Defining the concept of Mental Dysregulation in patients requiring ambulance and Emergency Department care; results of an international modified Delphi study

Abstract Background Various concepts are used to describe emotional or behavioral dysregulation in patients within emergency care research and practice, hindering recognition, monitoring, and treatment-development, while also risking misdiagnosis of co-occurring conditions. The objective of this study was to name and define an international and overarching concept, suitable for persons with lived experience, emergency care professionals, and academics. Methods A modified Delphi study was conducted in twelve countries, from December 2023 to January 2025. An international steering committee ( n = 14) guided the process and developed initial statements. In this steering committee the European Society for Emergency Medicine (EUSEM) and the Emergency Nursing Association (ENA) participated. An international Delphi panel anonymously rated their level of agreement and commented on both language and content of the statements in three Delphi rounds via an online survey. The steering committee and the Delphi panel consisted of three groups: persons with lived experience, emergency care professionals, and academics. Results 112 Delphi panel members participated, of which 89 (response rate: 79.5%) completed round 3. Out of 20 statements, one was dropped. The other 19 statements reached the threshold level of agreement of 75%, approving statements on the relevance, definition, relating factors and circumstances, types and levels of severity, and name of the concept. In addition, a steering committee synthesized the statements into a summarizing definition and developed a model for clinical reasoning. Conclusion Through engagement with a high number of international persons with lived experience, emergency care professionals, and academics, this study provides a clear definition of the concept of mental dysregulation, consisting of nineteen statements. The nineteen statement-definition, the summarizing definition and the clinical reasoning model contribute to a more person centered and holistic emergency care system that better serves patients experiencing mental dysregulation.