39 screened positive for MDD ( 25 %)
FIGURE 1 : Flowchart of patient enrollment .
157 screened in ED ( 45 %)
10 screened positive for suicide ( 6 %)
390 patients approached
345 patients completed CAD-MDD-S ( 89 %)
5 screened positive for both ( 3 %)
37 screened positive for MDD ( 20 %)
188 screened in student health services ( 55 %)
3 screened positive for suicide ( 2 %)
2 screened positive for both ( 1 %)
* CAD-MDD-S : a combination of the Computerized Adaptive Diagnostic Screening Tool for Major Depressive Disorder and four screening questions from the Columbia-Suicide Severity Rating Scale , ED : emergency department ; MDD : major depressive disorder
Number of Patients
180 160 140 120 100 80 60 40 20 0
FIGURE 2 : Groupings of time to completion estimates ( in minutes ) of CAD-MDD-S by patients in the study .
154
0 to 5
140
6 to 10
30
11 to 15 Time ( Minutes ) to Complete Screening
15
More than 15
There are a number of limitations with the present study . Firstly , we likely missed patients who would have qualified to participate in the study because our enrollment methods used student researchers during pre-determined time frames which revolved around their class schedules . Secondly , limited resources prevented daily round the clock screening of all patients . Thirdly , since our study did not record any demographic patient information upon enrollment , there were no comparisons within the sample to report and stratify according to factors such as gender , age , ethnicity , education , visit type , and dispositions . Additionally , since our study enrolled over 50 % of subjects at the student health services clinic , there is the possibility that the majority of the sample patients are students at the local university . Prior research has shown that depression and suicidality are of increasing concern on college campuses . 18 Therefore , our results may not be completely generalizable to the entire Appalachian region .
CONCLUSION
The successful implementation of CAD- MDD-S in our two acute care settings provides evidence that this tool could possibly be efficiently incorporated into routine patient assessment in other settings . Further research needs to be conducted within the Appalachian population with stronger focus outside of a university setting .
REFERENCES
1 . Greenberg PE , Fournier AA , Sisitsky T , Pike CT , Kessler RC . The economic burden of adults with major depressive disorder in the United States ( 2005 and 2010 ). J Clin Psychiatry . 2015 Feb ; 76 ( 2 ): 155-62 . treatment room . Prior literature has demonstrated that using tablets to participate in survey research is just as effective as the paper-and-pencil method , particularly in rural areas . 16 While the utilization of tablets may enhance privacy and increase participation , costs associated with obtaining and maintaining tablets as well as with training staff to administer the tools may provide challenges for acute care settings
seeking to implement a screening protocol . Response bias is an important consideration due to the sensitive nature of the questions being asked . Although limited , prior data on patient perceptions of screenings for public health-related topics does exist , such as mental health and intimate partner violence , and generally demonstrates patient support of these types of screenings in an ED setting . 17
2 . American Foundation for Suicide Prevention . Suicide Statistics . 2018 . Available at : https :// afsp . org / aboutsuicide / suicide-statistics /.
3 . Harris EC & Barraclough B . Suicide as an outcome for mental disorders . A metaanalysis . Br J Psychiatry . 1997 ; 170 : 205-228 .
28 • www . wvsma . org