St Onge Tara, Edmondson Donald, Cea Emily, Husain Syed, Chang Bernard P
New York, NY.
New York, NY.
J Emerg Nurs. 2018 Jan;44(1):46-51. doi: 10.1016/j.jen.2017.04.010. Epub 2017 May 17.
Posttraumatic stress disorder (PTSD) develops in 1 out of 8 survivors of acute coronary syndrome (ACS) events, and these persons have a doubling of risk for recurrent ACS and mortality. Overcrowding in the emergency department during ACS evaluation has been associated with increased risk for PTSD, and depressed patients have been found to be particularly vulnerable. Little is known about the mechanisms by which overcrowding increases PTSD risk in depressed patients. Our aim was to evaluate one possible mechanism, patient perception of crowding and care, in depressed and nondepressed ED patients evaluated for ACS.
We enrolled 912 participants in the REactions to Acute Care and Hospitalization study, an ongoing observational cohort study assessing patients evaluated for ACS. Participants completed the Emergency Department Perceptions questionnaire. Depressive symptoms were screened using the Personal Health Questionnaire Depression Scale. Objective ED crowding was calculated using the Emergency Department Work Index (EDWIN).
EDWIN scores did not significantly differ between groups. Although perceptions of ED crowding did not differ between groups, depressed patients perceived the emergency department as more stressful [t = 4.45, P < .001] and perceived poorer care [t = 3.03, P = .003]. Multiple regression modeling found a significant interaction between EDWIN scores and depression, predicting participants' perception of stress in the emergency department (F[7,904] = 7.93, P < .001).
We found that depressed patients experienced the emergency department as more stressful as objectively measured crowding increased. Our study highlights the complex interplay between cardiovascular disease and mental health in impacting patient health outcomes in the emergency department.
急性冠脉综合征（ACS）事件的幸存者中，八分之一会患上创伤后应激障碍（PTSD），这些人复发ACS和死亡的风险会加倍。ACS评估期间急诊科过度拥挤与PTSD风险增加有关，且已发现抑郁症患者尤其易受影响。关于过度拥挤增加抑郁症患者PTSD风险的机制知之甚少。我们的目的是评估一种可能的机制，即患者对拥挤和护理的感知，在因ACS接受评估的抑郁症和非抑郁症急诊科患者中的情况。
我们在“急性护理与住院反应”研究中招募了912名参与者，这是一项正在进行的观察性队列研究，评估因ACS接受评估的患者。参与者完成了急诊科感知问卷。使用个人健康问卷抑郁量表筛查抑郁症状。使用急诊科工作指数（EDWIN）计算急诊科客观拥挤程度。
各组之间的EDWIN评分无显著差异。尽管各组对急诊科拥挤的感知没有差异，但抑郁症患者认为急诊科压力更大[t = 4.45，P <.001]，且认为护理质量更差[t = 3.03，P =.003]。多元回归模型发现EDWIN评分与抑郁之间存在显著交互作用，可预测参与者对急诊科压力的感知（F[7,904] = 7.93，P <.001）。
我们发现，随着客观测量的拥挤程度增加，抑郁症患者在急诊科感受到的压力更大。我们的研究强调了心血管疾病和心理健康在影响急诊科患者健康结局方面的复杂相互作用。
