ED Patients with Prolonged Complaints and Repeat ED Visits Have an Increased Risk of Depression

Abstract

IntroductionThe objective of this study was to explore associations between presenting chief complaints of prolonged symptomatology, patient usage of the emergency department (ED), and underlying depression so that emergency physicians may better target patients for depression screening.MethodsA convenience sample of ED patients were administered the Beck Depression Inventory-II (BDI-II) to assess for depression. We correlated completed BDI-II surveys to patient information including demographics, pertinent history of present illness information, and past medical history.ResultsOut of 425 participants screened, we identified complaints of two weeks or longer in 92 patients (22%). Of these patients, mild to severe depression was recognized in over half of the population (47), yet only nine patients reported a prior depression diagnosis. These 92 patients also visited the ED three times as frequently as those patients with more acute complaints (p<0.001). Finally, our study showed that patients with mild to severe depression had three times as many ED visits compared to patients with minimal or no depression (p<0.001).ConclusionPatients with complaints of symptomatology two weeks or longer are more likely to have underlying depression when presenting to the ED. Patients with three or more ED visits within the past year also have a greater incidence of underlying depression. We found a strong correlation between complaints with symptomatology of two weeks or longer and multiple ED visits, in which underlying depression may have contributed to these patients’ ED visits.

Occult Suicidality and Psychiatric Disease Among Emergency Department Patients with Low-acuity Chief Complaints

“…These results are consistent with prior studies describing the under-diagnosis of depression and other mental health disorders among ED patients, 15 , 16 along with the presence of passive suicidal ideation among approximately 6%–12% of patients who are evaluated in the ED for non-psychiatric reasons. 5 , 6 , 13 , 17 The effectiveness of ED-based screening programs can be improved through the use of performance improvement methodologies, as well as careful training of the staff members who perform these screenings.…”