Gender Bias in the Management of Acute Psychiatric Episodes in the Emergency Department: A Cross-Sectional Analysis of the 2017-2019 Triennium

Background: There is growing evidence that gender is an important determinant of mental health and well-being. In this sense, both biological and socio-economic factors play a key role in how people experience psychological disturbances. This study aimed to examine whether there were sex- and gender-based differences in the management of psychiatric disorders in the emergency department.Methods: A cross-sectional retrospective study was conducted in the emergency department at Cruces University Hospital, Spain over the 2017-2019 period. Sex was codified as female/male and socio-economic deprivation index was compiled to address the impact of social determinants. Episodes were reclassified according to four major clusters. Psychotropic drug prescription was categorized according to the ATC classification. Poisson regression models, adjusted for age and socioeconomic status, were used.Findings: A total of 9.789 episodes (53·9% females) of individuals who required an acute-related psychiatric intervention were retrieved. Age distribution and socioeconomic quintiles revealed gender differences. Anxiety-related disorders accounted for up to 50% of all episodes. Female gender was found to be overrepresented in anxiety and stress-related disorders, mood disorders, and personality disorders. Men, on the other hand, accounted for 70% of psychoactive substance use disorders. Female patients were more likely to be prescribed anxiolytic and antidepressant medication during an emergency department visit, according to Poisson regression models.Interpretation: This study highlights the relevance of considering sex and gender as potential determinants in both the clinical presentation and management of acute psychiatric emergencies. Similarly, it emphasizes the relevance of implementing a gender-sensitive approach in biomedical sciences.Funding Information: This research was granted to MS by the Basque Women's Institute – Emakunde, Basque Country Government (2020-BTI2-PP-23) and to RS by the Basque Government (IT1512- 22).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The approval of the OSI Ezkerraldea-Enkarterri-Cruces Research Ethics Committee was obtained for the development of this study.