March 09, 2005

ER Underdiagoses Psych Disorders

A new study in the Journal of Consulting and Clinical Psychology (published by the American Psychological Association) reports that the rate of documented, diagnosed psychiatric disorders in emergency rooms (data based on three major emergency departments in the Midwest and South) is far below that of the national prevalence rate. While 20-28% of Americans are expected to have a diagnosis of a psychiatric disorder, only 5.27% were documented in the emergency departments studied.

A specific breakdown of diagnosed vs. expected diagnosis rates for various conditions includes:

-schizophrenia= 1.30% versus 0.32%

-mood disorders= 4% (national rate) versus 0.70% (emergency department rate)

-organic psychosis (psychosis due to brain injury or disease)= diagnostic ratios ranging from 3:1 to 25:1 depending on age group and method of estimation

-anxiety= 11-16% versus 1.19%

-substance use disorders = 7% versus 2.05%

-tobacco use disorder= 25% versus .23%

With respect to patient demographics, African Americans showed a larger rate of under-diagnosis than Caucasians. It is unlikely that this disparity is due to a lower prevalence of psychiatric disorders among African Americans, given that this demographic group is also more often exposed to the stressful conditions of poverty.

As far as possible reasons for this underdiagnosis phenomenon, physicians surveyed by the article noted "lack of psychiatric expertise, a belief that many mental disorders are relatively unimportant threats to health, and the inability to provide continuity of care for their patients."

In our current health insurance crisis, a growing number of Americans (particularly minorities and the poor) are depending on Emergency Departments to provide a significant portion of their primary care health needs. In light of this data, it is increasingly important for Emergency services to employ full-time mental health professionals, and to educate their physician staff about the importance and prevalance of common mental illnesses.

Source: Psychiatric Disorders Greatly Underdiagnosed In Hospital Emergency Departments, March 8 2005. Available at

See our FAQ guide ( info on what to do if you suspect you or someone close to you may be suffering from a psychiatric disorder.


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