title: Depression and doctor-patient communication in the emergency department.
abstract: Depression may adversely affect health outcomes by influencing doctor-patient communication. We aimed to determine the association between depressive symptoms and doctor-patient communication among patients presenting to the emergency department (ED) with a suspected acute coronary syndrome (ACS).
  
  
  
  We enrolled a consecutive sample of 500 patients evaluated for ACS symptoms from the ED of an urban medical center. Depressive symptoms (8-item Patient Health Questionnaire, PHQ-8) and doctor-patient communication in the ED (Interpersonal Processes of Care) were assessed during hospitalization. Logistic regression was used to determine the association between depressive symptoms and doctor-patient communication, adjusting for age, sex, race, ethnicity, education, language, health insurance status and comorbidities.
  
  
  
  Compared to nondepressed patients, depressed patients (PHQ-8≥10) were more likely (P<.05) to report suboptimal communication on five of seven communication domains: clarity, elicitation of concerns, explanations, patient-centered decision making and discrimination. A greater proportion of depressed versus nondepressed patients reported suboptimal overall communication (39.8% versus 22.9%, P<.001). In adjusted analyses, depressed patients remained more likely to report suboptimal doctor-patient communication (adjusted odds ratio 2.42, 95% confidence interval 1.52-3.87; P<.001).
  
  
  
  Depressed patients with ACS symptoms reported less optimal doctor-patient communication in the ED than nondepressed patients. Research is needed to determine whether subjectively rated differences in communication are accompanied by observable differences.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA.
authors.forename: Mytra
authors.initials: M
authors.lastname: Haerizadeh
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Moise
authors.affiliation: Department of Emergency Medicine, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA.
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Chang
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA. Electronic address: ik2293@cumc.columbia.edu.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology*; D000328:Adult; D000368:Aged; D003142:Communication; D003863:Depression / Q000523:psychology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations
keywords: Cardiovascular disease; Depression; Doctor–patient communication; Emergency department