Prospective Assessment of Depression and Anxiety Trajectories Among Emergency Department Patients with Somatic...

Emergency department (ED) patients exhibit higher rates of depression than those in primary care and the general population, but it is unclear whether these symptoms reflect chronic conditions or transient responses to acute stress. Our objective in this study was to evaluate the longitudinal trajectory of depression and anxiety identified in the ED to inform evidence-based screening and intervention strategies.

Adult, English-speaking ED patients with adequate literacy who presented to two urban academic EDs with somatic (non-psychiatric) chief complaints completed six mental health screening assessments at enrollment. Of 262 approached patients, 188 were enrolled, representing approximately 0.5% of all adult ED visits (188/37,898) during the study period. Follow-up assessments were completed through a secure phone app at one, two, and four weeks after ED discharge. The primary outcome was the longitudinal stability of depression and anxiety symptoms. The secondary outcome was differences in follow-up completion rates by baseline mental health status.

Among 188 patients with baseline assessments, 44 (23%) screened positive for major depressive disorder, 17 (9%) for moderate/severe depression, and 34 (18%) for moderate/severe anxiety at baseline. Overall, 50 patients (27%) screened positive for at least one of these conditions. Follow-up responses at weeks 1 (n = 42, 22%), 2 (n = 41, 22%), and 4 (n = 27, 14%) showed no significant changes in levels of depression as measured by the Computerized Adaptive Test-Depression Inventory or severity of anxiety as per the Computerized Adaptive Test for Anxiety severity. High intraclass correlation coefficients (0.76-0.84) for all measures indicated inter-individual differences accounted for most variance. Stability of the Computerized Adaptive Diagnostic Test for Major Depressive Disorder ranged from moderate to substantial (Cohen kappa: 0.74 at week 1 to 0.46 at week 4). Patients who were positive for major depressive disorder had significantly higher follow-up completion rates at weeks 2 and 4 (P = .04).

High baseline rates of depression and anxiety highlight the substantial mental health burden in ED patients. Among those who completed follow-up assessments, severity scores remained stable, suggesting these symptoms reflect ongoing conditions rather than transient stress. Future work should improve follow-up responses and assess whether ED-based identification and treatment improve outcomes.