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Comparison of hospitalized depressed patients relatives admitted through the emergency department or consultations.

BACKGROUND
A previous study showed an overuse of psychiatric emergencies by physicians. Now we study whether patients hospitalized through emergencies have more pejorative specifications than patients admitted through consultations.


METHOD
All patients with Major depressive disorder admitted in our department through emergencies (N=146) or consultations (N=2172) between January 1, 2010 and December 31, 2012 were included in an open study. They completed the Beck Depression Inventory (BDI), analogical visual scales about stress levels (in professional, social, family, married life), life events scale over the past year and the past month and the Olson Family Adaptation and Cohesion Scale.


RESULTS
The depression (t=1.438; p=0.90) and stress level in the previous month (t=1.704; p=0.90) was similar in both samples. Patients admitted through emergencies are characterized by lower levels of marital stress (t=2.590; p=0.01), higher levels of cohesion (t=-2.988, p=0.003), higher adaptability of the current couple (t=-2.975, p=0.003) as well as the adaptability of the family of the origin (t=-2.504, p=0.012).


CONCLUSIONS
If both samples are comparable in terms of stress or severity of depression, patients admitted through emergencies have relatives who are more supportive and more adaptable! How can we explain why they did not consult before? We propose the hypothesis that physicians and families would be exceeded or overloaded with symptoms they thought they could contain, forcing them at this point to request an urgent care of the pathology. On the contrary patients with environments which are less cohesive and adaptable would be redirected earlier to specialised consultation.