Impact of depressive illness on emergency department recidivism: a new approach to the “frequent flyer”

Study objectives: Recent articles have found an increasing rate in depressive illness and the successful use of a 2-question case-finding instrument for depression screening (2DEP?). Repeated emergency department (ED) visits for nonemergency causes and chronic problems have been previously addressed. No study has screened for a depressive illness link as a causation for these patients seeking frequent ED care. This study evaluates the relationship between screening results for depression and frequency of ED repeated visit. Methods: This institutional review board–approved, prospective survey evaluated all ED patients presenting during 10 consecutive days in randomized 6-hour blocks, with all hours equally represented. Adult patients presenting awake, alert, not in extremis, and without a psychiatric complaint were included and asked to answer 2DEP?. Patient characteristics, chief complaints, length of stay, number of visits during the past 12 months, and final diagnoses were included in analyses. Results: A total of 370 patients were included, with 54% female patients and a mean age of 42.3 years. These patients had a mean 2.7 (95% confidence interval 2.3 to 3.1) ED visits in the previous 12 months. Thirty-three percent of patients answered affirmative to both depression screening questions, and 44.2% of patients answered negatively to both questions, with 55.8% answering affirmatively to at least 1 question. The frequency of ED visits and depression screening correlated well (P=.75). Patients answering yes to both 2DEP? had a mean 3.3 visits, 1 positive response had 2.8 annual visits, and no positive responses had 1.5 annual visits (2-tailed χ2=0.011). The severity of visits did not differ between these 3 groups according to length of stay and mortality data. Conclusion: Despite being tested at a single institution, depression screening was found to predict ED patient return visits, with a high likelihood for nonemergency causes. After confirmation of these results in a multicenter study, antidepressant treatment and psychiatric referral may reduce the problem of ED patient recidivism.