Patterns of emergency department use among young people with bipolar disorder: A data linkage cohort study

ObjectiveTo charactertise emergency department (ED) use among young people with bipolar disorder (BD) and compare patterns to those observed in anxiety, depressive, and psychotic disorders. Design, setting and participantsData linkage study using administrative ED presentation records (January 2020 to October 2020) and a transdiagnostic youth mental health cohort of 2243 individuals aged 12-30 years in New South Wales, Australia. Main outcome measuresED presentation patterns (any presentation, frequency, and rates) and reasons for presentation (mental health-related and non-mental health-related). ResultsOf the 354 young people with BD, 309 (87.3%) presented to an ED at least once. ED presentation rates were higher for BD than for anxiety (incidence rate ratio [IRR]=1.82, p<.001) and depressive disorders (IRR=1.32, p<.001), but similar to psychotic disorders (IRR=0.91, p=.379). Differences were primarily driven by mental health-related presentations. Recurrent mental health presentations were associated with illness progression (clinical stage and functional impairment) rather than diagnosis. However, the likelihood of mental health-related presentations remained higher in BD compared with anxiety and depressive disorders after adjustment. ConclusionsYoung people with BD have high rates of ED use, comparable to those with psychotic disorders. Although mental health-related presentations are more common in BD than in anxiety and depressive disorders, recurrence is largely explained by markers of illness progression. These findings highlight the need for community-based services that provide continuous and coordinated care for young people with complex mental health needs.