Medical complexity and psychological distress are associated with frequent emergency department (ED) use. Despite this known association, our understanding is limited about which patients are at risk for persistent psychological distress and what patterns of distress emerge over time. A secondary data analysis was used to examine self-reported psychological distress (defined as ≥14 unhealthy days due to poor mental health in the past month) at 30 and 180 days following enrollment in a randomized control trial of 513 medically complex Veterans after a nonpsychiatric ED visit. We used a multivariable ordered logistic regression model to examine the association of a priori factors [baseline psychological distress, age, race, income, health literacy, deficits in activities of daily living (ADL), and deficits in instrumental activities of daily living] with three psychological distress classifications (no/low, intermittent, and persistent). Among 513 Veterans, 40% reported at baseline that they had experienced high psychological distress in the previous month. Older age was associated with lower odds of high psychological distress (OR = 0.95; 95% CI: 0.94-0.97). Baseline factors associated with significantly higher odds of persistent psychological distress at 30 and 180 days assessments, included having the inadequate income (OR = 1.61; 95% CI: 1.02-2.55), having low health literacy (OR = 1.63; 95% CI: 1.01-2.62), and reporting at least one ADL deficit (OR = 1.94; 95% CI: 1.13-3.33). Psychological distress at follow-up was common among medically complex Veterans with a recent ED visit. Future research should explore interventions that integrate distress information into treatment plans and/or link to mental health referral services. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

中文翻译：

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最近急诊科就诊的医疗复杂的退伍军人的心理困扰。

医疗复杂性和心理困扰与急诊科的频繁使用有关。尽管存在这种已知的联系，但我们对哪些患者面临持续性心理困扰的风险以及随着时间的推移出现何种困扰的方式的理解仍然有限。在对一项513名非精神病患者进行了医学方面的复杂退伍军人的随机对照试验纳入后的30天和180天，使用二级数据分析来检查自我报告的心理困扰（定义为过去一个月中因精神健康状况不佳而导致≥14天不健康的日子）。 ED访问。我们使用了多元有序Logistic回归模型来检验先验因素的关联[基线心理困扰，年龄，种族，收入，健康素养，日常生活活动不足（ADL），和日常工具活动的不足]，并具有三种心理困扰分类（无/低，间歇和持续）。在513名退伍军人中，有40％的人在基线时表示他们在上个月经历了高度的心理困扰。老年人与较高的心理困扰可能性较低（OR = 0.95； 95％CI：0.94-0.97）。在30天和180天评估时与持续性心理困扰可能性明显升高相关的基线因素包括收入不足（OR = 1.61; 95％CI：1.02-2.55），健康素养低（OR = 1.63; 95％CI： 1.01-2.62），并报告至少一个ADL缺陷（OR = 1.94； 95％CI：1.13-3.33）。近期进行急诊就诊的医学复杂的退伍军人在随访中的心理困扰很常见。未来的研究应探索将求救信息整合到治疗计划中和/或链接到心理健康转诊服务的干预措施。（PsycInfo数据库记录（c）2021 APA，保留所有权利）。