Patients' and caregivers' beliefs about depression screening and referral in the emergency department.
OBJECTIVE
To explore patients' and parents'/caregivers' beliefs about the acceptability of universal depression screening in the emergency department (ED) and their perceptions of the barriers and facilitators to a mental health referral following a positive screen.


METHODS
We conducted semistructured interviews with 60 patients seeking care and 59 caregivers in the ED of an urban children's hospital. Interviews were audiotaped, transcribed, coded, and entered into N6 (version 6.0; QSR, Thousand Oaks, Calif) for coding and content analysis.


RESULTS
Patients and caregivers supported the idea of depression screening in the ED, generally viewing screening as a reflection of care and concern. Respondents reported apprehension about stigma, privacy, and provider sensitivity. Introducing the screening concept early in the visit and as part of routine care was believed to reduce stigma. Respondents generally indicated that although they would likely follow through with a referral if given, stigma and denial were viewed as significant barriers. Caregivers also reported that logistical problems such as transportation, insurance, and agency hours created barriers to help seeking, but this could be offset by social supports and information about the agency and the provider.


CONCLUSIONS
Patients and caregivers generally support depression screening in the pediatric ED but identified several barriers to screening and referral for treatment. Recommendations include introduction of universal screening early in the ED visit, provision of specific information about the meaning of screening results, and support from family and health care providers to help reduce stigma and increase referral acceptability.
Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, PA, USA. megan.pailler@roswellpark.org
Megan E
ME
Pailler
Peter F
PF
Cronholm
Frances K
FK
Barg
Matthew B
MB
Wintersteen
Guy S
GS
Diamond
Joel A
JA
Fein
D000293:Adolescent; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003144:Communication Barriers; D003469:Culture; D003863:Depression / Q000175:diagnosis* / Q000208:ethnology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D015143:Philadelphia / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires