Predictors of Mental Health Problems Among Emergency Department Patients with High-Risk Alcohol Use Patterns

Background and Purpose: Substance use has been found to be associated with mental health problems in population based studies, although less is known about these associations in emergency department (ED) patients. A better understanding of co-occurring mental health and alcohol use problems in this population is important for identifying risk factors amenable to intervention. The purpose of this cross-sectional study is to examine the occurrence and sociodemographic predictors of co-occurring mental health problems in a large convenience sample of ED patients with problematic alcohol use. Methods: Participants were 2,762 patients from 12 large southern California hospital ED/trauma units participating in a broader alcohol and drug use screening effort (Screening, Brief Intervention, and Referral to Treatment or SBIRT). Adult patients were asked to participate in the screening regardless of the reason for their ED visit. A personal interview was administered in the ED by trained bilingual/bicultural health educators (HEs). HEs determined the patient's alcohol use severity level using the ASSIST brief screener, and those scoring as high risk or likely dependent are included in this study. HEs also asked how many days in the past 30 days the patient had experienced depression, anxiety, and cognitive/brain function problems (i.e., trouble understanding, concentrating, or remembering). Sociodemographic characteristics included the patient's gender, age in years, racial/ethnic background, annual family income, and current employment status. Results: Eighty-one percent of patients reported at least one of the three mental health problems. Approximately 64% of patient experienced at least 1 day of depression, 67% experienced anxiety, and 50% experienced brain function problems. Multiple mental health problems were common, with 54% reporting both depression and anxiety, 40% reporting depression and brain function problems, and 41% reporting anxiety and brain function problems. About 4% reported all 3 mental health problems. Adjusted odds ratios from multinomial logistic regression showed gender and employment status were consistent independent predictors, with women and the unemployed reporting more days of all three mental health problems than their counterparts. Younger age was associated with anxiety, and older age was associated with depression, although the associations were quite weak (age was not related to brain function problems). Those with relatively lower income were at greater risk for depression and brain function problems, although higher income was associated with anxiety. Non-Hispanic Whites reported greater anxiety and depression than Hispanics, Blacks, and Others, although no racial/ethnic differences were seen for brain function problems. Conclusions and Implications: Results indicate a high occurrence of self-reported recent mental health problems among ED patients with alcohol problems. Female gender and unemployed status were associated with all three mental health problems, and White non-Hispanic ethnicity was associated with anxiety and depression. Although the cross-sectional nature of the data limits making cause and effect statements, findings suggest that more in-depth mental health screenings be added to SBIRT efforts, particularly for those who screen at high risk for alcohol use. Identifying and intervening with alcohol and mental health problems may be particularly salient for those struggling with the current economic downturn and concomitant stressors.