Mental health has a huge and often underappreciated influence on our bodies and physical health. Recent research conducted by Wendy Marie Ingram, Ph.D., and her colleagues in the Department of Epidemiology and Health Services Research and the Biomedical Translational Informatics Institute at Geisinger Health System has revealed how one mental illness in particular — depression — impacts how patients use the Emergency Department (ED).
Dr. Ingram investigated the way in which adult patients with a Geisinger primary care physician (PCP) used the ED by looking at every ED encounter from 2005 to 2015. She found a striking link between those with a history of depression and more frequent ED visits. Merely having a history of depression increased the likelihood of visiting the ED. Patients who were seen more than 4 times per year (7 percent of ED visitors) had high rates of depression (49 percent) and antidepressant medication order histories (71 percent).
However, patients with depression were not being seen for overt mental health reasons. Instead, they tended to be seen for similar complaints as those without a history of depression, though much more frequently. They were seen most often in the ED for a variety of pain complaints.
The fact that patients with depression experience pain so uncontrollable or intolerable that it leads to an ED visit is perhaps less startling when you know more about depression. Depression is characterized not just by psychological symptoms, such as depressed mood or intense feelings of sadness, but it also manifests in various physical ways, known as somatic symptoms. Depression’s somatic symptoms can include sleep disturbances, digestive issues and sensations of physical pain.
Not surprisingly, then, patients who may not be receiving adequate treatment for their depression might be unaware that the abdominal, chest, head or back pain they are experiencing is actually due to their mental health condition. The Emergency Department is not an ideal location to receive care for this sort of ailment. Importantly, ED clinicians can rule out any other cause which could indeed be serious and life-threatening, such as heart attacks, strokes or neurological injury. However, when another cause is not identified, following up with an outpatient doctor to discuss these symptoms and examine whether these are somatic manifestations of depression may result in more effective mental health care plans and alleviation of the somatic symptoms.
Additionally, it is well known that having depression often results in worse outcomes of other conditions. For example, those with diabetes and depression do worse than those with diabetes alone. Again, despite the ED being the right place to stabilize patients experiencing acute complications or exacerbations of their other medical conditions, the root cause of these ED visits could be due to suboptimal care for mental illness.
This research reveals important interactions between a history of depression and frequent ED use by Geisinger PCP patients. Geisinger patients and clinicians alike may benefit from placing more emphasis on management of mental health conditions like depression.
Wendy Marie Ingram, Ph.D., is a computational biology postdoctoral fellow in the Department of Epidemiology and Health Services Research and the Biomedical Translational Informatics Institute at Geisinger Health System. She is interested in leveraging medical informatics, genomics, molecular biology, and integrative medicine to improve our understanding and treatment of mental illness.