Summary of Methods Section
A secondary data analysis of a prospective cross-sectional survey of persons coming to the ED who were 19 years of age and older was done. Between August 31 and October 30, 2016, information was gathered from St. Paul’s Hospital in Vancouver, British Columbia, an urban tertiary care facility. An estimated 87000 patients visit this ED each year. The University of British Columbia Providence Health Care Behavioural Research Ethics Board approved this study’s ethical conduct.
Because the data were easily accessible to the research team and could be used to address the research topic, secondary data analysis was selected as the research methodology. With this strategy, the researchers could effectively maximize the use of this data and think through the best ways to apply our findings to primary care. Patients who arrived at St. Paul’s Hospital’s ED were among the participants.
The study team located patients using SunRise ED Manager, the department’s computerized tracking board. Social workers, psychiatric liaison nurses, emergency physicians, and nurses these patients were asked to determine their eligibility for the study and to get in touch with the research team if they did. Patients who presented with acute mental health concerns at triage and were 19 years of age or older were included in the criteria.
If a participant required immediate pharmacologic treatment and physical restrictions due to acute behavioral agitation, they were also excluded if they were unable to read or speak English. The emergency department physicians and nurses who determined that they nurses were not medically capable or could not complete the questionnaire package, or who had been admitted due to acute substance use were also excluded from the study.
For the main study, a trained research assistant approached eligible individuals and asked them if they would want to participate. If the patient was on board, the research assistant reviewed the consent form with them and got their written consent. After that, participants received a research packet with six questionnaires in it. Each survey contained a participant number that made it impossible to identify the respondent. Each participant received a thank-you card and an honorarium as payment for their time after completing the package, which the research assistant then collected.
Summary of Main Findings
This study’s goal was to ascertain the degree to which social determinants of health (SDH) predict the severity of depression in adults who report to the ED with an acute mental health crisis. Using the validated PHQ-9 threshold score of 15 or more, 59% of research participants were found to have depression, with women reporting more severe levels of depression. Half of the participants said they did not have enough money to take care of their basic requirements, and 56% of participants said they had previously been diagnosed with depression.
About half of the participants (52%) said they felt safe less than half the time, while the majority (69%) said they were concerned about food security or not having enough to eat. However, just 59% of respondents to our study reported engaging in more than 2 hours of scheduled meaningful activity each week. Each of these regions indicated the severity of depression.
Worldwide statistics, including Canadian data, indicate a connection between SDH and patient outcomes and mental health. Age and gender are non-modifiable SDH characteristics. However, housing, work, income, and education are. No matter the treatment situation, the literature suggests that all SDH characteristics should be taken into account when assessing and treating individuals with mental illness.
Effective interventions are available to address the SDH factors, such as poverty, housing status, employment status, structured time, and loneliness, which were identified in this study as depression predictors. These factors include poverty, housing, employment, structured time, and loneliness. Studies emphasize the necessity of starting and encouraging a cross-sectoral approach to address the full spectrum of patient demands and to create partnerships across various stakeholders to prevent the siloing of services.
Article Critique
In my opinion, the study has several significant limitations. The patients in this study presented to a single emergency department (ED) with an acute mental health crisis rather than in a primary care setting. To see if there were any variations in the SDH, the researchers did not enroll a control group of patients with low PHQ-9 scores. Additionally, they only accepted people who could communicate in and understand English. It is unknown whether patients who speak another language as their first language have different SDH profiles and PHQ-9 scores.
Moreover, despite the fact that numerous studies show that the PHQ-9 is sensitive and specific for detecting depression, chart review was unable to validate the final diagnosis in this cohort. Even though many individuals had high PHQ-9 scores, only 56% of them had been given a depression diagnosis. Therefore, I do not consider the study’s results wholly reliable and agree with them.
Reference
Shyman, L., Barbic, D., Chau, S., Sukhorukov, R., Mathias, S., Leon, A., & Barbic, S. (2021). Social determinants of health and depression in adults presenting to the emergency department. Canadian Family Physician, 67(1), e337–e347.