A Retrospective Cohort Analysis of Mental Health-Related Emergency Department Visits Among Veterans and Non-Veterans Residing in Ontario, Canada: Une analyse de cohorte rétrospective des visites au service d'urgence liées à la santé mentale parmi les vétérans et non-vétérans résidant en Ontario, Canada.

IF 3.3 3区医学 Q2 PSYCHIATRY

Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie Pub Date : 2024-05-01 Epub Date: 2024-01-05 DOI:10.1177/07067437231223328

Kate St Cyr, Peter Smith, Paul Kurdyak, Heidi Cramm, Alice B Aiken, Alyson Mahar

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引用次数: 0

Abstract

Objectives: Emergency departments (EDs) are a vital part of healthcare systems, at times acting as a gateway to community-based mental health (MH) services. This may be particularly true for veterans of the Royal Canadian Mounted Police who were released prior to 2013 and the Canadian Armed Forces, as these individuals transition from federal to provincial healthcare coverage on release and may use EDs because of delays in obtaining a primary care provider. We aimed to estimate the hazard ratio (HR) of MH-related ED visits between veterans and non-veterans residing in Ontario, Canada: (1) overall; and by (2) sex; and (3) length of service.

Methods: This retrospective cohort study used administrative healthcare data from 18,837 veterans and 75,348 age-, sex-, geography-, and income-matched non-veterans residing in Ontario, Canada between April 1, 2002, and March 31, 2020. Anderson-Gill regression models were used to estimate the HR of recurrent MH-related ED visits during the period of follow-up. Sex and length of service were used as stratification variables in the models.

Results: Veterans had a higher adjusted HR (aHR) of MH-related ED visits than non-veterans (aHR, 1.97, 95% CI, 1.70 to 2.29). A stronger effect was observed among females (aHR, 3.29; 95% CI, 1.96 to 5.53) than males (aHR, 1.78; 95% CI, 1.57 to 2.01). Veterans who served for 5-9 years had a higher rate of use than non-veterans (aHR, 3.76; 95% CI, 2.34 to 6.02) while veterans who served for 30+ years had a lower rate compared to non-veterans (aHR, 0.60; 95% CI, 0.42 à 0.84).

Conclusions: Rates of MH-related ED visits are higher among veterans overall compared to members of the Ontario general population, but usage is influenced by sex and length of service. These findings indicate that certain subpopulations of veterans, including females and those with fewer years of service, may have greater acute mental healthcare needs and/or reduced access to primary mental healthcare.

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对居住在加拿大安大略省的退伍军人和非退伍军人中与精神健康相关的急诊就诊情况进行的回顾性队列分析》（A Retrospective Cohort Analysis of Mental Health-Related Emergency Department Visits Among Veterans and Non-Veterans Residing in Ontario, Canada）。

目的：急诊室（ED）是医疗保健系统的重要组成部分，有时也是通往社区心理健康（MH）服务的门户。这对于在 2013 年之前退伍的加拿大皇家骑警和加拿大武装部队的退伍军人来说尤为如此，因为这些人在退伍后会从联邦医疗保险过渡到省级医疗保险，并且可能会因为迟迟找不到初级医疗服务提供者而使用急诊室。我们的目的是估算居住在加拿大安大略省的退伍军人和非退伍军人之间与精神健康相关的急诊就诊危险比（HR）：(1) 整体；(2) 性别；(3) 服役时间：这项回顾性队列研究使用了 2002 年 4 月 1 日至 2020 年 3 月 31 日期间居住在加拿大安大略省的 18,837 名退伍军人和 75,348 名年龄、性别、地域和收入匹配的非退伍军人的医疗保健管理数据。安德森-吉尔回归模型用于估算随访期间与 MH 相关的 ED 复发性就诊率。性别和服役年限被用作模型中的分层变量：退伍军人与 MH 相关的急诊就诊调整 HR（aHR）高于非退伍军人（aHR，1.97，95% CI，1.70 至 2.29）。女性（aHR，3.29；95% CI，1.96 至 5.53）比男性（aHR，1.78；95% CI，1.57 至 2.01）受到的影响更大。服役 5-9 年的退伍军人的使用率高于非退伍军人（aHR，3.76；95% CI，2.34 至 6.02），而服役 30 年以上的退伍军人的使用率低于非退伍军人（aHR，0.60；95% CI，0.42 至 0.84）：结论：与安大略省普通人群相比，退伍军人中与精神健康相关的急诊就诊率总体较高，但就诊率受性别和服役年限的影响。这些研究结果表明，退伍军人中的某些亚群，包括女性和服役年限较短的退伍军人，可能有更多的急性精神医疗需求和/或获得初级精神医疗服务的机会较少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie 医学-精神病学

CiteScore

7.00

自引率

2.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Established in 1956, The Canadian Journal of Psychiatry (The CJP) has been keeping psychiatrists up-to-date on the latest research for nearly 60 years. The CJP provides a forum for psychiatry and mental health professionals to share their findings with researchers and clinicians. The CJP includes peer-reviewed scientific articles analyzing ongoing developments in Canadian and international psychiatry.