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Anxiety and depression are unrecognised in emergency patients admitted to the observation care unit
  1. Franck Perruche1,
  2. Caroline Elie2,
  3. Marguerite d'Ussel1,
  4. Patrick Ray3,
  5. Frédéric Thys4,
  6. Gérard Bleichner5,
  7. Pierre-Marie Roy6,
  8. Jeannot Schmidt7,
  9. Albéric Gayet8,
  10. Dominique Pateron9,
  11. Etienne Le Joubioux10,
  12. Nicolas Porcher11,
  13. Pascale Gamand12,
  14. Yann-Erick Claessens1
  1. 1Department of Emergency Medicine, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
  2. 2Department of Biostatistics, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
  3. 3Department of Emergency Medicine, Hôpital Pitié-Salpétriêre, AP-HP, Université Paris Diderot, Paris, France
  4. 4Department of Emergency Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
  5. 5Department of Emergency Medicine, Centre Hospitalier Victor Dupouy, Argenteuil, France
  6. 6Department of Emergency Medicine, Centre Hospitalier Universitaire, Angers, France
  7. 7Department of Emergency Medicine, Hôpital Gabriel Montpied, Clermont-Ferrand, France
  8. 8Department of Emergency Medicine, Centre Hospitalier Universitaire Lariboisière, AP-HP, Paris, France
  9. 9Department of Emergency Medicine, Hôpital Saint-Antoine, AP-HP, Paris, France
  10. 10Department of Emergency Medicine, Hôpital Général, Lens, France
  11. 11Department of Emergency Medicine, Hôpital de Lagny, Lagny, France
  12. 12Department of Emergency Medicine, Centre Hospitalier Général, Meaux, France
  1. Correspondence to Dr Yann-Erick Claessens, Department of Emergency Medicine, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques F-75679, Paris, France and Université Paris Descartes, 15 rue de l'école de médecine F-75005, Paris, France; yann-erick.claessens{at}


Objective To assess the sensitivity and specificity of emergency physicians in detecting anxiety and depression in patients requiring admission to the emergency department (ED) observation care unit for complementary investigations/treatment.

Methods 339 consecutive patients admitted to the emergency observation care unit of 14 EDs were interviewed with standardised questionnaires. The characteristics of the patients, EDs and attending ED physicians were collected. Patients' anxiety and depression were identified using the Hospital Anxiety and Depression Scale (HADS), a self-administered questionnaire. ED physicians were blind to the HADS score and were asked to declare whether they perceived anxiety and depression in each patient. The judgement of ED physicians and the HADS score were compared using sensitivity, specificity, positive and negative likelihood ratios.

Results The HADS questionnaire was correctly completed by 310 patients who comprised the study population. HADS detected symptoms of anxiety in 148 patients (47%) and symptoms of depression in 70 patients (23%). ED physicians determined the presence or absence of anxiety with a sensitivity of 48% (95% CI 40% to 56%) and a specificity of 69% (95% CI 61% to 75%). Positive and negative likelihood ratios were 1.54 (95% CI 1.16 to 2.06) and 0.75 (95% CI 1.28 to 3.28) for anxiety. They detected the presence or absence of depression with a sensitivity of 39% (95% CI 28% to 51%) and a specificity of 78% (95% CI 72% to 83%). Positive and negative likelihood ratios were 1.75 (95% CI 1.20 to 2.56) and 0.78 (95% CI 1.26 to 3.87) for depression.

Conclusion Although patients presenting to the ED often experience anxiety and depression, these symptoms are poorly detected by ED physicians.

  • Anxiety
  • depression
  • emergency medicine
  • HADS
  • mental health
  • nursing
  • emergency departments

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  • Funding This study was funded and supported by the French Society of Emergency Medicine (Société Française de Médecine d'Urgence, SFMU). It was conducted on behalf of the SUPER study group: Yann-Erick Claessens, Franck Perruche, Marguerite d'Ussel (Hôpital Cochin Paris, France), Patrick Ray (Pitié-Salpêtrière, Paris, France), Frédéric Thys (Brussels, Belgium), Gérard Bleichner, Catherine Legall (Argenteuil, France), Pierre-Marie Roy (Angers, France), Jeannot Schmidt (Clermont-Ferrand, France), Albéric Gayet, Patrick Plaisance (Hôpital Lariboisière, Paris, France), Dominique Pateron (Hôpital Saint-Antoine, Paris, France), Etienne Le Joubioux (Lens, France), Philippe Grippon, Faris Laras (Fontainebleau, France), Fleur Jourda de Vaux de Chabanolles (Hôpital Saint-Joseph, Paris, France), Nicolas Porcher (Lagny, France), Pascale Gamand (Meaux, France), Ingrid Villafranca (Kremlin-Bicêtre, France), Aline Santin, Bertrand Renaud (Créteil, France), Pascale Nehl (Marseille, France).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the CPP Paris Centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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