Family physician in Kelowna, BC.
Family physician in Kamloops, BC.
Can Fam Physician. 2021 Dec;67(12):e337-e347. doi: 10.46747/cfp.6712e337.
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.
Secondary data analysis.
St Paul's Hospital, an urban tertiary care hospital in Vancouver, BC.
Patients 19 years and older presenting to the ED with an acute mental health crisis.
Responses to demographic questionnaires focused on SDH and to measures of self-perceived health and depression. Relationships between depression and SDH were described using tests and 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.
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.
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.
评估健康的社会决定因素（SDH）在因急性心理健康危机而到急诊科就诊的成年人中预测抑郁程度的程度。
二次数据分析。
卑诗省温哥华市的圣保禄医院，一家城市三级保健医院。
19 岁及以上因急性心理健康危机到急诊科就诊的患者。
针对 SDH 以及自我感知健康和抑郁的问题，对人口统计学问卷的回答。使用检验和检验描述抑郁与 SDH 之间的关系。使用线性回归确定 SDH 变量预测患者健康问卷-9（PHQ-9）所测抑郁评分的程度。
主要研究有 202 名参与者。对完成 PHQ-9 的 156 名（77%）参与者的数据进行了二次分析。在该样本中，60%的参与者为男性，37%为女性，4%为其他。平均（SD）年龄为 39.1（13.8）岁，大多数参与者为白人（65%）或原住民（18%）。37%的参与者仅完成高中学业，72%的参与者失业。女性、无法获得清洁饮用水、食品安全差、感到不安全、时间结构使用不足、缺乏社区意识和对住房不满，这些因素显著预测抑郁评分较高。总体而言，59%的受访者符合中度或重度抑郁（PHQ-9 评分≥15）的标准，其中 37%的人报告过去 2 周内几乎每天都有自杀念头。
这项研究表明，在急诊科筛查抑郁和 SDH 都很重要。由于急诊科通常没有能力为这部分人群提供适当水平的后续治疗，因此这项研究对初级保健具有重要意义。为有抑郁和 SDH 风险因素的人制定明确的后续支持途径，对于优化患者预后、促进患者安全、提高患者满意度以及优化急诊科和初级保健之间的资源利用至关重要。
