Identifying Variability in Patient Characteristics and Prevalence of Emergency Department Utilization for Mental Health Diagnoses in Rural and Urban Communities

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In order to redirect at-risk patients to more appropriate, cost-effective behavioral health care, research must identify the prevalence, and common characteristics, of patients presenting to the emergency department (ED) for mental disorders. Question: Are large, small, and/or isolated rural patients presenting to the ED for mental disorders in greater proportion than urban ED patients?


Analyses included data from the Health Care Cost and Utilization Project State Emergency Department Databases (2013) provided by 7 states, covering all Census regions. Variables included patient demographics, ZIP code, and primary and secondary ED diagnoses. ZIP codes were linked to the Rural-Urban Commuting Areas, aggregating into 4 categories. Prevalence rates were compared within and between groups (P < .05).


Nearly 1 in 20 ED visits carried a primary/secondary diagnosis of mental disorder. Large, small, and isolated rural patients were not more likely than urban patients to present to the ED for mental disorders. Large, small, and isolated rural residents diagnosed with a primary/secondary mental disorder in the ED were more likely than urban to be female, 65 years of age or older, covered by Medicaid or Medicare, and dual eligible. The top 3 diagnoses for mental disorders in the ED were anxiety-state, unspecified; depressive disorder; and suicidal ideation.


EDs treating large, small, or isolated rural patients with mental disorders are more likely to treat populations identified in the literature at greater risk of preventable visits, readmitting, and more costly care. Recommendations are made for policy, community interventions, workforce, and training.

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