Socioeconomic and health status differences between depressed and nondepressed ED elders

doi:10.1053/ajem.2002.30097

The American Journal of Emergency Medicine

Volume 20, Issue 2, March 2002, Pages 71-73

Presented at the Society for Academic Emergency Medicine Annual Meeting San Francisco, CA, May 2000.

https://doi.org/10.1053/ajem.2002.30097 Get rights and content

Abstract

The objective of the study was to describe differences in demographics, medical conditions, and social situation between depressed and nondepressed elderly emergency department (ED) patients. We studied a prospective convenience sample of English-speaking ED patients ≥ 65 years, without altered mental status, obvious dementia or delirium, participating in a depression screening study during an ED visit for a nonpsychiatric complaint. Demographics were collected. Research personnel administered the Geriatric Depression Scale (GDS), the Folstein Mini-Mental State Examination and a health questionnaire. A total of 103 subjects were enrolled. GDS identified 33 patients (32%) with DEP. DEP patients were more likely to report the following: lower income, lower education level, more medical conditions, less independence, assisted living, and poorer overall health than ND patients. A third of these elderly ED patients report symptoms consistent with depression. There are significant differences in socioeconomic characteristics, health status, and functional ability. Future depression studies should focus on elders with these characteristics. (Am J Emerg Med 2002;20:71-73. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Section snippets

Methods

This was a prospective, convenience sample of patients 65 years of age and older, participating in an ED depression screening study. Data were collected daily between 9 AM and 10 PM over a 6-month consecutive period at an urban, university, tertiary care hospital ED with 65,000 annual visits. Excluded patients were those with altered mental status, obvious dementia, medical extremis, impaired hearing, or those presenting with a psychiatric chief complaint. The study was approved by the hospital

Results

During times the RA was available, a total of 148 patients were eligible. Of these, 20 refused to participate, 14 were discharged before the RA was able to request consent, 5 were enrolled but then refused to answer further questions, 5 had language barriers, and 1 had a severe hearing impairment. Therefore, 103 subjects supplied data for analysis. Of these, 33 (32%) had a GDS score ≥10 and were considered depressed. The remaining 70 (68%) patients had GDS scores <10 and were used as the

Discussion

A third of the elder ED patients in our study were depressed. This number is similar to that reported in other community settings, including the limited number of studies performed on ED patients.5, 6, 7, 22 Clearly, depression in the elderly is a significant problem that needs to be identified and addressed.

Although Meldon et al reported no clinical characteristics that predict depression in elderly ED patients, we found several demographic, medical, and social variables that occur with

Conclusions

The prevalence of depression in these elderly ED patients is consistent with previous reports of depression in other outpatient settings. There are significant differences in socioeconomic characteristics, health status, and functional ability between depressed and nondepressed ED elders. ED physicians should be aware of these differences to increase recognition of geriatric depression. Identification of elders at risk for depression should become a priority for ED practitioners.

Acknowledgements

The authors thank Eric Anderson, James Boswell, Daniel Choi, Chirag Desai, Glen Pearlstein, Shalini Sood, David Schonbrun, Matt Waxman, and the staff of the Emergency Department of Albany Medical Center for their help with data collection. They also thank Terry L. Peters, MS for her assistance with data analysis.

References (23)

AT Beekman et al.
Major and minor depression in later life: A study of prevalence and risk factors
J Affect Disord
(1995)
SW Meldon et al.
Depression in geriatric ED patients: Prevalence and recognition
Ann Emerg Med
(1997)
AB Sanders
Care of the elderly in emergency departments: Conclusions and recommendations
Ann Emerg Med
(1992)
SW Meldon et al.
Recognition of depression in geriatric ED patients by emergency physicians
Ann Emerg Med
(1997)
MF Folstein et al.
“Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician
J Psychiatric Res
(1975)
JA Yesavage et al.
Development and validation of a geriatric depression screening scale: a preliminary report
J Psychiatr Res
(1983)
SW Meldon et al.
Utility of clinical characteristics in identifying depression in geriatric ED patients
Am J Emerg Med
(1999)
NIH Consensus Development Panel on Depression in Late Life
Diagnosis and treatment of depression in late life
JAMA
(1992)
WE Broadhead et al.
Depression, disability days, and days lost from work in a prospective epidemiologic survey
JAMA
(1990)
J Unutzer et al.
Depressive symptoms and the cost of health services in HMO patients aged 65 years and older
JAMA
(1997)

J Garrard et al.

Clinical detection of depression among community-based elderly people with self reported symptoms of depression

J Gerontology

(1998)

Cited by (23)

Dietary lipids and geriatric depression scale score among elders: The EPIC-Greece cohort
2009, Journal of Psychiatric Research
Citation Excerpt :
Older age was found to be a risk factor, as has been noted in several other studies (Snowdon, 2001). Another socio demographic factor that has been reportedly associated with depression is education in cross-sectional studies (Raccio-Robak et al., 2002; Papadopoulos et al., 2005). There was a statistically non-significant negative association of education and GDS score.
In a prospective epidemiological investigation aiming to identify dietary lipids potentially associated with affective state and depression, 610 healthy men and women aged 60 years or older, participating in the EPIC-Greece cohort and residing in the Attika region had dietary, sociodemographic, anthropometric, medical and lifestyle variables ascertained at enrollment. Six to 13 years later, affective state was evaluated through the 15-point geriatric depression scale (GDS) score along with cognitive function and medical variables. In multivariate linear regression analysis, while adjusting for potential confounders, GDS score was negatively associated with dietary intake of monounsaturated lipids (MUFA) and their main source, olive oil, and positively associated with intake of polyunsaturated lipids (PUFA) and one of their principal sources, seed oils. Intake of calories, total lipids, fish and seafood or saturated lipids did not exhibit significant association with GDS. Potential non-linearities were assessed by quantile multivariate regression analysis: The median GDS score was positively associated with PUFA and seed oils intake, while other lipid groups showed no appreciable associations. The 90th percentile of the GDS score (towards the high end) exhibited significant negative associations with MUFA and olive oil, weaker positive associations with PUFA and seed oils and no appreciable association with other lipid group dietary intakes. We conclude that among Attika elders, lower intake of seed oils and higher intake of olive oil prospectively predict a healthier affective state. Olive oil intake, in particular, predicts a lower chance of scoring in the highest part of the GDS.
Mood disorder screening among adult emergency department patients: a multicenter study of prevalence, associations and interest in treatment
2008, General Hospital Psychiatry
Citation Excerpt :
The successes observed with depression screening in outpatient settings, combined with the ED's vital role in identifying and intervening with diseases among segments of the population who would not otherwise find care, have led to further calls for increased attention to depression in the ED [9]. Several prospective, ED-based studies have discovered very high rates of mood disorders, with approximately one-quarter to one-third of patients screening positive [10–15]. Schriger et al. [15] studied a sample of 190 ED patients presenting with vague or longstanding somatic complaints and found that 26% of their sample screened positive for a mood disorder.
Planning for emergency department (ED)-initiated interventions for mood disorders requires confirmation of prevalence data, identification of predictors, and an assessment of patient interest in such interventions.
For two 24-h periods, consecutive patients aged 18+ years presenting to four Boston EDs were enrolled. We collected data on demographics, medical history, psychiatric history, healthcare utilization, depressive symptoms, manic symptoms and interest in hypothetical ED-initiated interventions. Patients with severe illness, altered mental status or severe emotional disturbance were excluded.
Of 476 screened patients, 152 (32%; 95% CI, 28–36%) screened positive for depression and 17 (4%; 95% CI, 2-6%) for mania. Depressed patients were more likely than nondepressed patients (all P<.01) to have income <20,000/year (43% vs. 25%), a substance abuse history (19% vs. 5%), a chronic medical condition (67% vs. 53%), use tobacco (42% vs. 22%), have at least one ED visit in the past 6 months (76% vs. 56%) and have at least one hospitalization for substance abuse in the past 6 months (5% vs. 1%). About 50% of patients who screened positive for any mood disorder were interested in at least one ED-based intervention.
ED patients screening positive for mood disorder symptoms are likely to have complex psychiatric, medical and social histories, which will be necessary to take into account when designing ED-initiated interventions.
A depression screen and intervention for older ED patients
2007, American Journal of Emergency Medicine
Citation Excerpt :
Our study contributes to the limited data that are currently available regarding older ED patients with depression. Although there are several studies addressing the prevalence and/or recognition of depression in older ED patients [1,5,18], to the best of our knowledge, there has been only 1 prior study published as part of a larger-scale intervention involving this population [13]. The substantial prevalence of depression in our population is in concordance with prior studies.
The objectives of this study were to determine the effect of screening examinations for depression on the care of older emergency department (ED) patients and to assess recognition of depression by emergency physicians (EPs). This was a prospective interventional study of 267 patients 70 years or older. Patients were screened for depression using the Short-Form Geriatric Depression Scale, and the results were presented to EPs after assessing EP recognition of depression. The prevalence of depression was 16.5% (44/267; 95% confidence interval, 12.0%-20.9%). Fifteen (34.1%) of 44 patients with depression were recognized by EPs as being depressed. Screening results did not alter care in any of the 44 patients with depression. No patients were given referrals or discharge instructions specifically to address depression. Depression is highly prevalent and poorly recognized in older ED patients. Use of the Short-Form Geriatric Depression Scale did not alter care of older patients with depression.
Identification of depression in an inner-city population using a simple screen
2005, Academic Emergency Medicine
The purpose of this study was to compare a brief screening tool with physicians' usual practice in detecting depressive symptoms in patients presenting with somatic complaints to an inner-city emergency department. Depression is a major cause of morbidity and mortality in the United States. Underprivileged patients who rely on emergency departments for primary care remain at risk for undetected depression.
This prospective observational study included all patients older than 18 years presenting to an urgent care clinic staffed by emergency physicians in an urban public hospital during an eight-week period. Clinically unstable patients and those with a chief complaint of depression were excluded. After consenting, patients completed a previously validated two-question screening tool for depression. Patients identified as having depressive symptoms were referred to social workers for evaluation for possible psychiatric intervention.
Of the 226 patients enrolled, 55% (124/226; 95% confidence interval [CI] = 48% to 61%) screened positive for depressive symptoms. Physicians identified 14% (31/226; 95% CI = 10% to 19%) as having depressive symptoms. The κ value was 0.22 (95% CI = 0.14 to 0.29). All patients but one identified as positive by the physicians screened positive on the screening tool. Patients who screened positive were referred to social workers. The physicians failed to identify 19 of the patients who needed further psychiatric care.
Depressive symptoms are common among patients in urgent care settings with somatic complaints. A simple screening tool identified more patients for further evaluation than does physicians' usual practice.
A multicenter study of depression among emergency department patients
2004, Academic Emergency Medicine
Citation Excerpt :
The 12-month prevalence of depression as reported by ED patients was 30%, about five times greater than one national community-based estimate of 6.6% for major depressive disorder.1 We have not found similar studies measuring the overall prevalence of depression in the ED, but our results are in accordance with studies of geriatric depression in the ED that have reported prevalence rates of 27% and 33%.8,21 Our results not only demonstrate that the 12-month prevalence of depression is elevated among ED patients but also identify several factors associated with depression.
The authors sought to determine the 12-month prevalence of depression among emergency department (ED) patients using a single-question screen.
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.
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.
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.
The relationship between Comprehensive Geriatric Assessment parameters and depression in elderly patients
2022, Frontiers in Aging Neuroscience

View all citing articles on Scopus

^*: Address reprint requests to Mara McErlean, MD, Department of Emergency Medicine MC-139, Albany Medical College, 43 New Scotland Ave, Albany, NY 12208. E-mail: [email protected]

^**: 0735-6757/02/2002-0001$35.00/0

View full text

Original ContributionsSocioeconomic and health status differences between depressed and nondepressed ED elders*,**

Abstract

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgements

J Affect Disord

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

J Psychiatric Res

J Psychiatr Res

Am J Emerg Med

Diagnosis and treatment of depression in late life

JAMA

Depression, disability days, and days lost from work in a prospective epidemiologic survey

JAMA

Depressive symptoms and the cost of health services in HMO patients aged 65 years and older

JAMA

Clinical detection of depression among community-based elderly people with self reported symptoms of depression

J Gerontology

Original Contributions
Socioeconomic and health status differences between depressed and nondepressed ED elders*,**