Depression and anxiety among emergency department patients:Utilization and barriers to care

Abstract

Background

Anxiety and depression rates among ED patients are substantially higher than in the general population. Additionally, those with mental health issues often have difficulty accessing care. Unfortunately, issues of anxiety and depression are frequently not addressed in the ED due to competing care priorities. This may lead to increased burden and overcrowding in EDs.

Objective

This study related anxiety and depression with ED utilization and perceived barriers to care.

Methods

In order to limit the impact of insurance coverage on ED utilization and access to care, a convenience sample of adults 45-85 years of age in the ED were surveyed. The GAD-7 and PHQ-9 were used to measure anxiety and depression.

Results

A total of 251 subjects were enrolled. Severe anxiety was observed in 10% of patients, while moderately severe or severe depression was observed in 12%. Patients who were both severely anxious and depressed visited the ED nearly twice as often as non-anxious and non-depressed patients. The majority of patients cited at least one moderate barrier to care, and greater anxiety and depression scores were related to greater perceived barriers to care. Perceived barriers to care were > 3 times higher among patients who were both anxious and depressed compared to in patients who were neither depressed nor anxious and twice as high as in those who were either depressed or anxious (p<.001).

Conclusion

Patients identified with internalizing mental health concerns utilize the ED at elevated rates while also reporting the greatest difficulties accessing care. These findings highlight the need for ED interventions aimed at identifying patient mental health concerns, as well as perceived barriers to care, in order to design interventions to effectively improve continuity of care.

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