Trends in U.S. Emergency Department Visits for Anxiety-Related Mental Health Conditions, 1992-2001
J Clin Psychiatry 2008;69(2):286-294
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To describe trends in anxiety-related mental health
visits to U.S. emergency departments, an expanding portal of access for mental
Method: Data from 1992 through 2001 were obtained from the
National Hospital Ambulatory Medical Care Survey using mental health-related
ICD-9-CM, E- and V-codes as well as National Center for Health
Statistics--assigned Patient Reason-for-Visit classification codes.
Population-weighted anxiety-related emergency department visit rates were
analyzed over time by age, gender, race, Hispanic ethnicity, insurance status,
urban status, region of the country, urgency of presentation, and use of
Results: There were 53 million mental health-related visits,
increasing from 4.9% to 6.3% of all emergency department visits (p = .003) and
from 17.1 to 23.6 per 1000 U.S. population across the decade (p = .000).
Anxiety-related visits were common (16% of all mental health visits) and
increased significantly from 3.5 to 5.0 visits per 1000 U.S. population over
the decade (p = .011). Anxiety-related visits increased significantly among
non-Hispanic whites, children (< 15 years), adults younger than 49 years, and
the privately insured; changes among Medicare, Medicaid, and self-pay patients
were not significant. Overall hospitalization rates declined from 23% to 21%
between 1992 and 2001 (p = .037), but they did not change significantly for
anxiety-related visits (8%), which remained the least likely visit type to be
admitted of all mental health visits for the entire decade. In contrast to
rural emergency departments, urban emergency departments witnessed significant
increases in anxiety-related visits, rising from 2.9 to 5.2 per 1000 U.S.
population across the decade (p trend = 0.007). Regionally, anxiety-related
visits were highest in the Northeast, lowest in the West, and increased
significantly in only the South and Northeast.
Conclusion: During the decade, there was an expansion of
anxiety-related visits to U.S. emergency departments, reflecting an increase in
anxiety-related emergency department care-seeking, an increase in anxiety
awareness among patients and practitioners, or both.