STRESSFUL LIFE EVENTS AND PSYCHIATRIC EMERGENCIES

Abstract

During the past 15-20 years, the public has turned to general hospitals for services previously provided by family physicians. The emergency room now functions as the primary provider of mental health services for much of the inner-city population, especially for those people in lower socioeconomic groups. The purpose of this study was to examine the relationship between psychosocial stressors and the use of the psychiatric emergency room at a large city hospital. Patients arriving at the emergency room were interviewed with a version of the Psychiatric Epidemiology Research Interview (PERI) Life Events Scale. This scale assessed the amount of stress to which each subject was exposed during the past year. A distinction was made between exogenous events, those not confounded with a subject's psychopathology, and endogenous events, those confounded with a subject's psychopathology. A separate exogenous and endogenous stress score was thus computed for each respondent, as well as a total stress score. Comparisons were made between 60 patients who had used the emergency room before (repeaters) and 60 patients whose current visit was their first, at least within the past year (non-repeaters). An equal number of white, black, and Hispanic subjects (40 of each) were included in the sample. Each patient was diagnosed by the staff member who clinically evaluated the patient, using the DSM II.;No significant differences were found between the mean exogenous, endogenous, or total stress levels of repeaters and non-repeaters. In addition, increased stress was not significantly related to increased emergency room use. The repeater group did not, as predicted, contain an overrepresentation of individuals who were diagnosed as borderline. Instead, schizophrenic patients were significantly more likely to make repeated visits to the emergency room, (chi)('2) (1) = 8.04, p < .005. As predicted, non-repeaters were significantly more likely to be accompanied by family and/or friends than repeaters, who were more often alone, (chi)('2) (1) - 4.97, p = .026. When social status was controlled, there were no significant differences between the stress scores of white, black, and Hispanic patients. Finally, men and women reported similar levels of stress--contrary to the findings of some other studies.