Mental Health Symptom Screening Among Adult Emergency Department Patients: A Cross-Sectional Study

Mental health symptoms profoundly influence healthcare outcomes and utilization. Although mental health conditions are common in emergency department (ED) patients, routine, noncrisis screening is not consistently implemented; thus, problems may go unrecognized outside of psychiatric crisis presentations. We aimed to estimate the prevalence of current symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) among ED patients using validated screening tools.

We conducted a secondary analysis of cross-sectional data from 1305 randomly selected, adult patients from 3 urban, academic EDs. Validated survey instruments included (i) Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety Short Form 8a, (ii) Emotional Distress Depression Short Form 8a, and (iii) Primary Care PTSD Short Form. The primary outcome was the proportion of ED patients screening positive for elevated symptoms. We also describe the demographic characteristics of the sample and select social determinants of health.

Participants had a median age of 48 years (IQR, 32-59); 53.1% were female and 49.0% were White. Socioeconomic challenges were common, with 57.2% unemployed and 45.5% reported annual income below $35,000. Overall, 706/1305 (54.1%, 95% CI, 51.4-56.8) screened positive for elevated symptoms for at least 1 mental health condition: anxiety 46.9% (n = 612; CI, 44.2-49.6), depression 36.8% (n = 480; CI, 34.2-39.4), and PTSD 21.9% (n = 286; 19.7-24.2). More than one-third (36.6%, n = 477) screened positive for 2 or more.

Over half of ED patients screened positive for elevated symptoms. These findings underscore the epidemiologic burden of mental health symptoms in the ED and highlight the potential value of further research into brief, systematic screening during ED visits to identify and connect patients with appropriate mental health resources.