title: National differences between ED and ambulatory visits for suicidal ideation and attempts and depression.
abstract: BACKGROUND
  Many suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high.
  
  
  OBJECTIVE
  The primary objective of the study is to determine a relationship between the incidence of suicidal and depressed patients presenting to EDs and the incidence of depressed patients presenting to outpatient clinics. The secondary objective is to analyze trends among suicidal patients.
  
  
  METHODS
  The National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey were screened to provide a sampling of ED and outpatient visits, respectively. Suicidal and depressed patients presenting to EDs were compared with depressed patients presenting to outpatient clinics. Subgroup analyses included age, sex, race/ethnicity, method of payment, regional variation, and urban verses rural distribution.
  
  
  RESULTS
  Emergency department visits for depression (1.16% of visits in 2002) and suicide attempts (0.51% of visits in 2002) remained stable over the years. Office visits for depression decreased from 3.14% of visits in 2002 to 2.65% of visits in 2008. Non-Latino whites had a higher percentage of ED visits for depression and suicide attempt and office visits for depression than other groups. The percentage of ED visits for suicide attempt resulting in hospital admission decreased by 2.06% per year.
  
  
  CONCLUSIONS
  From 2002 to 2008, the percentage of outpatient visits for depression decreased, whereas ED visits for depression and suicide remained stable. When examined in the context of a decreasing prevalence of depression among adults, we conclude that an increasing percentage of the total patients with depression are being evaluated in the ED, vs outpatient clinics.
authors.affiliation: Department of Emergency Medicine, Center for Trauma and Injury Prevention Research, School of Medicine, University of California-Irvine, Orange, CA 92868. Electronic address: bchakrav@uci.edu.
authors.forename: Bharath
authors.initials: B
authors.lastname: Chakravarthy
authors.affiliation: Department of Emergency Medicine, Center for Trauma and Injury Prevention Research, School of Medicine, University of California-Irvine, Orange, CA 92868.
authors.forename: Shannon
authors.initials: S
authors.lastname: Toohey
authors.affiliation: Department of Emergency Medicine, Center for Trauma and Injury Prevention Research, School of Medicine, University of California-Irvine, Orange, CA 92868.
authors.forename: Yalda
authors.initials: Y
authors.lastname: Rezaimehr
authors.affiliation: Department of Emergency Medicine, Center for Trauma and Injury Prevention Research, School of Medicine, University of California-Irvine, Orange, CA 92868.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, Center for Trauma and Injury Prevention Research, School of Medicine, University of California-Irvine, Orange, CA 92868.
authors.forename: Wirachin
authors.initials: W
authors.lastname: Hoonpongsimanont
authors.affiliation: Keck School of Medicine, Department of Emergency Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Menchine
authors.affiliation: Department of Emergency Medicine, Center for Trauma and Injury Prevention Research, School of Medicine, University of California-Irvine, Orange, CA 92868.
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfipour
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology