Individual and Neighborhood-level Predictors of Repeat ED Visits in Early Psychosis at an Urban Safety Net Hospital

Brittany M. Gouse MD, MPH (1,2) Samantha LaMartine PsyD (2), Luisa Camacho MPH (2), Madison R. Boschulte (2), Hannah E. Brown MD (1,2)

1. Department of Psychiatry, Boston University School of Medicine
2. Department of Psychiatry, Boston Medical Center

Abstract

Background: Repeat emergency department (ED) visits for treatment of psychosis are a significant driver of morbidity early in illness course. We investigated both individual and neighborhood-level sociodemographic predictors of risk of repeat psychosis-related ED visits.

Methods: We retrospectively evaluated electronic medical records of individuals 18-35 years-old who had at least one ED visit between 3/1/2019-2/28/2021 with an International Classification of Disease 10 code of F20-F25. EMR data was crosswalked to Census tract and American Community Survey data to calculate socioeconomic status (SES) metrics. Chi-square and independent samples T-tests were conducted to compare demographics between individuals with or without at least one repeat ED visit. Poisson regression was used to model number of repeat ED visits across sociodemographic factors.

Results: Of the 477 included individuals, 187 (39.2%) individuals had at least one repeat ED visit. Mean neighborhood percentile percentage of persons below poverty (0.77 vs 0.69, p=.001), without high school diploma (0.75 vs 0.67, p=.001), and SES social vulnerability index score (0.75 vs 0.66, p=.002) were higher among individuals with repeated ED visits compared to those with a single ED visit. While there were no sex differences, there was an association between race/ethnicity and repeat visits (Χ2(4) = 17.43, p=.002), with a higher proportion of Black (46.7%) compared to Latinx/Hispanic (29.9%) and white (28.6%) individuals with at least one repeat ED visit. Compared to white individuals, Black individuals had a higher rate of repeat ED visits (IRR 1.92 95% CI, 1.4–2.8; p <.001).

Conclusions: This work highlights disparities in repeat ED visit risk based on race/ethnicity and neighborhood-level SES among individuals with early psychosis and highlights the urgent need for targeted community interventions.