Fulbrook P, Lawrence P
School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, QLD, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
J Psychiatr Ment Health Nurs. 2015 Feb;22(1):30-8. doi: 10.1111/jpm.12191. Epub 2014 Dec 18.
Compared to the general population, people with mental health disorders have an increased risk of morbidity and mortality, and are associated with higher health-care costs and lost societal productivity. Evidence indicates that more people are presenting to emergency departments with mental health disorders and that this group represents a disproportionately large number of emergency department attendees. The study results indicate that around a third of people who attended the emergency department may have had a mental health disorder, which is more than that found in the general adult Australian population. The results also suggest that the majority of emergency department attendees that have a mental health disorder are not identified at this opportunistic point of contact. The emergency department is an ideal point of contact to screen people for mental health problems. If problems are identified early, and treatment is started early, then it is likely that more people would be helped before their mental health problem became severe. However, increased identification of mental health problems may have implications for mental health services in terms of workload and delivery. The aim of this study was to estimate the prevalence of mental health disorders in an Australian general emergency department. A cross-sectional survey was used to screen a sample of 708 patients, using the Kessler Psychological Distress Scale (K10). The mean age of participants was 50.2 years, and their mean K10 score was 19.96 (SD 7.83), with 24% categorized as having high or very high psychological distress. Seventeen per cent self-reported having a mental health issue. Post-probability calculations based on observed K10 scores estimated that 37% of participants had an actual mental health disorder. The results suggest the prevalence of mental health disorder is significantly higher in emergency department attendees than Australian population norms, supporting the contention that a substantial proportion of ED attendees has a mental health disorder that, in the majority of cases, is not investigated at this point of contact. There is potential to screen all emergency department attendees for the presence of mental health disorder; early identification of mental illness would enable early referral for treatment. However, if all patients are screened, then it is likely that more mental health conditions will be picked up. The implications for mental health nursing are that this may increase workload.
与普通人群相比，患有精神健康障碍的人发病和死亡风险更高，且与更高的医疗保健成本以及社会生产力损失相关。有证据表明，前往急诊科就诊的患有精神健康障碍的人数在增加，而且这一群体在急诊科就诊者中所占比例过高。研究结果表明，在前往急诊科就诊的人群中，约三分之一的人可能患有精神健康障碍，这一比例高于澳大利亚普通成年人群。研究结果还表明，大多数患有精神健康障碍的急诊科就诊者在这一偶然接触点未被识别出来。急诊科是筛查人们是否存在精神健康问题的理想接触点。如果问题能早发现、治疗能早开始，那么很可能会有更多人在精神健康问题变得严重之前得到帮助。然而，精神健康问题识别率的提高可能会给精神健康服务的工作量和服务提供带来影响。本研究的目的是估计澳大利亚一家普通急诊科中精神健康障碍的患病率。采用横断面调查方法，使用凯斯勒心理困扰量表（K10）对708名患者进行抽样筛查。参与者的平均年龄为50.2岁，平均K10评分为19.96（标准差7.83），其中24%被归类为有高度或非常高度的心理困扰。17%的人自我报告有精神健康问题。根据观察到的K10评分进行的概率后计算估计，37%的参与者实际患有精神健康障碍。结果表明，急诊科就诊者中精神健康障碍的患病率显著高于澳大利亚人群的标准水平，这支持了这样一种观点，即相当一部分急诊科就诊者患有精神健康障碍，且在大多数情况下，在这一接触点并未进行调查。对所有急诊科就诊者进行精神健康障碍筛查具有可行性；早期识别精神疾病将有助于早期转诊治疗。然而，如果对所有患者进行筛查，那么可能会发现更多的精神健康状况。这对精神健康护理的影响是，这可能会增加工作量。
