Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older

BMC Psychiatry

Mark E Kunik¹  Martha L Bruce²  C Nathan Marti³  Namkee G Choi³ 

[1] VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA;Weill Cornell Medical College, White Plains, NY, USA;The University of Texas at Austin, Austin, TX, USA

关键词: Emergency department;    Depression;    Homebound older adults;   

Others  :  1124199
DOI  :  10.1186/1471-244X-12-233

 received in 2012-06-20, accepted in 2012-12-21,  发布年份 2012

【 摘 要 】

Background

Previous research found a high prevalence of depression, along with chronic illnesses and disabilities, among older ED patients. This study examined the relationship between depressive symptom severity and the number of ED visits among low-income homebound older adults who participated in a randomized controlled trial of telehealth problem-solving therapy (PST).

Methods

The number of and reasons for ED visits were collected from the study participants (n=121 at baseline) at all assessment points—baseline and 12- and 24-week follow-ups. Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). All multivariable analyses examining the relationships between ED visits and depressive symptoms were conducted using zero-inflated Poisson regression models.

Results

Of the participants, 67.7% used the ED at least once and 61% of the visitors made at least one return visit during the approximately 12-month period. Body pain (not from fall injury and not including chest pain) was the most common reason. The ED visit frequency at baseline and at follow-up was significantly positively associated with the HAMD scores at the assessment points. The ED visit frequency at follow-up, controlling for the ED visits at baseline, was also significantly associated with the HAMD score change since baseline.

Conclusions

The ED visit rate was much higher than those reported in other studies. Better education on self-management of chronic conditions, depression screening by primary care physicians and ED, and depression treatment that includes symptom management and problem-solving skills may be important to reduce ED visits among medically ill, low-income homebound adults.

Trial registration

ClinicalTrials.gov Identifier: NCT00903019

【 授权许可】

   
2012 Choi et al.; licensee BioMed Central Ltd.

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