Depression as Modifiable Coronary Risk Factor in the Emergency Department Chest Pain Observation Unit

INTRODUCTION: Depression is a modifiable coronary risk factor (CRF) that is 2 times more prevalent in women. OBJECTIVES: To describe the prevalence and severity of depression in women admitted with chest pain to an emergency department (ED) observation unit (ED-CPC) and to determine acceptance of a behavioral health referral. METHODS: We conducted a prospective observational study at an urban tertiary care hospital ED. English speaking females >or=35 years admitted to the ED-CPC were eligible. A study nurse acquired consent of patients Monday to Friday, 9 AM to 5 PM between July 2006 and May 2007. A 16-item Quick Inventory of Depressive Symptomatology was administered to screen for depression. Those with severe depression were evaluated on site by a psychiatrist. Three- and 6-month follow-up telephone surveys were conducted for health services utilization. RESULTS: Of 188 women screened, 114 (61%) were enrolled. Of these, 39 (34%) screened positive for depression; 17 were already under psychiatric care. Depressed women were likely to be younger (P = 0.02), nonwhite (P = 0.04), have lower incomes (P = 0.03), <or= high school education (P = 0.01), and nonprivate insurance (P = 0.01) as compared with nondepressed women. Both groups had comparable Framingham Risk Scores and CRFs except for higher obesity in the depressed (P = 0.01). At 6 months the depressed group had higher nonpsychiatric specialty referrals (RR = 2.2; CI = 1.2-4.2) and nondepressed patients had fewer ED visits for cardiac symptoms (RR = 0.89; CI = 0.8-0.9). Three-quarters (71%) agreed to participate in a future trial that referred these patients for psychiatric treatment. CONCLUSION: Depression is common in CPC women offering an opportunity for further investigation and intervention in moderate-risk CPC patients.