Objectives: To explore patients' and parents'/caregivers' beliefs about the acceptability of universal depression screening in the emergency department (ED) and their perceptions of the barriers and facilitators to a mental health referral following a positive screen.
Methods: We conducted semistructured interviews with 60 patients seeking care and 59 caregivers in the ED of an urban children's hospital. Interviews were audiotaped, transcribed, coded, and entered into N6 (version 6.0; QSR, Thousand Oaks, Calif) for coding and content analysis.
Results: Patients and caregivers supported the idea of depression screening in the ED, generally viewing screening as a reflection of care and concern. Respondents reported apprehension about stigma, privacy, and provider sensitivity. Introducing the screening concept early in the visit and as part of routine care was believed to reduce stigma. Respondents generally indicated that although they would likely follow through with a referral if given, stigma and denial were viewed as significant barriers. Caregivers also reported that logistical problems such as transportation, insurance, and agency hours created barriers to help seeking, but this could be offset by social supports and information about the agency and the provider.
Conclusions: Patients and caregivers generally support depression screening in the pediatric ED but identified several barriers to screening and referral for treatment. Recommendations include introduction of universal screening early in the ED visit, provision of specific information about the meaning of screening results, and support from family and health care providers to help reduce stigma and increase referral acceptability.
From the *Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia; †Department of Family Medicine and Community Health; ‡Center for Clinical Epidemiology and Biostatistics; §Leonard Davis Institute of Health Economics; ∥Department of Anthropology, University of Pennsylvania; ¶Department of Psychiatry, The Children's Hospital of Philadelphia; and #The University of Pennsylvania School of Medicine, Philadelphia, PA.
Reprints: Megan E. Pailler, PhD, Department of Psychology, Roswell Park Cancer Institute, Elm and Carlton St, Buffalo, NY 14263 (e-mail: firstname.lastname@example.org).
Supported by a grant (No. H34MC04366) from the Emergency Medical Services for Children Program, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.