Predictors of Psychiatric Emergency Department Visits Following Inpatient Discharge: Secondary Analysis of a Stepped-Wedge Cluster Randomized Trial.

Background: The period following discharge from psychiatric inpatient care represents a critical transition phase marked by heightened vulnerability to relapse, including increased risks of emergency department (ED) utilization. Understanding the risk factors for ED utilization after hospital discharge will help identify individuals who should be targeted for enhanced follow up care in the community. Objective: This study aimed to examine the sociodemographic and clinical factors associated with psychiatric ED utilization within six months of discharge from inpatient psychiatric care among individuals assigned to different postdischarge interventions. The goal is to identify high-risk groups to inform targeted follow up strategies and enhance transitional care planning. Methods: This study analyzed secondary data from a pragmatic stepped-wedge cluster-randomized trial which recruited patients across ten health care sites in Alberta, Canada, from March 2022 to February 2024. For the primary study, a total of 1098 psychiatric inpatients were allocated to one of three post-discharge conditions: treatment as usual (TAU), SMS, or SMS plus peer support (SMS+ PS). Sociodemographic and clinical data were collected at discharge. ED visits 6-months postdischarge were recorded. χ2 tests identified variables associated with ED utilization. Significant predictors were entered into a logistic regression model to determine adjusted odds ratios (ORs) and 95% CIs. Results: Of the 1098 participants, demographic and clinical variables were examined for association with mental health ED visits at 6-months post discharge. Univariate analysis identified six significant predictors: age, ethnicity, relationship status, employment, housing status, and prior ED use. Logistic regression analysis identified several predictors of mental health ED visits 6-months postdischarge. Compared to participants under 25 years, those aged 26-40 was less likely to revisit the ED (OR 0.66, 95% CI 0.46-0.95), as were those over 40 years (OR 0.58, 95% CI 0.37-0.92). Individuals identifying as mixed or other ethnicity were less likely than White people to return to the ED (OR 0.52, 95% CI 0.28-0.96). Unemployed participants had higher odds of ED use than those employed (OR 1.66, 95% CI 1.18-2.34). Prior ED attendance was the strongest predictor (OR 2.45, 95% CI 1.03-5.80). Housing status showed varied but nonsignificant effects. Conclusions: This study highlights key demographic and clinical factors influencing psychiatric ED use following inpatient discharge. The findings emphasize the importance of targeted transitional care interventions, particularly for high-risk groups such as younger, unemployed, and previously ED-utilizing individuals, and support the integration of scalable approaches like SMS and peer support into discharge planning.