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) 2022 APA, all rights reserved).

中文翻译：

---

最近去急诊室就诊的医疗复杂退伍军人的心理困扰。

医疗复杂性和心理困扰与急诊科 (ED) 的频繁使用有关。尽管存在这种已知关联，但我们对哪些患者有持续性心理困扰的风险以及随着时间的推移会出现哪些困扰模式的了解有限。二次数据分析用于检查在参加随机对照试验后 30 天和 180 天的自我报告的心理困扰（定义为过去一个月中由于心理健康状况不佳而导致的 ≥ 14 天） ED访问。我们使用多变量有序逻辑回归模型来检查先验因素[基线心理困扰、年龄、种族、收入、健康素养、日常生活活动（ADL）缺陷、和工具性日常生活活动的缺陷] 具有三种心理困扰分类（无/低、间歇性和持续性）。在 513 名退伍军人中，40% 的基线报告称他们在上个月经历了严重的心理困扰。年龄较大与高度心理困扰的几率较低相关（OR = 0.95；95% CI：0.94-0.97）。在 30 天和 180 天的评估中，与显着更高的持续心理困扰几率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)，并报告至少一项 ADL 缺陷（OR = 1.94；95% CI：1.13-3.33）。随访中的心理困扰在最近去急诊室就诊的医学复杂的退伍军人中很常见。未来的研究应该探索将痛苦信息整合到治疗计划中和/或与心理健康转诊服务相关联的干预措施。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。