Emergency department and early detection of adolescents and young adults at risk of developing mental disorders: an exploratory study

https://doi.org/10.4081/ripppo.2020.459

Authors

  • Marco Solmi | marco.solmi83@gmail.com Neurosciences Department, University of Padua; Padua Neuroscience Center, University of Padua; Padua University Hospital, Psychiatry Unit, Padua, Italy; Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
  • Foscarina Della Rocca Padua University Hospital, Emergency Department, Padua, Italy.
  • Vito Cianci Padua University Hospital, Emergency Department, Padua, Italy.
  • Alessandro Giacometti Padua University Hospital, Emergency Department, Padua, Italy.
  • Chiara Alexopulos Padua University Hospital, Emergency Department, Padua, Italy.
  • Umberto Granziol Neurosciences Department, University of Padua; Padua Neuroscience Center, University of Padua; Padua University Hospital, Psychiatry Unit, Padua, Italy; Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Padua University Hospital, Emergency Department, Padua; Department of General Psychology, University of Padua, Padova, Italy. https://orcid.org/0000-0002-6286-6569
  • Angela Favaro Neurosciences Department, University of Padua; Padua Neuroscience Center, University of Padua; Padua University Hospital, Psychiatry Unit, Padua, Italy. https://orcid.org/0000-0002-6540-5194
  • Paolo Fusar-Poli Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
  • Miranda Zoleo Padua University Hospital, Emergency Department, Padua, Italy.
  • Carla Cremonese Padua University Hospital, Psychiatry Unit, Padua, Italy. https://orcid.org/0000-0003-3775-022X

Abstract

The objective of this study is to assess the potential role of Emergency Department (ED) for early detection of mental disorders. Two cohorts (6,759 subjects aged 14 to 24 accessing ED, 165 subjects with mental disorders) were matched by ID and merged. Primary outcome was the proportion of individuals accessing ED before receiving a diagnosis of mental disorder in Mental Health Service (MHS). Secondary outcomes were age of first access to ED in subjects later accessing to MHS, and time from first ED access to receiving a diagnosis of mental disorder at MHS. We assessed whether gender, severity of ED presentation, and number of ED accesses predicted primary outcome. Almost half of individuals who later developed mental disorders (49.7%) accessed ED before access to MHS. Mean age of first ED contact among those later accessing to MHS was 17.34 (2.1), and ED access preceded access to MHS by 3.68 (2.11) years. Gender and severity of ED presentation were not associated with the access to MHS, while higher number of ED accesses was associated with later access to MHS (OR range: 1.17-1.36, p<0.05). Despite its limitations, the present study suggests ED might represent a contact point for individuals who later access to MHS. Future early detection programs should involve ED in their outreach and screening approaches. Additional studies are needed to assess if subjects earlier accessing to ED are at risk-of-developing or already suffer from a mental disorder, and to validate screening instruments specifically designed for ED.

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References

Berk M, Post R, Ratheesh A, et al. Staging in bipolar disorder: from theoretical framework to clinical utility. World Psychiatry. 2017;16(3):236-244. DOI: https://doi.org/10.1002/wps.20441

Millan MJ, Andrieux A, Bartzokis G, et al. Altering the course of schizophrenia: Progress and perspectives. Nat Rev Drug Discov. 2016;15(7):485-515. DOI: https://doi.org/10.1038/nrd.2016.28

de la Fuente-Tomas L, Sánchez-Autet M, García-Álvarez L, et al. Clinical staging in severe mental disorders; bipolar disorder, depression and schizophrenia. Rev Psiquiatr Salud Ment. 2019;12(2):106-115. DOI: https://doi.org/10.1016/j.rpsmen.2018.08.002

Cosci F, Fava GA. Staging of mental disorders: Systematic review. Psychother Psychosom. 2013;82(1):20-34. DOI: https://doi.org/10.1159/000342243

Tortella-Feliu M, Fullana MA, Pérez-Vigil A, et al. Risk factors for posttraumatic stress disorder: An umbrella review of systematic reviews and meta-analyses. Neurosci Biobehav Rev. 2019;107:154-165. DOI: https://doi.org/10.1016/j.neubiorev.2019.09.013

O’Brien JD. Current prevention concepts in child and adolescent psychiatry. Am J Psychother. 1991;45(2):261-268. DOI: https://doi.org/10.1176/appi.psychotherapy.1991.45.2.261

Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369(9569):1302-1313. DOI: https://doi.org/10.1016/S0140-6736(07)60368-7

Firth J, Siddiqi N, Koyanagi A, et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry. 2019. DOI: https://doi.org/10.1016/S2215-0366(19)30387-6

Patton GC, Sawyer SM, Santelli JS, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016;387(10036):2423-2478. DOI: https://doi.org/10.1016/S0140-6736(16)00579-1

Arango C, Díaz-Caneja CM, McGorry PD, et al. Preventive strategies for mental health. The Lancet Psychiatry. 2018;5(7):591-604. DOI: https://doi.org/10.1016/S2215-0366(18)30057-9

Fusar-Poli P, McGorry PD, Kane JM. Improving outcomes of first-episode psychosis: an overview. World Psychiatry. 2017;16(3):251-265. DOI: https://doi.org/10.1002/wps.20446

Conus P, Macneil C, Mcgorry PD. Public health significance of bipolar disorder: Implications for early intervention and prevention. Bipolar Disord. 2014;16(5):548-556. DOI: https://doi.org/10.1111/bdi.12137

Bauer M, Andreassen OA, Geddes JR, et al. Areas of uncertainties and unmet needs in bipolar disorders: clinical and research perspectives. The Lancet Psychiatry. 2018;5(11):930-939. DOI: https://doi.org/10.1016/S2215-0366(18)30253-0

Miller IW, Camargo CA, Arias SA, et al. Suicide prevention in an emergency department population: The ED-safe study. JAMA Psychiatry. 2017;74(6):563-570. DOI: https://doi.org/10.1001/jamapsychiatry.2017.0678

Boudreaux ED, Camargo CA, Arias SA, et al. Improving Suicide Risk Screening and Detection in the Emergency Department. Am J Prev Med. 2016;50(4):445-453. DOI: https://doi.org/10.1016/j.amepre.2015.09.029

Babeva K, Hughes JL, Asarnow J. Emergency Department Screening for Suicide and Mental Health Risk. Curr Psychiatry Rep. 2016;18(11):100. DOI: https://doi.org/10.1007/s11920-016-0738-6

Greenslade JH, Hawkins T, Parsonage W, Cullen L. Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms. Hear Lung Circ. 2017;26(12):1310-1316. DOI: https://doi.org/10.1016/j.hlc.2017.01.001

Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain. J Health Psychol. 2019;24(6):717-725. DOI: https://doi.org/10.1177/1359105316683785

Correll CU, Solmi M, Veronese N, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017;16(2). DOI: https://doi.org/10.1002/wps.20420

Barratt H, Rojas-García A, Clarke K, et al. Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis. Abe T, ed. PLoS One. 2016;11(4):e0154449. DOI: https://doi.org/10.1371/journal.pone.0154449

Moulin A, Evans EJ, Xing G, Melnikow J. Substance use, homelessness, mental illness and medicaid coverage: A set-up for high emergency department utilization. West J Emerg Med. 2018;19(6):902-906. DOI: https://doi.org/10.5811/westjem.2018.9.38954

Nager AL, Pham PK, Grajower DN, Gold JI. Mental Health Screening among Adolescents and Young Adults in the Emergency Department. Pediatr Emerg Care. 2017;33(1):5-9. DOI: https://doi.org/10.1097/PEC.0000000000000529

Canner JK, Giuliano K, Selvarajah S, Hammond ER, Schneider EB. Emergency department visits for attempted suicide and self harm in the USA: 2006-2013. Epidemiol Psychiatr Sci. 2018;27(1):94-102. DOI: https://doi.org/10.1017/S2045796016000871

Ting SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA. Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993-2008. Gen Hosp Psychiatry. 2012;34(5):557-565. DOI: https://doi.org/10.1016/j.genhosppsych.2012.03.020

Doshi A, Boudreaux ED, Wang N, Pelletier AJ, Camargo CA. National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001. Ann Emerg Med. 2005;46(4):369-375. DOI: https://doi.org/10.1016/j.annemergmed.2005.04.018

Olfson M, Gameroff MJ, Marcus SC, Greenberg T, Shaffer D. Emergency treatment of young people following deliberate self-harm. Arch Gen Psychiatry. 2005;62(10):1122-1128. DOI: https://doi.org/10.1001/archpsyc.62.10.1122

Ranney ML, Freeman JR, Connell G, et al. A Depression Prevention Intervention for Adolescents in the Emergency Department. J Adolesc Heal. 2016;59(4):401-410. DOI: https://doi.org/10.1016/j.jadohealth.2016.04.008

Ranney ML, Pittman SK, Dunsiger S, et al. Emergency department text messaging for adolescent violence and depression prevention: A pilot randomized controlled trial. Psychol Serv. 2018;15(4):419-428. DOI: https://doi.org/10.1037/ser0000193

Fusar-Poli P, Rutigliano G, Stahl D, et al. Development and Validation of a Clinically Based Risk Calculator for the Transdiagnostic Prediction of Psychosis. JAMA psychiatry. 2017;74(5):493-500. DOI: https://doi.org/10.1001/jamapsychiatry.2017.0284

Fusar-Poli P. Extending the benefits of indicated prevention to improve outcomes of first-episode psychosis. JAMA Psychiatry. 2017;74(7):667-668. DOI: https://doi.org/10.1001/jamapsychiatry.2017.1009

R Foundation for Statistical Computing, Vienna AU https://www. R org/. R Core Team (2019). R: A language and environment for statistical computing.

Bertolote J, McGorry P. Early intervention and recovery for young people with early psychosis: Consensus statement. In: British Journal of Psychiatry. Vol 187. ; 2005:s116-9. DOI: https://doi.org/10.1192/bjp.187.48.s116

Cotter J, Zabel E, French P, Yung AR. Prolonged duration of untreated psychosis: a problem that needs addressing. Early Interv Psychiatry. 2017;11(3):263-268. DOI: https://doi.org/10.1111/eip.12308

Minichino A, Rutigliano G, Merlino S, et al. Unmet needs in patients with brief psychotic disorders: Too ill for clinical high risk services and not ill enough for first episode services. Eur Psychiatry. 2019;57:26-32. DOI: https://doi.org/10.1016/j.eurpsy.2018.12.006

Rutigliano G, Merlino S, Minichino A, et al. Long term outcomes of acute and transient psychotic disorders: The missed opportunity of preventive interventions. Eur Psychiatry. 2018;52:126-133. DOI: https://doi.org/10.1016/j.eurpsy.2018.05.004

Anderson KK, Fuhrer R, Wynant W, Abrahamowicz M, Buckeridge DL, Malla A. Patterns of health services use prior to a first diagnosis of psychosis: The importance of primary care. Soc Psychiatry Psychiatr Epidemiol. 2013;48(9):1389-1398. DOI: https://doi.org/10.1007/s00127-013-0665-3

Anderson KK, Fuhrer R, Malla AK. The pathways to mental health care of first-episode psychosis patients: A systematic review. Psychol Med. 2010;40(10):1585-1597. DOI: https://doi.org/10.1017/S0033291710000371

Penttilä M, Jaä̈skel̈ainen E, Hirvonen N, Isohanni M, Miettunen J. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: Systematic review and meta-analysis. Br J Psychiatry. 2014;205(2):88-94. DOI: https://doi.org/10.1192/bjp.bp.113.127753

Correll CU, Galling B, Pawar A, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: A systematic review, meta-analysis, and meta-regression. JAMA Psychiatry. 2018;75(6):555-565. DOI: https://doi.org/10.1001/jamapsychiatry.2018.0623

Fusar-Poli P. The Clinical High-Risk State for Psychosis (CHR-P), Version II. Schizophr Bull. 2017;43(1):44-47. DOI: https://doi.org/10.1093/schbul/sbw158

Oliver D, Davies C, Crossland G, et al. Can We Reduce the Duration of Untreated Psychosis? A Systematic Review and Meta-Analysis of Controlled Interventional Studies. Schizophr Bull. 2018;44(6):1362-1372. DOI: https://doi.org/10.1093/schbul/sbx166

Fusar-Poli P, Díaz-Caneja CM, Patel R, et al. Services for people at high risk improve outcomes in patients with first episode psychosis. Acta Psychiatr Scand. 2016;133(1):76-85. DOI: https://doi.org/10.1111/acps.12480

Cheung D, Roper L, Purdon SE. Pathways to (specialized) care: Patient costs and contacts en route to a first-episode psychosis clinic. Early Interv Psychiatry. 2014;8(4):375-381. DOI: https://doi.org/10.1111/eip.12093

van Os J, Guloksuz S. A critique of the “ultra-high risk” and “transition” paradigm. World Psychiatry. 2017;16(2):200-206. DOI: https://doi.org/10.1002/wps.20423

Fusar-Poli P, Sullivan SA, Shah JL, Uhlhaas PJ. Improving the Detection of Individuals at Clinical Risk for Psychosis in the Community, Primary and Secondary Care: An Integrated Evidence-Based Approach. Front psychiatry. 2019;10:774. DOI: https://doi.org/10.3389/fpsyt.2019.00774

Fusar-Poli P, Schultze-Lutter F, Cappucciati M, et al. The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophr Bull. 2016;42(3):732-743. DOI: https://doi.org/10.1093/schbul/sbv162

Yung AR, Yung AR, Pan Yuen H, et al. Mapping the Onset of Psychosis: The Comprehensive Assessment of At-Risk Mental States. Aust New Zeal J Psychiatry. 2005;39(11-12):964-971. DOI: https://doi.org/10.1080/j.1440-1614.2005.01714.x

Pelizza L, Azzali S, Paterlini F, et al. Screening for psychosis risk among help-seeking adolescents: Application of the Italian version of the 16-item prodromal questionnaire (iPQ-16) in child and adolescent neuropsychiatry services. Early Interv Psychiatry. 2019;13(4):752-760. DOI: https://doi.org/10.1111/eip.12554

Fusar-Poli P, Solmi M, Brondino N, et al. Transdiagnostic psychiatry: a systematic review. World Psychiatry. 2019;18(2):192-207. DOI: https://doi.org/10.1002/wps.20631

Downey LVA, Zun LS. Identifying Undiagnosed Pediatric Mental Illness in the Emergency Department. Pediatr Emerg Care. 2018;34(2):e21-e23. DOI: https://doi.org/10.1097/PEC.0000000000001151

Kular A, Perry BI, Brown L, et al. Stigma and access to care in first-episode psychosis. Early Interv Psychiatry. 2019;13(5):1208-1213. DOI: https://doi.org/10.1111/eip.12756

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Published
2020-09-18
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Keywords:
Mental disorders, early detection, prevention, emergency department, prediction, adolescent psychiatry, pathway to care
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How to Cite
Solmi, M., Della Rocca, F., Cianci, V., Giacometti, A., Alexopulos, C., Granziol, U., Favaro, A., Fusar-Poli, P., Zoleo, M., & Cremonese, C. (2020). Emergency department and early detection of adolescents and young adults at risk of developing mental disorders: an exploratory study. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(2). https://doi.org/10.4081/ripppo.2020.459