The aims of this study were to report on the prevalence of stress, the factors reported as being causal of stress, and the health problems reported by those experiencing stress among a cross-sectional sample of adult ED patients. We found that almost half of the ED patients that we sampled not only reported experiencing frequent stress but also reported many of the psychosocial causes of stress (such as work, relationship, and finances), health problems associated with stress (such as being overweight and depressed) and unhealthy coping strategies (such as cigarette and marijuana use) associated with experiencing persistent stress. As such, stress needs to be considered as a co-morbid condition in the care of the ED patient. This is consistent, for example, with research that demonstrates that irrespective of participants' usual ability to restrict food intake, under conditions of acute stress, highly- stressed participants were more likely to eat food with high fat and high salt content, and eat more food, than participants who had low situational stress.[10] Other research has demonstrated that acute stress affects cognitive functioning associated with the prefrontal cortex, a brain area associated with several major psychiatric disorders including anxiety and depression.[11]

A substantial body of research has demonstrated the effectiveness of a brief intervention in reducing negative consequences, including injuries, associated with alcohol use among ED patients.[812] Initiatives from organizations such as Substance Abuse and Mental Health Services Administration (SAMHSA) have been instrumental in encouraging EDs to include screening for alcohol use problems as part of standard patient care in the ED.[13] This comes from the recognition that alcohol use is strongly related to the reason for the ED visit among a significant proportion of patients,[8] and that failure to at least screen patients for alcohol use problems misses an opportunity to intervene with the patient to prevent future ED visits. Our finding further supports that of other research that ED patients are stressed and may benefit from such an intervention.[7]

In terms of target populations for a stress intervention, our examination of a sample from a busy urban level 1 ED population reveals that both young and old were equally stressed, but females and ill patients reported significantly more stress. For those reporting more frequent stress an intervention should address the etiology of the stress, the medical implications of stress, and techniques to reduce stress. In addition, it is possible that marijuana use or overeating is used to self medicate stress or that stress is contributing to depression. Interventions that address substance use (such as alcohol, marijuana, cigarettes) or depression have to determine if the experience of stress as a response to chronic or acute life experiences are contributing to and sustaining an individual's problem. It is likely that failure to address the issue of stress may reduce the effectiveness of an intervention.

In an effort to minimize the length of the assessment, the present study examines stress in terms of only very brief self reported measure. Future investigations may benefit by utilizing standardized instruments on stress that can provide additional information on the relative experience of stress within an ED population compared to others. These results do not indicate any causal factors for experiencing stress. We do not know, for example, if marijuana use is a coping strategy for dealing with stress, or if imbibing marijuana is a cause of stress. Although anecdotally many of our clinical interventionists reported that ED patients undergoing a brief intervention reported that they were stressed, and associated their alcohol and/or marijuana use with experiencing stress, we do not know if the intervention having reduced alcohol and/or marijuana use increased or decreased patients experience and consequences of stress.