Depression and Anxiety Among Emergency Department Patients: Utilization and Barriers to Care

Abar, Beau; Holub, Ashley; Lee, Joseph; DeRienzo, Vincent; Nobay, Flavia

doi:10.1111/acem.13261

Cited by 27 publications

(34 citation statements)

References 9 publications

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“…We also found that a positive MDD screen was associated with increased subsequent health care utilization during the 1‐year follow‐up period. While associations between depression and health care utilization have been previously reported in the primary care clinic, specialty clinic, elderly ED patient populations, and adult ED patients with abdominal pain, our study represents one of the first reports specific to the general adult ED population …”

Section: Discussionmentioning

confidence: 71%

“…In addition, ED visit frequency at 12‐ and 24‐week follow‐up intervals were associated with changes in HAMD scores from baseline . In one prior report in the general adult ED population, patients with moderate or severe depression reported a median of two ED visits in the past 6 months while those who screened negative for depression reported one visit . Notably, that study also documented strong correlations between mental health scores for depression and anxiety and perceived barriers to care …”

Section: Discussionmentioning

confidence: 72%

“…Little is known about the prevalence, spectrum of severity, and outcomes (e.g., patterns of health care utilization) of MDD in the adult ED population. A few small to moderately sized studies utilized single‐question, paper short‐form or self‐administered computer‐based short‐form screening instruments, resulting in MDD prevalence estimates of 16% to 32%. One large study of 5,641 adult ED patients utilizing the Patient Health Questionnaire (PHQ‐9) classified approximately 23% of ED patients as moderately to severely depressed .…”

Section: Introductionmentioning

confidence: 99%

“…None of these reports have addressed the spectrum of MDD symptom severity for those patients who screen positive. Also, only one small study has documented the link between depression severity and ED visits in the general adult population . Consequently, there is significant uncertainty regarding the true burden of MDD in the ED population.…”

Section: Introductionmentioning

confidence: 99%

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Depression in Emergency Department Patients and Association With Health Care Utilization

Beiser

Ward

et al. 2019

Academic Emergency Medicine

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Background: Depression is one of the most common illnesses in the United States, with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the emergency department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a nonpsychiatric ED population and its association with subsequent ED visits and hospitalizations.Methods: This prospective cohort study enrolled a convenience sample of English-speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015, and September 21, 2015.Patients completed a computerized adaptive depression diagnostic screen (CAD-MDD) and dimensional depression severity measurement test (CAT-DI) via tablet computer. Primary outcomes included number of ED visits and hospitalizations assessed from index visit until January 1, 2016. Negative binomial regression modeling was performed to assess associations between depression, depression severity, clinical covariates, and utilization outcomes.Results: Of 999 enrolled patients, 27% screened positive for MDD. The presence of MDD conveyed a 61% increase in the rate of ED visits (incidence rate ratio [IRR] = 1.61, 95% confidence interval [CI] = 1.27 to 2.03) and a 49% increase in the rate of hospitalizations (IRR = 1.49, 95% CI = 1.06-2.09). For each 10% increase in MDD severity, there was a 10% increase in the relative rate of subsequent ED visits (IRR = 1.10, 95% CI = 1.04 to 1.16) and hospitalizations (IRR = 1.10, 95% CI = 1.02 to 1.18). Across the range of the severity scale there was over a 2.5-fold increase in the rate of ED visits and hospitalization rates.Conclusions: Rates of depression were high among a convenience sample of English-speaking adult ED patients presenting with nonpsychiatric complaints and independently associated with increased risk of subsequent ED utilization and hospitalization. Standardized assessment tools that provide rapid, accurate, and precise classification of MDD severity have the potential to play an important role in identifying ED patients in need of urgent psychiatric resource referral.From the

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Depression in Emergency Department Patients and Association With Health Care Utilization

Beiser

Ward

et al. 2019

Academic Emergency Medicine

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“…There was evidence of a mild, but highly statistically significant linear association between the summary score of depression and anxiety level and age of study participants (Spearman's -Filho et al, 2009). In addition, depression and anxiety have been reported to be high among patients attending the emergency departments (Abar et al, 2017). Hence, according to a recent study, severe anxiety was observed in 10% of the patients, whereas moderately severe or severe depression was observed in 12% of the patients (Abar et al, 2017).…”

Section: 7 Respectively)mentioning

confidence: 98%

Depression, anxiety and socio-demographic factors among hospitalized patients in Gjakova region, Kosovo

Jerliu¹,

Kamberi²,

Sefa³

et al. 2019

JOSHA

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Aim: The aim of our study was to assess the level and selected socio-demographic correlates of depression and anxiety among hospitalized adult patients in transitional Kosovo. Results: Mean summary score of the 16 items related to depression and anxiety level among hospitalized patients was 41.4±16.6; median score was 41 (interquartile range: 27-57). In multivariable-adjusted models, mean summary score of depression and anxiety level was higher among older patients, participants with low educational attainment, those with a low-income level, and individuals residing in urban areas. Conclusion: The study reveals a relatively high level of depression and anxiety among hospitalized adult patients in a major region of transitional Kosovo, especially among individuals pertinent to the low socioeconomic group. These findings should raise the awareness of policymakers and decision-makers in Kosovo in order to design appropriate strategies and implement effective programs. josha.org

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Computer adaptive testing to assess impairing behavioral health problems in emergency department patients with somatic complaints

et al. 2022

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Objectives To assess: (1) the prevalence of mental health and substance use in patients presenting to the emergency department (ED) through use of a computer adaptive test (CAT‐MH), (2) the correlation among CAT‐MH scores and self‐ and clinician‐reported assessments, and (3) the association between CAT‐MH scores and ED utilization in the year prior and 30 days after enrollment. Methods This was a single‐center observational study of adult patients presenting to the ED for somatic complaints (97%) from May 2019 to March 2020. The main outcomes were computer‐adaptive‐assessed domains of suicidality, depression, anxiety, post‐traumatic stress disorder (PTSD), and substance use. We conducted Pearson correlations and logistic regression for objectives 2 and 3, respectively. Results From a sample of 794 patients, the proportion of those at moderate/severe risk was: 24.1% (suicidality), 8.3% (depression), 16.5% (anxiety), 12.3% (PTSD), and 20.4% (substance use). CAT‐MH domains were highly correlated with self‐report assessments (r = 0.49–0.79). Individuals who had 2 or more ED visits in the prior year had 62% increased odds of being in the intermediate‐high suicide risk category (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.07–2.44) compared to those with zero prior ED visits. Individuals who scored in the intermediate‐high‐suicide risk group had 63% greater odds of an ED visit within 30 days after enrollment compared to those who scored as low risk (OR, 1.63; 95% CI, 1.09, 2.44). Conclusion The CAT‐MH documented that a considerable proportion of ED patients presenting for somatic problems had mental health conditions, even if mild. Mental health problems were also associated with ED utilization.

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Depression and Anxiety Among Emergency Department Patients: Utilization and Barriers to Care

Cited by 27 publications

References 9 publications

Depression in Emergency Department Patients and Association With Health Care Utilization

Depression in Emergency Department Patients and Association With Health Care Utilization

Depression, anxiety and socio-demographic factors among hospitalized patients in Gjakova region, Kosovo

Computer adaptive testing to assess impairing behavioral health problems in emergency department patients with somatic complaints

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