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Psychiatric Disorders in Patients Presenting to the Emergency Department for Minor Injury

Richmond, Therese S.; Hollander, Judd E.; Ackerson, Theimann H.; Robinson , Keith; Gracias, Vicente; Shults, Justine; Amsterdam, Jay

doi: 10.1097/01.NNR.0000280616.13566.84

Background: Thirty-five percent of all Emergency Department (ED) visits are for physical injury.

Objectives: To examine the proportion of patients presenting to an ED for physical injury with a history of or current Axis I/II psychiatric disorders and to compare patients with a positive psychiatric history, a negative psychiatric history, and a current psychiatric disorder.

Methods: A total of 275 individuals were selected randomly from adults presenting to the ED with a documented anatomic injury but with normal physiology. Exclusion criteria were: injury in the previous 2 years or from medical illness or domestic violence; or reported treatment for major depression or psychoses. Psychiatric history and current disorders were diagnosed using the Structured Clinical Interview for the Diagnostic and Statistical Manual Disorders, 4th edition (DSM-IV), a structured psychiatric interview. Three groups (positive psychiatric history, negative psychiatric history, current psychiatric disorder) were compared using Chi-square and analysis of variance.

Results: The sample was composed of men (51.6%) and women (48.4%), with 57.1% Black and 39.6% White. Out of this sample, 103 patients (44.7%) met DSM-IV criteria for a positive psychiatric history (n = 80) or a current psychiatric disorder (n = 43). A past history of depression (24%)exceeded the frequency of a history of other disorders (anxiety, 6%; alcohol use/abuse, 14%; drug use/abuse, 15%; adjustment, 23%; conduct disorders, 14%). Current mood disorders (47%) also exceeded other current diagnoses (anxiety, 9%; alcohol, 16%; drug, 7%; adjustment, 7%; personality disorders, 12%). Those with a current diagnosis were more likely to be unemployed (p <.001) at the time of injury.

Conclusions: Psychiatric comorbid disorders or a positive psychiatric history was found frequently in individuals with minor injury. An unplanned contact with the healthcare system (specifically an ED) for treatment of physical injury offers an opportunity for nurses to identify patients with psychiatric morbidity and to refer patients for appropriate therapy.

Therese S. Richmond, PhD, CRNP, is Associate Professor, School of Nursing; Judd E. Hollander, MD, is Professor and Clinical Research Director, Department of Emergency Medicine, School of Medicine; Theimann H. Ackerson, MSSW, is Research Project Manager, School of Nursing; Keith Robinson, MD, is Associate Professor, Department of Physical Medicine & Rehabilitation, School of Medicine; Vicente Gracias, MD, is Assistant Professor of Surgery, Division of Traumatology & Surgical Critical Care, School of Medicine; Justine Shults, PhD, is Assistant Professor of Biostatistics, Department of Clinical Epidemiology & Biostatistics, School of Medicine; and Jay Amsterdam, MD, is Professor of Psychiatry, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.

Editor's Note: Materials documenting the review process for this article are posted at

Accepted for publication April 20, 2007.

This study was supported by NIMH RO1-MH63818 to Dr. Richmond. There are no other financial interests that influenced the material in this manuscript or from which any of the authors would benefit. The authors thank Jennifer Robey, RN, and Frank D. Sites, MHA, RN, for invaluable oversight of subject identification and enrollment in the Emergency Department. Preliminary reports of this study were presented at the 7th World Injury Conference in Vienna, Austria, June 2004 and at the National Teaching Institute in Anaheim, California, in May 2006.

Corresponding author: Therese S. Richmond, PhD, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.