Prevalence of psychiatric diagnoses among frequent users of rural emergency medical services.

OBJECTIVE: This study aimed to determine whether there was an increased prevalence of psychiatric disorders among frequent users of rural emergency medical services.

METHODS: In a matched comparison design, I compared frequent users of the emergency departments of 2 rural hospitals, both affiliated with an academic centre, with randomly selected users and with randomly selected users who had the same medical diagnoses. The main outcome measures were psychiatric diagnoses on a structured clinical interview, along with medical diagnoses and number of emergency department visits in the past year.

RESULTS: Ninety-three percent of frequent users had at least 1 DSM-IV psychiatric diagnosis, differing from 50% of random users matched for presenting complaint. A random user group, not matched for presenting complaint, showed 28% prevalence of DSM-IV diagnoses. Frequent users were more often state insured (Medicaid) and less often insured privately. The most common diagnoses among frequent users were major depression, generalized anxiety disorder, adjustment disorder, somatoform pain disorder, substance abuse and dependence, and dysthymia. The treating emergency department physician mentioned a psychiatric diagnosis for only 9% of frequent users.

CONCLUSION: Frequent users have a disproportionately high prevalence of psychiatric disorders (under-documented by their physicians), which may affect their pattern of emergency department use. This suggests the need for better recognition, diversion, and management.