Lilian Shyman1, Roman Sukhorukov2, David Barbic3, Steve Mathias4, Shannon Chau5, Adelena Leon6, Skye Barbic7. 1. Family physician in Kelowna, BC. 2. Family physician in Kamloops, BC. 3. Emergency physician at St Paul's Hospital in Vancouver, BC. 4. Psychiatrist at St Paul's Hospital and Executive Director of Foundry. 5. Graduate student in the Dietetics Program at the University of British Columbia (UBC) in Vancouver and was a co-op student for this study. 6. Research coordinator at UBC. 7. Health systems researcher, Research Lead at Foundry, and Assistant Professor in the Department of Occupational Science and Occupational Therapy at UBC. skye.barbic@ubc.ca.
Abstract
OBJECTIVE: To estimate the extent to which social determinants of health (SDH) predict levels of depression in adults presenting to the emergency department (ED) with an acute mental health crisis. DESIGN: Secondary data analysis. SETTING: St Paul's Hospital, an urban tertiary care hospital in Vancouver, BC. PARTICIPANTS: Patients 19 years and older presenting to the ED with an acute mental health crisis. MAIN OUTCOME MEASURES: Responses to demographic questionnaires focused on SDH and to measures of self-perceived health and depression. Relationships between depression and SDH were described using t tests and χ 2 tests. The extent to which SDH variables predicted depression scores, as measured by the Patient Health Questionnaire-9 (PHQ-9), was determined using linear regression. RESULTS: The primary study had 202 participants. Data for the 156 (77%) participants who completed the PHQ-9 were assessed in this secondary analysis. In this sample, 60% of participants identified as men, 37% as women, and 4% as other. The mean (SD) age was 39.1 (13.8) years, with most participants identifying as white (65%) or Indigenous (18%). Thirty-seven percent had a high school diploma or less education, and 72% reported being unemployed. Identifying as a woman, lack of access to clean drinking water, poor food security, feeling unsafe, little structured use of time, lack of a sense of community, and dissatisfaction with housing significantly predicted higher depression scores. Overall, 59% of respondents met the criteria for moderately severe or severe depression (PHQ-9 score ≥ 15), with 37% of those reporting thoughts of suicide nearly every day for the past 2 weeks. CONCLUSION: This study demonstrates the importance of screening for both depression and SDH in the ED. Because the ED often does not have the capacity to address appropriate levels of follow-up for this population, this study has important implications for primary care. Developing a clear pathway of follow-up support for people with depression and SDH risk factors will be critical to optimize patient outcomes, promote patient safety, enhance patient satisfaction, and optimize the use of resources between the ED and primary care.
OBJECTIVE: To estimate the extent to which social determinants of health (SDH) predict levels of depression in adults presenting to the emergency department (ED) with an acute mental health crisis. DESIGN: Secondary data analysis. SETTING: St Paul's Hospital, an urban tertiary care hospital in Vancouver, BC. PARTICIPANTS: Patients 19 years and older presenting to the ED with an acute mental health crisis. MAIN OUTCOME MEASURES: Responses to demographic questionnaires focused on SDH and to measures of self-perceived health and depression. Relationships between depression and SDH were described using t tests and χ 2 tests. The extent to which SDH variables predicted depression scores, as measured by the Patient Health Questionnaire-9 (PHQ-9), was determined using linear regression. RESULTS: The primary study had 202 participants. Data for the 156 (77%) participants who completed the PHQ-9 were assessed in this secondary analysis. In this sample, 60% of participants identified as men, 37% as women, and 4% as other. The mean (SD) age was 39.1 (13.8) years, with most participants identifying as white (65%) or Indigenous (18%). Thirty-seven percent had a high school diploma or less education, and 72% reported being unemployed. Identifying as a woman, lack of access to clean drinking water, poor food security, feeling unsafe, little structured use of time, lack of a sense of community, and dissatisfaction with housing significantly predicted higher depression scores. Overall, 59% of respondents met the criteria for moderately severe or severe depression (PHQ-9 score ≥ 15), with 37% of those reporting thoughts of suicide nearly every day for the past 2 weeks. CONCLUSION: This study demonstrates the importance of screening for both depression and SDH in the ED. Because the ED often does not have the capacity to address appropriate levels of follow-up for this population, this study has important implications for primary care. Developing a clear pathway of follow-up support for people with depression and SDH risk factors will be critical to optimize patient outcomes, promote patient safety, enhance patient satisfaction, and optimize the use of resources between the ED and primary care.
Authors: Harvey A Whiteford; Louisa Degenhardt; Jürgen Rehm; Amanda J Baxter; Alize J Ferrari; Holly E Erskine; Fiona J Charlson; Rosana E Norman; Abraham D Flaxman; Nicole Johns; Roy Burstein; Christopher J L Murray; Theo Vos Journal: Lancet Date: 2013-08-29 Impact factor: 79.321
Authors: Laura P Richardson; Elizabeth McCauley; David C Grossman; Carolyn A McCarty; Julie Richards; Joan E Russo; Carol Rockhill; Wayne Katon Journal: Pediatrics Date: 2010-11-01 Impact factor: 7.124