED visit]) among individuals with major psychiatric disorders and STBs presenting to the ED.

methodsAdults with MDD (n = 347), BD (n = 298), and SSD (n = 100) and active STBs were recruited from eight EDs across the United States as part of a larger study on treatment for STBs. Chart reviews and participant assessments were conducted during the 52-weeks following participant ED discharge.

resultsParticipants with BD and SSD had higher rates of, and shorter time to, inpatient hospitalization and ED visit over follow-up than people with MDD. There were no differences in rates of outpatient treatment between diagnostic groups. Lack of employment and outpatient mental health treatment utilization were associated with inpatient hospitalization over follow-up. Lack of employment, a substance use disorder, and chronic pain were associated with ED visit over follow-up.

conclusionsResults show that treatment utilization differs by major psychiatric diagnosis. These findings suggest that people with BD and SSD may benefit from additional supports, including vocational services, during and following ED visits to minimize future acute treatment utilization.