Mental Health

Emergency department clinicians rarely address depression

Identifying a patient with depression is often missed amid the bustling activity of an emergency department (ED). Yet that environment may be a good venue for detecting it, a new study finds. Karin V. Rhodes, M.D., M.S., and colleagues from the University of Pennsylvania reviewed audio recordings of conversations between providers and 871 women aged 18 to 65 who visited either a city or suburban hospital's ED between June 2001 and December 2002.

Of the 486 women randomized to complete a health risk survey on a computer, nearly half of them (48 percent) reported they felt sad or depressed for more than 2 weeks during the past month, and 28 percent said they felt sad or depressed for most of the prior 2 weeks. Providers were more likely to address depression and other psychosocial issues when the patient self-disclosed these risk factors on the computer. However, even when prompted to do so by the computer, providers addressed depression with only 70 patients (8 percent) and had significant discussions with only 20 patients (2 percent).

It was not uncommon for ED providers to dismiss a patient's concerns, be judgmental, interrupt their response, or ask multiple questions at one time. On a positive note, in most significant discussions, providers expressed empathy (85 percent) and asked well-worded sensitive questions (90 percent). When ED providers did address depression, they generally spent less than 90 seconds. However, even this minimal attention to depression was associated with improved patient satisfaction.

Considering the volume of patients who move through emergency departments, the authors suggest that emergency department providers can do more to identify patients with depression and link them to appropriate mental health resources. This study was funded in part by the Agency for Healthcare Research and Quality (HS11096).

See "Characterizing emergency department discussions about depression," by Dr. Rhodes, Hallie M. Kushner, M.A., Joanna Bisgaier, B.A., and Elizabeth Prenoveau, B.A., in the October 2007 Academic Emergency Medicine 14(10), pp. 908-11.

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