Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 878-888 |
| Number of pages | 11 |
| Journal | Academic Emergency Medicine |
| Volume | 26 |
| Issue number | 8 |
| DOIs | |
| State | Published - 2019 |
Funding
From the 1Section of Emergency Medicine, the 3Section of Emergency Medicine, Department of Medicine, the 4Section of General Internal Medicine, and the 5Center for Health Statistics, Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL; and the 2Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL. Ms. Vu is currently at Rollins School of Public Health, Emory University, Atlanta, GA. Received November 13, 2018; revision received March 7, 2019; accepted March 12, 2019. Presented at the Society for Academic Emergency Medicine Annual Meeting, New Orleans, LA, May 12, 2016 and the Academy Health Annual Research Meeting, June 27, 2016. The authors have no relevant financial information or potential conflicts to disclose. RDG was supported by R01-MH66302 from the National Institute of Mental Health. NL was funded by K23 DK092783 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). CEW was supported by 4T32HS000084-18 from the Agency for Healthcare Research and Quality (AHRQ). RDG is a founder of Adaptive Testing Technologies, which distributes the CAT-MDD and CAT-DI instruments. Author contributions: DGB, RDG, and NL conceived of the study and designed the protocol; DGB supervised the overall conduct of the study and data quality control; MV coordinated the patient recruitment workforce and managed the data; CEW, RDG, and DGB provided statistical advice on study design and analyzed the data; DGB drafted the manuscript; all authors contributed substantially to its revision; and DGB takes responsibility for the paper as a whole. Supervising Editor: Damon R. Kuehl, MD. Address for correspondence and reprints: David G. Beiser; e-mail: [email protected]. ACADEMIC EMERGENCY MEDICINE 2019;26:878–888.
ASJC Scopus subject areas
- Emergency Medicine
