A multicenter study of depression among emergency department patients

Objectives: The authors sought to determine the 12-month prevalence of depression among emergency department (ED) patients using a single-question screen. Methods: This cross-sectional study was conducted in four Boston-area EDs. For two 24-hour periods, consecutive patients aged 18 years or older were interviewed, excluding those who were severely ill, potential victims of sexual assault, or emotionally disturbed. During the interview, patients were asked "Have you had any of the following problems during the past 12 months?" Patients answered "yes" or "no" to a list of health problems that included depression. In a validation study, the authors found that this simple approach correlated well with results from the validated Center for Epidemiologic Studies Depression Scale. Results: Of 752 eligible patients, 539 (72%) were interviewed. Of these patients, 30% (95% confidence interval = 26% to 34%) reported depression within the past 12 months. Compared with their nondepressed counterparts, depressed patients were more likely middle-aged, female, and of lower socioeconomic status. Depressed patients were more likely to be smokers and to report a diagnosis of asthma or arthritis/ rheumatism. In a multivariate analysis, factors that were independently associated with depression were lower level of education, smoking, and self-reported anxiety, chronic fatigue, and back problems. Conclusions: A 30% 12-month prevalence of depression among ED patients was found. Depressed patients had a distinct sociodemographic and health profile. In the future, awareness of risk factors for depression in the ED setting and use of simple screening instruments could aid in the recognition of depression, with subsequent referral to mental health services.