“Frequent Flyers” in Emergency Department More Likely to Have Depression

Individuals who have sought treatment at the emergency room more than three times in the past year, and individuals with symptoms lasting at least two weeks, have about three times greater risk of depression than patients without these characteristics, found a new study.

“We found a strong correlation between complaints with symptomatology of two weeks or longer and multiple ED visits,” the authors wrote. “Within EDs, physical symptoms are often misinterpreted as having an organic origin while mental illnesses, such as depression, may be the underlying cause or exacerbating the patient’s complaint.”

The authors cited past research estimating that 6 in 10 patients with depression do not get diagnosed, while between one-quarter and one-third of ED patients have depression.

Kris Brickman, MD, and his colleagues from the University of Toledo Medical Center administered the Beck Depression Inventory-II to 425 patients who presented to The University of Toledo Medical Center Emergency Department over a six-month period. While the majority (58%) of the patients had no or minimal depression, 15% had mild depression, 20% had moderate depression, and 8% had severe depression — these data are in line with previously reported findings. Self-reported depression risk increased along with age, which was an average 32 years across a sample ranging from 23 to 44 years old.

The researchers then compared these screening results with the patients’ demographics, medical history, and the specific history of their current illness complaint. About 1 in 5 patients (22%) who were screened had symptoms lasting at least two weeks, and approximately half of these 92 patients presented with mild to severe depression according to the BDI-II. However, of those 47 individuals showing mild to severe depression, only 9 had been previously diagnosed with depression.

Those patients with symptoms lasting at least two weeks also visited the emergency room three times as often as patients with acute complaints. In addition, patients with mild to severe depression visited the emergency room three times more often, compared to those without depression. Because those assessed in this study were a convenience sample, it’s unclear how generalizable the findings are.

“EDs have become the safety net for many who seek treatment for chronic medical issues,” Brickman’s team notes. “With a significant percentage of the U.S. population visiting the ED each year due to a lack of access to a primary source of healthcare, detecting depression in the ED is of utmost importance.”

Reference

Brickman KR, Bahl R, Marcinkowski NF, et al. ED patients with prolonged complaints and repeat ED visits have an increased risk of depression. West J Emerg Med. 2016;17(5):613-616.