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Predictors of repeat visits to hospital psychiatric emergency departments in Malaga (Spain) and in Lisbon (Portugal)
  1. Berta Moreno-Küstner1,2,
  2. Ingeborg Warnke3,
  3. Carlos Nordt4,
  4. Gemma Fernandez5,
  5. José Ramos6,
  6. Pedro Paulino-Matos5,
  7. Wulf Rössler7,8,9,
  8. Graça Cardoso10
  1. 1 Department of Personality, Assessment and Treatment, Faculty of Psychology, University of Malaga, Malaga, Spain
  2. 2 Maristán Network, Institute of Biomedical Research of Malaga, Malaga, Spain
  3. 3 Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
  4. 4 Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
  5. 5 Mental Health Unit North, Malaga University Regional Hospital, Malaga, Spain
  6. 6 Department of Psychiatry, Hospital Fernando Fonseca, Amadora, Portugal
  7. 7 University of Zurich, Zurich, Switzerland
  8. 8 Institute of Psychiatry, Universidad de Sao Paulo, Sao Paulo, Brazil
  9. 9 Laboratory of Neuroscience, University of São Paulo, Sao Paulo, Brazil
  10. 10 Chronic Diseases Research Center (CEDOC), NOVA Medical School Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Maristán Network, Lisbon, Portugal
  1. Correspondence to Professor Berta Moreno-Küstner, Department of Personality, Assessment and Treatment, Faculty of Psychology. University of Malaga, Campus de Teatinos, s/n. 29071, Malaga, Spain; bertamk{at}


Objective This study describes the profile of people with mental disorders attending emergency departments (EDs) in two countries and to identify specific mental disorders associated with repeat emergency visits.

Methods Retrospective analyses of 1 year of EDs data from two hospitals with psychiatric departments, one in Amadora/Sintra (Lisbon, Portugal, 2008) and the other in Malaga (Spain, 2009), were carried out. To determine which mental disorders were associated with repeat visits in each setting, negative binomial models were calculated.

Results There were 5141 visits for a mental disorder made by 3667 patients. Patients with affective disorder were the most frequent (32.2%). Among all mental health patients, 19.9% had at least one repeat visit during the year. For the two EDs setting combined, patients with personality disorders (incidence rate ratio (IRR)=3.79, 95% CI: 2.39 to 6.02) and psychotic disorders (IRR=1.46, 95% CI: 1.13 to 1.89) were more likely to have repeat visits compared with patients with affective disorders, whereas mental disorders due to psychoactive substance use (IRR=0.52, 95% CI: 0.37 to 0.73) was associated with lower likelihood of repeat visits. Nearly all significant differences were attributable to the Malaga sample, where patients with personality disorders were four times more likely to have repeat EDs visits compared with patients with affective disorders. However, at both sites, patients with mental disorders due to psychoactive substance use were less likely to have repeat visits.

Conclusions Certain mental disorders may be predictive of more frequent ED visits. The different results for each country suggest that further studies might focus not only on the characteristics of patients, but also on local healthcare organisation.

  • psychiatry
  • emergency department
  • mental health

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  • Contributors BM-K and GC were involved in the conception, designing, analysis, interpretation of data and drafting the article. IW and CN were involved in the analysis, interpretation of data and drafting the article. GF, JR, PP-M and WR were involved in the interpretation of data and drafting the article. All authors provided final approval of the version to be published.

  • Funding University of Malaga (Research Department), the Andalusian Government (PI338/2008; CTS-945).

  • Competing interests None declared.

  • Ethics approval Ethical Committee of the University Regional Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.