Physical and mental illnesses combined increase emergency department visits

People with both physical illnesses and mental disorders visit the emergency department more frequently than people with multiple physical illnesses or mental illness alone, according to a study in CMAJ (Canadian Medical Association Journal).

"Physical multimorbidity and mental disorders are associated with frequent visits to the emergency department," says author Mr. Marc Simard, Institut national de santé publique du Québec (INSPQ), Québec, Quebec. "When both are present, the sum of their impacts is greater than its parts. This potential synergy between physical multimorbidity and mental disorders significantly increases total impact on public health."

The large study looked at data on more than 5.3 million adults in Quebec, Canada, between 2012 and 2016. Researchers found that each additional physical illness in people with mental illness was associated with a larger increase in frequent visits to the emergency department compared to people without mental illness. Between people with 0 to 4 or more physical conditions, the absolute risk increased 16.2% for people with serious mental health disorders compared to people with common mental health issues (15.3%) or no disorders (11.4%).

The authors suggest that innovative health approaches such as using clinical case managers in emergency departments to connect patients to nonemergency care providers could improve the care such patients receive. Approaches to promote high-quality care for mental illness have the potential to prevent up to 6% of emergency visits in Quebec.

"The linked study used rigorous methodology to show and quantify what should be intuitive to those of us who routinely treat patients with comorbid psychiatric and medical conditions," writes Dr. Mark Sinyor, Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, with coauthors in a related commentary. "It contributes to a growing understanding of the interrelationship between mental and physical illness and suggests the need for a parallel synergy in the treatment strategy of these conditions, which is already beginning to occur."

"[T]he close interplay between mental and physical disorders strongly suggests that health care should ideally be provided via a collaborative approach in centres with expertise in both types of conditions," argue the commentary authors.

"Combined impacts of multimorbidity and mental disorders on frequent emergency department visits: a retrospective cohort study in Quebec, Canada" is published July 2, 2019.