Psychological distress and emergency department utilization in the United States: evidence from the Medical Expenditure Panel Survey.
OBJECTIVE
Psychological distress not only has substantial health and social consequences, but is also associated with emergency department (ED) use. Previous studies have typically used cross-sectional data to focus on the relation between serious psychological distress and dichotomized ED utilization measures, without assessing the volume of ED use or examining nonserious levels of psychological distress. The objective of this study was to explore the association between ED utilization volume and the full spectrum of psychological distress.


METHODS
Data from Panel 14 of the Medical Expenditure Panel Survey (MEPS; 2009-2010, n = 9,743) provided a nationally representative sample of U.S. individuals. ED utilization volume and three specifications of the Kessler Psychological Distress Scale (K6) were analyzed: a dichotomous serious/no serious psychological distress measure, a five-category ordinal measure, and a scale measure with a range of 0 to 24. Negative binomial-logit hurdle regression models were used to analyze how the different specifications of the K6 psychological distress measure were related to ED use.


RESULTS
Adults with serious psychological distress in 2009 had 1.59 (95% confidence interval [CI] = 1.15 to 2.20) times greater adjusted odds of having one or more ED visits in 2010 than those without serious psychological distress. Nonserious psychological distress levels in 2009 were also associated with increased adjusted odds of having at least one ED visit in 2010. The K6 scores showed a dose-response relationship in terms of the adjusted odds of having one or more ED visits. The adjusted odds ratios (ORs) were 1.86 (95% CI = 1.37 to 2.54) for adults with K6 scores at or above 11, OR 1.76 (95% CI = 1.38 to 2.25) for adults with K6 scores between 6 and 10, OR 1.33 (95% CI = 1.05 to 1.68) for adults with K6 scores between 3 and 5, and OR 1.17 (95% CI = 0.92 to 1.48) for adults with K6 scores of 1 or 2. In addition, the adjusted odds of having one or more ED visits in 2010 significantly increased with increasing psychological distress in 2009 (OR = 1.04, 95% CI = 1.03 to 1.06). Each additional point added to the K6 scale results in an increase in the adjusted odds of an ED visit.


CONCLUSIONS
Even a low level of psychological distress, and not just serious psychological distress, may be an early indicator of future ED use. These results highlight the need to develop novel responses to better manage or avert ED use not only for adults with serious psychological distress but also for those who are experiencing even mild symptoms of psychological distress.
The School of Public Health, Department of Health Management and Policy, University of North Texas Health Science Center, Fort Worth, TX; The Analytic Services Department, Magellan Health Services Maryland Heights, MO.
Erica L
EL
Stockbridge
Fernando A
FA
Wilson
José A
JA
Pagán
D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000191:economics / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult