Almost half of incident psychiatric ED visits are first-contact visits

First-contact visits comprised approximately half of incident psychiatric ED visits, according to results of a cohort study published in JAMA Network Open.

Better access to outpatient mental health and addiction services may have made this avoidable, researchers noted.

“In previous studies, more than half of children and youth had no prior contact with outpatient mental health services in the 2 years prior to their first psychiatric ED visit, and for women postpartum, the rate of first contact was as high as 60%,” Paul Kurdyak, MD, PhD, of the department of psychiatry at the University of Toronto in Canada, and colleagues wrote. “Whether high rates of first contact in the ED are the norm in general adult populations is largely unknown.”

The investigators aimed to assess how often EDs served as a first point of contact for adults’ mental health care, as well as to identify significant factors linked to this outcome. They conducted the current study in Ontario, Canada, between 2010 and 2018 by analyzing health care administrative data of all individuals aged 16 years or older with an incident psychiatric ED visit (n = 659,084). A total of 298,924 participants had the incident ED visit as a first contact. No outpatient mental health or addictions contact during the 2 years before the incident ED visit served as the primary outcome. The researchers also assessed the association between so-called first-contact ED visits and predisposing factors, including age, sex immigrant status and comorbidity; enabling factors, including neighborhood income, rurality and continuity of primary care; and need factors, including diagnosis from incident ED visit.

Results showed older individuals aged 65 to 84 years compared with individuals aged 16 to 24 years were more likely to have first-contact ED visits (adjusted OR = 1.13; 95% CI, 1.12-1.14), as were men (aOR = 1.14; 95% CI, 1.13-1.15), immigrants (aOR = 1.2; 95% CI, 1.18-1.21), rural residents (aOR = 1.21; 95% CI, 1.2-1.21) and those with minimal primary care (aOR = 1.68; 95% CI, 1.67-1.69). Kurdyak and colleagues reported a higher likelihood of first-contact ED visits for all diagnoses than mood disorders, especially for substance and alcohol use disorder (aOR = 1.66; 95% CI, 1.65-1.68).

“The ED is a reasonable resource of last resort, particularly in cases with high acuity or concerns for safety,” the researchers wrote. “Our findings suggest that the ED is being used as a replacement for outpatient services that could be accessed in a more timely fashion. In other words, a substantial proportion of the first-contact ED visits in our study appear to be avoidable. The factors associated with first-contact ED visits indicate that efforts to avoid the ED as a site of first contact require outpatient services to become more accessible.”