Do patients coming in to the emergency department for minor injury display psychiatric comorbidities?

Research Abstract with Commentary

Abstract: Psychiatric disorders in patients presenting to the Emergency Department for minor injury

BACKGROUND: Thirty-five percent of all Emergency Department (ED) visits are for physical injury.
OBJECTIVES: To examine the proportion of patients presenting to an ED for physical injury with a history of or current Axis I/II psychiatric disorders and to compare patients with a positive psychiatric history, a negative psychiatric history, and a current psychiatric disorder. METHODS: A total of 275 individuals were selected randomly from adults presenting to the ED with a documented anatomic injury but with normal physiology. Exclusion criteria were: injury in the previous 2 years or from medical illness or domestic violence; or reported treatment for major depression or psychoses. Psychiatric history and current disorders were diagnosed using the Structured Clinical Interview for the Diagnostic and Statistical Manual Disorders, 4th edition (DSM-IV), a structured psychiatric interview. Three groups (positive psychiatric history, negative psychiatric history, current psychiatric disorder) were compared using Chi-square and analysis of variance.
RESULTS: The sample was composed of men (51.6%) and women (48.4%), with 57.1% Black and 39.6% White. Out of this sample, 103 patients (44.7%) met DSM-IV criteria for a positive psychiatric history (n = 80) or a current psychiatric disorder (n = 43). A past history of depression (24%) exceeded the frequency of a history of other disorders (anxiety, 6%; alcohol use/abuse, 14%; drug use/abuse, 15%; adjustment, 23%; conduct disorders, 14%). Current mood disorders (47%) also exceeded other current diagnoses (anxiety, 9%; alcohol, 16%; drug, 7%; adjustment, 7%; personality disorders, 12%). Those with a current diagnosis were more likely to be unemployed (p <.001) at the time of injury. CONCLUSIONS: Psychiatric comorbid disorders or a positive psychiatric history was found frequently in individuals with minor injury. An unplanned contact with the healthcare system (specifically an ED) for treatment of physical injury offers an opportunity for nurses to identify patients with psychiatric morbidity and to refer patients for appropriate therapy. Richmond, T.S., Hollander, J.E., Ackerson, T.H., Robinson, K., Gracias, V., Shults, J., Amsterdam, J. (2007). Psychiatric disorders in patients presenting to the Emergency Department for minor injury. Nursing Research, 56, 275-82.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

The framework for the study – which is not described in the abstract – indicates that when psychiatric disorders occur along with traumatic injury, the potential for disability is substantial. What is remarkable about the findings of this descriptive study is the high numbers of patients with psychiatric conditions, despite the fact that those with major depression and psychoses were excluded. Also impressive is the fact that persons with the fewest resources available to them (those with lower levels of education, the unemployed) were the most likely to have comorbid psychiatric disorders.

Do these patients resemble those seen in the SJH ED for minor injury? Maybe not… there were 57% black patients, which does not reflect an Orange County population. However, the other demographic variables may be more in line with our patients.

What the study did not do was ask what resulted from knowledge of the psychiatric disorder in terms of referrals, or work up in the ED. These aims were beyond the purpose of this study, but are important to consider in thinking about the implications of these findings for SJH nurses. I believe this study points to the potential screening/referral role of nurses in the ED for multiple conditions, such as those described in this article (psychiatric disorders).