AHRQ Stats: Emergency Department Care for Mental and Substance Use Disorders

The rate of emergency department visits related to depression, anxiety or stress reactions increased 56 percent between 2006 and 2013. During the same period, visits related to psychoses or bipolar disorders increased 52 percent while visits related to substance use disorders increased 37 percent. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #216: Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006-2013.)

Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006-2013

Audrey J. Weiss, Ph.D., Marguerite L. Barrett, M.S., Kevin C. Heslin, Ph.D., and Carol Stocks, Ph.D., R.N.

Introduction

Mental illnesses are common in the United States. In 2014, there were an estimated 43.6 million adults aged 18 years or older in the United States with a mental, behavioral, or emotional disorder during the past year, representing 18.1 percent of all U.S. adults.¹Approximately one in eight visits to emergency departments (EDs) in the United States involves mental and substance use disorders (M/SUDs).² Between 2007 and 2011, the rate of ED visits related to M/SUDs increased by over 15 percent.³ ED visits involving M/SUDs are considered potentially avoidable—if these conditions were adequately managed through appropriate outpatient care, then ED visits should be rare.^4,5 These potentially preventable M/SUD-related ED visits also affect hospitals, because M/SUD-related ED visits are more than twice as likely to result in hospital admission compared with ED visits that do not involve M/SUDs.⁶

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents data on trends from 2006 to 2013 in the rate of ED visits involving the following categories of M/SUDs: substance use disorders (SUDs); depression, anxiety or stress reactions; and psychoses or bipolar disorders. These three categories are based on all-listed diagnoses. Analyses were limited to patients aged 15 years and older. Trends in ED visit rates per 100,000 population aged 15 years and older are presented for each type of M/SUD. Change in the rate of ED visits involving M/SUDs over the 7-year period 2006-2013 are presented by patient age, sex, community-level income, hospital region, and patient location of residence. Change in the distribution of ED visits involving M/SUDs between 2006 and 2013 by expected primary payer also is provided. Differences in estimates of 10 percent or greater are noted in the text.

Findings

Trends in M/SUD-related ED visits, 2006-2013
Figure 1 provides trends in the rate of ED visits involving SUDs; depression, anxiety or stress reactions; and psychoses or bipolar disorders per 100,000 population aged 15 years and older, from 2006 to 2013.

Highlights

The rate of emergency department (ED) visits per 100,000 population related to mental and substance use disorders (M/SUDs) increased substantially between 2006 and 2013. The increase over these 7 years was higher for mental disorders (55.5 percent for depression, anxiety or stress reactions and 52.0 percent for psychoses or bipolar disorders) than for substance use disorders (37.0 percent).

The most rapid increases in the population rate of ED visits involving M/SUDs from 2006 to 2013 by age and sex were as follows:
- SUDs: women aged 45-64 years (50.2 percent increase)
- Depression, anxiety, or stress reactions: men aged 45-64 years (64.5 percent increase)
- Psychoses or bipolar disorders: men and women aged 18-44 years (56.7 and 61.6 percent increase, respectively) and men aged 45-64 years (59.2 percent increase)

Between 2006 and 2013, increases in the population rate of ED visits involving M/SUDs were largest among those in the lowest income communities, with increases of 40.8 percent (SUDs) to 79.4 percent (depression, anxiety or stress reactions).