Identification of depression in an inner-city population using a simple screen.
OBJECTIVE
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.


METHODS
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.


RESULTS
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 kappa 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.


CONCLUSIONS
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.
Haughey
Marianne T
MT
Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY 10461, USA. mthaughey@yahoo.com
Calderon
Yvette
Y
Torres
Sandra
S
Nazario
Steven
S
Bijur
Polly
P
D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D004635:Emergency Medicine / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation* / Q000379:methods*; D009519:New York City / Q000453:epidemiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014505:Urban Population / Q000706:statistics & numerical data