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Digital screening tool could help hospitals detect mental health problems often missed in patients who come to the emergency room with physical complaints – ScienceDaily


A new study by Indiana University researchers found that about 45% of patients who go to the emergency room for physical injuries and illnesses also have mental health and substance use problems that are often overlooked. Patients who reported high levels of suicidal thoughts and plans were also found to have more frequent emergency room visits.

That’s why IU researchers, expanding on previous research, used a computer-based adaptive test to screen for mental health and substance use problems in patients with nonpsychiatric complaints to see if emergency room visits are an important opportunity to screen for mental health problems. health.

With findings recently published in Journal of the American College of Emergency Physicians, is the largest study using multidomain mental health screening of nonpsychiatric patients in the emergency department. The test, known as the Computerized Adaptive Mental Health Test, adjusts questions based on respondents’ answers.

“The results of our study are really important for health care companies and health economists,” said Brian D’Onofrio, the study’s principal investigator and a professor of psychology and brain sciences in IU Bloomington’s College of Arts and Sciences. ‚ÄúPeople who keep coming back to the emergency room are high-risk patients. That’s where screening can be very helpful in identifying people at high risk — suicidal, depression, anxiety, post-traumatic stress or substance use problems — and getting them the care they need.”

Along with follow-up, mental health screenings can also reduce the need for future visits, reducing the burden on emergency rooms, he said.

For the study, researchers asked randomly selected patients in an Indianapolis emergency room to complete a computer-based adaptive test that tests for five conditions: depression, anxiety, post-traumatic stress disorder, suicidality and substance use disorders. The purpose of the study was to understand the prevalence of these problems through a screening process that is robust in large urban emergency departments where physicians have competing and pressing interests.

The study found that of 794 patients, 24.1% had moderate to severe risk of suicidality, 8.3% had depression, 16.5% had anxiety, 12.3% had PTSD, and 20.4% had substance use disorders. substances. It also found that people who visited the emergency room twice or more in the previous year were 62% more likely to be in the medium-high risk category for suicide compared to those who had never visited. Individuals classified as moderate-to-high risk for suicide were 63% more likely to return to the emergency department within 30 days of their emergency department visit compared to those classified as low risk.

Past research has also shown that many patients who end their lives by suicide often visit the emergency room or the health care system for non-psychiatric reasons shortly before the suicide attempt.

The results of the study suggest that computer-based adaptive testing may be a viable option for rapidly screening a large group of patients in the emergency department for their mental health, as it provides results consistent with standard screening tests. It’s also faster than other screening methods, making it more practical for use in busy environments, said IU Ph.D. student Lauren O’Reilly, a researcher in D’Onofrio’s lab whose current research focuses on suicidality.

The researchers then said that more work is needed to understand the implications of this study, such as how emergency departments can integrate screening into their routines and overcome barriers to mental health care both in and out of the emergency department.

“If emergency departments do screen, it’s critical that after the screen, steps are taken to ensure appropriate care, such as intervention, safety planning, or communication with providers,” O’Reilly said. “This is a particularly serious problem given the global shortage of mental health services.”

The study also opens new perspectives for improving the quality of care in emergency departments in general.

“My hope is that these results will inform discussion, intervention, and linking of emergency department patients to appropriate care,” said Paul Moussi, the study’s senior author and assistant professor of emergency medicine at the IU School of Medicine. “The emergency room is the right place for someone in crisis. I believe that we have an obligation to not only stabilize and treat patients in crisis, but also to make sure we do everything we can to get them the resources they need to avoid crises in the future.”

This research was supported by an IU Responding to the Addictions Crisis Grand Challenge grant.

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