Depression Symptoms and Risk Factors in Adult Emergency Department Patients: A Multisite Cross-Sectional Prevalence Survey

Objectives. To identify the proportion of adult emergency department (ED) patients who screen positive for depression. Secondary aims were to identify factors associated with a positive depression screen and determine predictors of a positive depression screen. Methods. This cross-sectional, prevalence survey of ED patients was conducted at two inner-city hospitals. 350 ED patients were screened for depression using the Patient Health Questionnaire-9 (PHQ-9). Clinical and demographic risk factors were examined through medical records and additional questionnaires. Results. Of 350 participants screened, 50 (14.3%; 95% CI = 11.0–18.4%) screened positive. Independent predictors of depression risk included self-reported depression and/or a previous diagnosis of depression (OR = 8.345; 95% CI = 3.524–19.762), seeing a mental health service provider in the past 6 months (OR = 4.518; 95% CI = 2.107–9.690), and previous discussion about mental health with a local doctor (OR = 2.369; 95% CI = 1.025–5.475). Conclusion. ED patients were found to be at a higher risk of depression than the general population. ED-based depression screening, particularly of high-risk populations, has the potential to increase case detection rates and allow earlier management of these patients. Further research and validation of an ED-based depression screening tool are required. 1. Introduction It is important to detect depression in the emergency department (ED). Depression may contribute to the clinical presentation via self-harm or somatisation; it may be an important focus for post-ED care, and even though its management is not usually the responsibility of the ED, ED staff can have an important role in informing patients of the nature of their problem and engaging them in appropriate care; and, like all health care sectors, the ED can contribute to the public health task of detecting depression, which is known to be widely underrecognised and undertreated. In detecting depression, the clinical assessment is primary, but screening using validated depression rating scales is an important complementary method. Depression is highly prevalent in the general population but almost certainly of greater prevalence in the ED population. In the general population, depression is the second leading cause of disability worldwide [1], a significant risk factor for suicide [1], and associated with increased comorbidity and mortality [2, 3], decreased adherence to medication and treatment [4], higher healthcare utilization and costs [4], and reduced quality of life [5]. In Australia, depression