Who visits the psychiatric emergency room for the first time?

To examine patient and system characteristics of first-time ("incident") vs. recurrent ("recurrent") use of a psychiatric emergency room (PER).

Data on demographic and clinical characteristics and health service utilization were collected for incident and recurrent users (n=3,719) who visited the PER of the university hospital in Leuven, Belgium, between March 2000 and March 2002.

About 64% (n=2,368) were incident and 36% (n=1,351) were recurrent users. The PER was the first treatment setting ever for 50% of the incident users. Incident users were most likely over 69 years (OR=2.84, P<0.001), employed (OR=2.21, P<0.001), or referred by a health care professional (OR=1.72, P<0.001). They were less likely to have a personality disorder (OR=0.40, P<0.001) or to have used inpatient or outpatient services in the past (OR's 0.11 and 0.65, respectively, P<0.001). About 44% were admitted, 38% referred for outpatient treatment, 9% referred to the outpatient crisis-intervention program, and 9% refused any follow-up.

The PER was a first treatment setting ever for 1 in 3 patients. Incident and recurrent users differed in sociodemographic characteristics, pathways to care, service use, and the presence of a personality disorder. They did not differ in axis 1 disorders, comorbid mental disorders, or pathways after care.