Abstract
Objectives
Emergency Department (ED) utilization accounts for a large portion of healthcare services
in the US. Disturbance of circadian rhythms may affect mental and behavioral health
(MBH) conditions, which could result in increased ED visits and subsequent hospitalizations,
thus potentially inducing staffing shortages and increasing ED wait time. Predicting
the burden of ED admissions helps to better plan care at the EDs and provides significant
benefits. This study investigates if increased ED visits for MBH conditions are associated
with seasonality and changes in daylight savings time.
Methods
Using ED encounter data from a large academic medical center, we have examined univariate
and multivariate associations between ED visits for MBH conditions and the annual
time periods during which MBH conditions are more elevated due to changes in the seasons.
We hypothesize that ED visits for MBH conditions increase within the 2-week period
following the daylight savings time changes.
Results
Increased MBH ED visits were observed in certain seasons. This was especially true
for non-bipolar depressive illness. We saw no significant changes in MBH visits as
associated with changes in the daylight savings time.
Conclusions
Data do not provide conclusive evidence of a uniform seasonal increase in ED visits
for MBH conditions. Variation in ED MBH visits may be due to secular trends, such
as socioeconomic factors. Future research should explore contemporaneous associations
between time-driven events and MBH ED visits. It will allow for greater understanding
of challenges regarding psychiatric patients and opportunities for improvement.
Keywords
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References
- Mental illness.([cited 2018 June 20]; Available from:)
- Mental health and substance abuse-related emergency department visits among adults, 2007. HCUP statistical brief #92.U.S. Agency for Healthcare Research and Quality, Rockville, MD2010
- Mental health and emergency medicine: a research agenda.Acad Emerg Med. 2009; 16: 1110-1119
- Patient- and practice-related determinants of emergency department length of stay for patients with psychiatric illness.Ann Emerg Med. 2012; 60 (p. 162-71.e5)
- National Hospital Ambulatory Medical Care Survey: 2011 emergency department summary tables.Centers for Disease Control and Prevention (CDC), Atlanta, GA2011
- National Hospital Ambulatory Medical Care Survey: 2015 emergency department summary tables.Centers for Disease Control and Prevention (CDC), Atlanta, GA2015
- Healthcare cost and utilization project.Agency for Healthcare Research and Quality, Rockville, MD2018
- Impact of the mental healthcare delivery system on California emergency departments.West J Emerg Med. 2012; 13: 51-56
- Emergency room visits for mental health conditions: expect long waits.([cited 2018 June 21]; Available from:)
- Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments.West J Emerg Med. 2014; 15: 1-6
- Factors associated with longer length of stay for mental health emergency department patients.J Emerg Med. 2014; 47: 412-419
- Daylight saving time in psychiatric illness.J Affect Disord. 1990; 19: 177-181
- Seasonality and bipolar disorder: a systematic review, from admission rates to seasonality of symptoms.J Affect Disord. 2014; 168: 210-223
- The relationship of person-specific eveningness chronotype, greater seasonality, and less rhythmicity to suicidal behavior: a literature review.J Affect Disord. 2018; 227: 721-730
- Adjusting to the changes to and from Daylight Saving Time.Nature. 1976; 261: 688-689
- Spring and autumn daylight saving time changes: studies of adjustment in sleep timings, mood, and efficiency.Ergonomics. 1980; 23: 167-178
- The effects of changing the phase and duration of sleep.J Exp Psychol Hum Percept Perform. 1976; 2: 30-41
- Traffic accident increases as a possible indicant of desynchronosis.Chronobiologia. 1980; 7: 527-529
- Fatal alcohol-related traffic crashes increase subsequent to changes to and from daylight savings time.Percept Mot Skills. 1998; 86: 879-882
- Fatal accidents following changes in daylight savings time: the American experience.Sleep Med. 2001; 2: 31-36
- Daylight savings time transitions and the incidence rate of unipolar depressive episodes.Epidemiology. 2017; 28: 346-353
- The bipolarity of light and dark: a review on Bipolar Disorder and circadian cycles.J Affect Disord. 2015; 185: 219-229
- Sleep reduction as a final common pathway in the genesis of mania.Am J Psychiatry. 1987; 144: 201-204
- Daylight savings time changes, New York.(Available from:)https://www.timeanddate.com/time/change/usa/new-york?year=2013Date: 2018 January 12
- Seasonality in trauma admissions – are daylight and weather variables better predictors than general cyclic effects?.PLoS One. 2018; 13e0192568
- Costs and trends of emergency department utilization pre- and post-ACA: evidence from a rural Georgia hospital in American Public Health Association (APHA) annual meeting.2017 (Atlanta, GA)
- Secular trends in adult sleep duration: a systematic review.Sleep Med Rev. 2012; 16: 223-230
Article Info
Publication History
Published online: October 31, 2018
Accepted:
October 27,
2018
Received in revised form:
October 22,
2018
Received:
September 25,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
