A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

Boudreaux, Edwin D.; Cagande, Consuelo; Kilgannon, J. Hope; Kumar, Anita; Camargo, Carlos A.

doi:10.4088/pcc.v08n0202

Cited by 20 publications

(35 citation statements)

References 22 publications

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“…This rate falls within the rate of depression reported by others who studied ED populations (16%-55%). 6,16,[26][27][28][29] However, other investigators have not focused exclusively on ED patients within this high-risk vulnerable age group or have included those with a previous diagnosis of depression or those patients who presented to the ED with psychiatric complaints.…”

Section: Discussionmentioning

confidence: 99%

Unsuspected or Unacknowledged Depressive Symptoms in Young Adult Emergency Department Patients

Biros

Mann

Hanson

et al. 2009

Academic Emergency Medicine

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Objectives: The objective was to determine the frequency of unsuspected or unacknowledged depressive symptoms among young adult emergency department (ED) patients. Methods:The Beck Depression Inventory-II (BDI-II) and a demographic ⁄ lifestyle questionnaire were administered to a cross-section of medically stable, English-speaking young adult ED patients (aged 18-23 years) with nonpsychiatric chief complaints. The frequency of moderate to severe depressive symptoms was determined. Group results were analyzed with descriptive statistics; multivariate analysis assessed for patient characteristics associated with depressive symptoms.Results: A total of 2,898 patients were screened; 2,255 were eligible for enrollment, and 1,264 enrolled (56%; 64% female, 42% African American; mean age = 21 [±1.7] years). Twenty-nine percent had BDI-II scores consistent with moderate to severe depressive symptoms. Patient characteristics associated with depressive symptoms included knowledge of someone who had intentionally hurt him-or herself (odds ratio [OR] = 2) or died a violent nonaccidental death (OR = 1.4), low personal income (OR = 1.8), chronic health issues (OR = 1.7), cigarette smoking (OR = 1.6), and African American race (OR = 1.5). Those who attended school (OR = 0.5), engaged in frequent social activities (OR = 0.5), or drove a car (OR = 0.7) were less likely to have depressive symptoms. Patients lacked insight into their depressive symptoms.Conclusions: There is a high prevalence of depressive symptoms in young adult ED patients. Young adults often do not recognize, or are reluctant to acknowledge, depressive symptoms. Specific patient characteristics may be useful in deciding which young adults should undergo ED screening for depression.ACADEMIC EMERGENCY MEDICINE 2009; 16:288-294 ª

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Section: Discussionmentioning

confidence: 99%

Unsuspected or Unacknowledged Depressive Symptoms in Young Adult Emergency Department Patients

Biros

Mann

Hanson

et al. 2009

Academic Emergency Medicine

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“…3–9 Many ED patients have unrecognized risk incidental to their chief complaint. 10–12 In the two largest studies to date, point prevalence of active ideation among ED patients presenting with non-psychiatric complaints was 8%, 13,14 which went undetected by treating ED clinicians. This far exceeds community estimates of around 3% over a period of an entire year.…”

Section: Introductionmentioning

confidence: 99%

Improving Suicide Risk Screening and Detection in the Emergency Department

Boudreaux

Camargo

Arias

et al. 2016

American Journal of Preventive Medicine

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144

114

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Introduction The Emergency Department Safety Assessment and Follow-up Evaluation Screening Outcome Evaluation examined whether universal suicide risk screening is feasible and effective at improving suicide risk detection in the emergency department (ED). Methods A three-phase interrupted time series design was used: Treatment as Usual (Phase 1), Universal Screening (Phase 2), and Universal Screening + Intervention (Phase 3). Eight EDs from seven states participated from 2009 through 2014. Data collection spanned peak hours and 7 days of the week. Chart reviews established if screening for intentional self-harm ideation/behavior (screening) was documented in the medical record and whether the individual endorsed intentional self-harm ideation/behavior (detection). Patient interviews determined if the documented intentional self-harm was suicidal. In Phase 2, universal suicide risk screening was implemented during routine care. In Phase 3, improvements were made to increase screening rates and fidelity. Chi-square tests and generalized estimating equations were calculated. Data were analyzed in 2014. Results Across the three phases (N=236,791 ED visit records), documented screenings rose from 26% (Phase 1) to 84% (Phase 3) (χ2 [2, n=236,789]=71,000, p<0.001). Detection rose from 2.9% to 5.7% (χ2 [2, n=236,789]=902, p<0.001). The majority of detected intentional self-harm was confirmed as recent suicidal ideation or behavior by patient interview. Conclusions Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection. If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.

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“…Emergency departments (EDs) are a key setting for suicide prevention, as up to 8% of all ED patients have active or recent suicidal ideation (SI), [4-6] multiple ED visits appear to be a risk factor for suicide, [7] and many suicide victims are seen in an ED shortly before death. [8] Based on models using national suicide statistics, ED-based interventions might help decrease suicide deaths by 20% annually.…”

Section: Introductionmentioning

confidence: 99%

Lethal Means Access and Assessment Among Suicidal Emergency Department Patients

et al. 2016

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Background Reducing access to lethal means (especially firearms) might prevent suicide, but counseling of at-risk individuals about this strategy may not be routine. Among emergency department (ED) patients with suicidal ideation or attempts (SI/SA), we sought to describe home firearm access and examine ED provider assessment of access to lethal means. Methods This secondary analysis used data from the Emergency Department Safety Assessment and Follow-up Evaluation, a 3-phase, 8-center study of adult ED patients with SI/SA (2010-2013). Research staff surveyed participants about suicide-related factors (including home firearms) and later reviewed the ED chart (including documented assessment of lethal means access). Results Among 1358 patients with SI/SA, 11% (95%CI 10-13%) reported ≥1 firearm at home; rates varied across sites (range: 6% to 26%) but not over time. On chart review, 50% (95%CI 47-52%) of patients had documentation of lethal means access assessment. Frequency of documented assessment increased over study phases (40% to 60%, p<0.001) but was not associated with state firearm ownership rates. Among the 337 (25%, 95%CI 23-27%) patients discharged to home, 55% (95%CI 49-60%) had no documentation of lethal means assessment; of these, 13% (95%CI 8-19; n=24) actually had ≥1 firearm at home. Among all those reporting ≥1 home firearm to study staff, only half (50%, 95%CI 42-59) had provider documentation of assessment of lethal means access. Conclusions Among these ED patients with SI/SA, many did not have documented assessment of home access to lethal means, including patients who were discharged home and had ≥1 firearm at home.

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A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

Cited by 20 publications

References 22 publications

Unsuspected or Unacknowledged Depressive Symptoms in Young Adult Emergency Department Patients

Unsuspected or Unacknowledged Depressive Symptoms in Young Adult Emergency Department Patients

Improving Suicide Risk Screening and Detection in the Emergency Department

Lethal Means Access and Assessment Among Suicidal Emergency Department Patients

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