Socioeconomic and Demographic Modifiers of Depression's Impact on Emergency Department Utilization: A Stratified Analysis

Abstract

Background

The emergency department (ED) is often considered the last line of defense for urgent health crises, and people with depression may rely more heavily on ED services to address unexpected issues related to mental health or physical health due to the acute onset of symptoms or a lack of routine medical care.

Objective

This study aims to investigate the association between depressive symptoms and ED utilization and to systematically evaluate the moderating effects of socioeconomic status (SES), gender, and age on this relationship.

Methods

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) covering the period from 2005 to 2018, with a final sample of 26,299 adult participants. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and ED utilization was categorized based on participants' self-reported medical service use.

Results

Logistic regression analysis indicated that each 1-point increase in PHQ-9 score was associated with a 6% increase in the likelihood of ED utilization (p < 0.001). The association between depressive symptoms and ED utilization was significantly stronger in women, particularly for those with severe depression (p = 0.021).

Conclusion

This study demonstrates that depressive symptoms are significantly associated with a higher likelihood of ED utilization, with this association strongly moderated by SES, gender, and age. The varying impact of specific depressive symptoms, such as delayed movement or speech and sleep problems, on ED utilization highlights the importance of early intervention and targeted mental health support for high-risk groups to help reduce ED visit frequency.