- In an exclusive analysis for the Wall Street Journal, Truveta Research explored mental health-related emergency department visits.
- The rate of ED encounters related to mental health conditions peaked in 2021 for all conditions studied, besides schizophrenia, which peaked in 2020.
- Anxiety-related ED encounters were the highest among the mental health conditions studied; 4.6% of ED encounters for 30-44-year-olds were related to anxiety.
- The 12-17 age group had a nearly 2-fold higher rate of ED encounters related to depression compared to the next highest age group (18-29-year-olds).
- Across all years, males had roughly 2.5-fold the rate of ED encounters related to schizophrenia as females did. Males aged 30-44 years of age had the highest rates (1.7%) of all age and sex groups. This was 3.2-fold higher than females aged 30-44.
Emergency departments (EDs), traditionally designed to handle acute physical health crises, have witnessed a steady rise in visits related to mental health conditions prior to and into the COVID pandemic (Holland et al., 2021; Theriault et al., 2020). This shift underscores not only the growing prevalence of mental health challenges but also gaps in access to outpatient and preventative care. In recent years, the intersection of mental health and emergency healthcare has become an increasingly critical topic of discussion.
Prior studies have shown increased visits for younger adults (Santo et al., 2021) and seasonal patterns for a variety of mental health-related conditions, including depressive disorders, suicidal ideation or self-harm, trauma- and stressor-related disorders, cannabis-related disorders, lifestyle or life management factors, mood disorders, poisoning by drugs, and symptoms of mental and substance use conditions for populations between 10-17 years old from 2018–2023 (Radhakrishnan et al., 2023).
Over time, patterns in ED visits and mental health prescriptions reveal important trends that shed light on how society addresses these challenges. In an exclusive analysis for the Wall Street Journal, we used Truveta Data to understand which mental health conditions were most related to ED encounters, which age and sex groups were driving these trends, and how these trends have changed over time.
Methods
Using a subset of Truveta Data, we included a population of people who had an ED encounter between January 2018 and September 2024. Within each of these encounters, we identified those that were related to at least one of six conditions:
- Anxiety
- Bipolar
- Depression
- Obsessive compulsive disorder (OCD)
- Disruptive behavior disorder (DBD)
- Schizophrenia
We found the monthly percentage of ED visits that were related to each mental health condition. We present anxiety and depression rates across different age groups, as well as schizophrenia rates segmented by both age and sex.
Results
We included over 1.6 million ED encounters across the study period. Rates of ED visits related to anxiety and depression were the highest of those studied. Across the study period, 3.5% of ED visits were related to anxiety and 2.0% of visits were related to depression. Bipolar and schizophrenia conditions saw average rates of 0.8% and 0.7%, respectively.
The year with the highest percent of ED encounters related to mental health conditions was 2021 for all conditions except schizophrenia; ED encounters related to schizophrenia peaked in 2020. Anxiety and depression peaked at 4.1% (a 35% increase from the lowest previous rate) and 2.3% (a 29.4% increase from the lowest previous rate), respectively. Since peaking, the rate of ED encounters related to mental health conditions have continued to decrease. Although rates have continued to decrease, so far in 2024, ED visits related to schizophrenia, bipolar, and OCD remain higher than 2018 rates.
Anxiety and depression by age
During the study period, 18-29 (3.8%) and 30-44 (3.9%) year- olds had the highest rates of anxiety-related ED encounters. All age groups reached their highest rates in 2021; in 2021, 4.6% of ED encounters for 30-44-year-olds were related to anxiety.
The 12-17 age group had nearly a 2-fold higher rate of ED encounters related to depression than the next highest age group (18-29-year-olds). Across the study period, 3.9% of ED encounters for the 12-17-year-olds were related to depression. The rate of ED encounters peaked for 12-17- and 18-29-year-olds in 2021; however, all older age groups saw peak rates in 2022.
Schizophrenia by age and sex
Across all years, males had a roughly 2.5-fold higher rate of ED encounters related to schizophrenia than females. Males aged 30-44 had the highest rates of all age and sex groups; across the study period, 1.7% of ED encounters were related to schizophrenia within this age group. This was 1.4-fold higher than the next highest age group (males aged 18-29 years old) and 3.2-fold higher than females aged 30-44.
Rates of schizophrenia-related ED encounters increased from 2018 and peaked in 2020 or 2021 for all age and sex groups. Rates have gradually decreased since peaking; however, so far in 2024, the rate for males in the 30-44 age group remains higher than 2018.
Discussion
The findings from this study highlight the critical role EDs play in addressing mental health conditions. The results presented here underscore both the challenges and opportunities in mental health care delivery overall and for specific demographic groups.
The study results align with broader trends observed in the last two decades. Between 2007 and 2016, there was a marked increase in psychiatric and substance use-related diagnoses in EDs (Theriault et al., 2020). The peak in anxiety- and depression-related ED visits in 2021 underscores how external stressors, such as the COVID-19 pandemic, exacerbated existing mental health issues. However, the study also revealed a notable decline in ED visits related to with mental health conditions after 2021. This is consistent with other reports; the CDC reported decreases in ED visits for suicide-related behaviors and drug overdoses since 2022 (Anderson et al., 2023). While rates have been decreasing, this progress must be sustained through proactive interventions, as for some conditions, rates haven’t lowered yet to 2018 levels.
Within this study, we also saw age and sex differences. Young adults (18-29 years) and adults aged 30-44 years consistently exhibited the highest rates of anxiety-related ED encounters, while adolescents (12-17 years) faced a disproportionate burden of depression. Additionally, men in the 30–44-year age range had the highest rates of schizophrenia-related ED encounters. While actions have been taken to increase school-based healthcare services focused on mental healthcare (U.S. Department of Education, 2023), sustained effort remains essential. Prior research has found for people who often visited the ED for mental health reasons, they perceived every visit as necessary (Digel Vandyk et al., 2018). This underscores the continued need for tailored, individualized approaches to support those with mental health conditions, rather than relying on one-size-fits-all solutions.
Continued efforts and research are essential to deepen our understanding of the multifaceted dynamics influencing mental health care, why people show up to the ED, and to identify opportunities for improvement. The ongoing reliance on EDs for severe mental health conditions highlights the urgent need for robust outpatient care networks. Additionally, expanding access to early intervention and community-based mental health services can help reduce the dependence on crisis care in EDs. Finally, implementing tailored interventions for high-risk groups, such as adolescents with depression and males with schizophrenia, can address disparities and improve outcomes.
There are a few limitations associated with this study. First, the data included in this study represent ED visits that were related to mental health conditions. The mental health condition did not necessarily cause the ED encounter, and casual relationships should not be drawn. Additionally, the findings are limited to ED encounters and do not capture the full spectrum of mental health care needs or outcomes. Finally, we report annual rates through 2024; however, we only included data through September 2024. Caution should be used when interpreting the 2024 rates.
By understanding these dynamics, we can identify opportunities to strengthen mental health care, reduce ED dependency, and foster a more supportive healthcare system for all.
These are preliminary research findings and not peer reviewed. Data are constantly changing and updating. These findings are consistent with data accessed on October 11, 2024.
Citations
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Digel Vandyk, A., Young, L., MacPhee, C., & Gillis, K. (2018). Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons. Qualitative Health Research, 28(4), 587–599. https://doi.org/10.1177/1049732317746382
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Radhakrishnan, L., Carey, K., Pell, D., Ising, A., Brathwaite, D., Waller, A., Gay, J., Watson-Smith, H., Person, M., Zamore, K., Brumsted, T., Price, C., Clark, P. M., Haas, G. A., Gracy, L., Johnston, S., Chen, Y., Muñoz, K., Henry, M., … Leeb, R. T. (2023). Seasonal Trends in Emergency Department Visits for Mental and Behavioral Health Conditions Among Children and Adolescents Aged 5–17 Years—United States, January 2018–June 2023. MMWR. Morbidity and Mortality Weekly Report, 72(38), 1032–1040. https://doi.org/10.15585/mmwr.mm7238a3
Santo, L., Peters, Z., & DeFrances, C. (2021). Emergency Department Visits for Adults with Mental Health Disorders: United States, 2017–2019. National Center for Health Statistics (U.S.). https://doi.org/10.15620/cdc:112081
Theriault, K. M., Rosenheck, R. A., & Rhee, T. G. (2020). Increasing Emergency Department Visits for Mental Health Conditions in the United States. The Journal of Clinical Psychiatry, 81(5). https://doi.org/10.4088/JCP.20m13241
U.S. Department of Education. (2023). Biden-Harris Administration Takes Action to Help Schools Deliver Critical Health Care Services to Millions of Students. https://www.ed.gov/about/news/press-release/biden-harris-administration-takes-action-to-help-schools-deliver-critical-health-care-services-to-millions-of-students