Depression in Emergency Department Patients and Association with Healthcare Utilization

• Type of Material: Article
• Authors: David G. Beiser, University of Chicago; Charlotte E. Ward, Northwestern University; Milkie Vu, Emory University; Neda Laiteerapong, University of Chicago; Robert D. Gibbons, University of Chicago
• Language: English
• Date: 2019-08-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 by the Society for Academic Emergency Medicine.
• Final Published Version (URL): http://dx.doi.org/10.1111/acem.13726
• Title of Journal or Parent Work: Academic Emergency Medicine
• Volume: 26
• Issue: 8
• Start Page: 878
• End Page: 888
• Grant/Funding Information: RDG is supported by R01-MH66302 from the National Institute of Mental Health.; Robert Gibbons is a founder of Adaptive Testing Technologies that distributes the CAT-MDD and CAT-DI instruments.; CEW is supported by 4T32HS000084-18 from the Agency for Healthcare Research and Quality (AHRQ).; NL is funded by K23 DK092783 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
• Keywords: healthcare utilization; computer adaptive testing; depression; behavioral health
• Research Categories: Health Sciences, Occupational Health and Safety; Biology, Biostatistics; Psychology, Behavioral; Computer Science

Abstract

Background Depression is one of the most common illnesses in the U.S., 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 non-psychiatric emergency department (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 (IRR=1.61, 95% CI: 1.27–2.03) 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 (incident rate ratio, IRR=1.10, 95% CI: 1.04–1.16) and hospitalizations (IRR=1.10, 95% CI: 1.02–1.18). 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 non-psychiatric 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.