• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Patient-Physician Relationship/ Care  • Psychosocial Issues  • Psychiatry  • Suicide  • Psychiatry, Other  • Violence and Human Rights  • Violence and Human Rights, Other  • Emergency Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

Mark Olfson, MD, MPH; Steven C. Marcus, PhD; Jeffrey A. Bridge, PhD

Arch Gen Psychiatry. 2012;69(1):80-88. doi:10.1001/archgenpsychiatry.2011.108

Context  Although concern exists over the quality of emergency mental health services, little is known about the mental health care of adults who are admitted to emergency departments for deliberately harming themselves and then discharged to the community.

Objective  To describe the predictors of emergency department discharge, the emergency mental health assessments, and the follow-up outpatient mental health care of adult Medicaid beneficiaries treated for deliberate self-harm.

Design  A retrospective longitudinal cohort analysis.

Setting  National Medicaid claims data supplemented with county-level sociodemographic variables and Medicaid state policy survey data.

Participants  Adults aged 21 to 64 years who were treated in emergency departments for 7355 episodes of deliberate self-harm, focusing on those who were discharged to the community (4595 episodes).

Main Outcome Measures  Rates and adjusted risk ratios (ARRs) of discharge to the community, mental health assessments in the emergency department, and outpatient mental health visits during the 30 days following the emergency department visit.

Results  Most patients (62.5%) were discharged to the community. Emergency department discharge was directly related to younger patient age (21-31 years vs 45-64 years) (ARR, 1.18 [99% confidence interval {CI}, 1.10-1.25]) and self-harm by cutting (ARR, 1.18 [99% CI, 1.12-1.24]) and inversely related to poisoning (ARR, 0.84 [99% CI, 0.80-0.89]) and recent psychiatric hospitalization (ARR, 0.74 [99% CI, 0.67-0.81]). Approximately one-half of discharged patients (47.5%) received a mental health assessment in the emergency department, and a similar percentage of discharged patients (52.4%) received a follow-up outpatient mental health visit within 30 days. Follow-up mental health care was directly related to recent outpatient mental health care (ARR, 2.30 [99% CI, 2.11-2.50]) and treatment in a state with Medicaid coverage of mental health clinic services (ARR, 1.13 [99% CI, 1.05-1.22]) and inversely related to African American (ARR, 0.86 [99% CI, 0.75-0.96]) and Hispanic (ARR, 0.86 [99% CI, 0.75-0.99]) race/ethnicity.

Conclusion  Most adult Medicaid beneficiaries who present for emergency care for deliberate self-harm are discharged to the community, and many do not receive emergency mental health assessments or follow-up outpatient mental health care.

Author Affiliations: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York (Dr Olfson); Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and School of Social Policy and Practice, University of Pennsylvania (Dr Marcus); and The Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, and Department of Pediatrics, The Ohio State University, Columbus (Dr Bridge).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Emergency Treatment of Self-Injurious Behavior: Are We Doing Our Best?
JWatch Psychiatry 2012;2012:1-1.
FULL TEXT