RT Journal Article
SR Electronic
T1 Social determinants of health and depression in adults presenting to the emergency department
JF Canadian Family Physician
JO Can Fam Physician
FD The College of Family Physicians of Canada
SP e337
OP e347
DO 10.46747/cfp.6712e337
VO 67
IS 12
A1 Shyman, Lilian
A1 Sukhorukov, Roman
A1 Barbic, David
A1 Mathias, Steve
A1 Chau, Shannon
A1 Leon, Adelena
A1 Barbic, Skye
YR 2021
UL http://www.cfp.ca/content/67/12/e337.abstract
AB Objective To estimate the extent to which social determinants of health (SDH) predict levels of depression in adults presenting to the emergency department (ED) with an acute mental health crisis.Design Secondary data analysis.Setting St Paul’s Hospital, an urban tertiary care hospital in Vancouver, BC.Participants Patients 19 years and older presenting to the ED with an acute mental health crisis.Main outcome measures Responses to demographic questionnaires focused on SDH and to measures of self-perceived health and depression. Relationships between depression and SDH were described using t tests and χ2 tests. The extent to which SDH variables predicted depression scores, as measured by the Patient Health Questionnaire–9 (PHQ-9), was determined using linear regression.Results The primary study had 202 participants. Data for the 156 (77%) participants who completed the PHQ-9 were assessed in this secondary analysis. In this sample, 60% of participants identified as men, 37% as women, and 4% as other. The mean (SD) age was 39.1 (13.8) years, with most participants identifying as white (65%) or Indigenous (18%). Thirty-seven percent had a high school diploma or less education, and 72% reported being unemployed. Identifying as a woman, lack of access to clean drinking water, poor food security, feeling unsafe, little structured use of time, lack of a sense of community, and dissatisfaction with housing significantly predicted higher depression scores. Overall, 59% of respondents met the criteria for moderately severe or severe depression (PHQ-9 score ≥ 15), with 37% of those reporting thoughts of suicide nearly every day for the past 2 weeks.Conclusion This study demonstrates the importance of screening for both depression and SDH in the ED. Because the ED often does not have the capacity to address appropriate levels of follow-up for this population, this study has important implications for primary care. Developing a clear pathway of follow-up support for people with depression and SDH risk factors will be critical to optimize patient outcomes, promote patient safety, enhance patient satisfaction, and optimize the use of resources between the ED and primary care.