A unique, computerized screening project designed to target and screen emergency room patients for depression, suicidality, post-traumatic stress disorder (PTSD) and domestic violence is underway at Grady Memorial Hospital. Debra Houry, MD, MPH, assistant professor of emergency medicine at Emory University School of Medicine, is principal investigator of the kiosk project, which has screened more than 1,000 patients ages 18 to 55 since it began last fall.
Three days each week, patients are able to use one of two computerized kiosks to complete 15-minute exercises that include questions related to high blood pressure and exercise and eating habits. A resource list of local health clinics, primary care doctors, smoking cessation and substance abuse programs is given to all patients.
"What's great about this is that anything patients screen positive for, they get targeted resources and an information sheet when they complete the exercise," Dr. Houry says. "We added the general health questions as a service to our patients. So far, with our preliminary data we're finding that it is making a big difference in patients' lives."
According to Dr. Houry, several female patients have left violent relationships, more than 50 percent have developed safety plans, and almost all have kept and used their resource lists. All interviews with domestic violence victims are conducted and scheduled at a pre-determined time before they leave the hospital.
The $1.6 million study is funded in part by a three-year grant from the Centers for Disease Control and Prevention and a five-year grant from the National Institute of Mental Health. The CDC portion of the grant specifically targets the safety of screening for domestic violence and the follow-up of all reported victims; the NIMH grant examines mental health symptoms and the prevalence of domestic violence.
"I have been so surprised at the amount of depression and post-traumatic stress disorder in our patient population," Dr. Houry notes. "I think a lot of that has to do with the ongoing challenges our patients have on a daily basis, with poverty and being surrounded by violence much of the time. As far as our findings are concerned, there is a significant correlation with domestic violence and suicidality, post-traumatic stress disorder, and depressive symptoms. Yet, I am pleased that giving patients much-needed intervention like resources and identifying them as victims has really improved their quality of life."
Dr. Houry says that of the patients enrolled in the study, 38 percent were domestic violence victims, with 39 percent of males reporting themselves as victims. Twenty-nine percent of males reported being perpetrators. Of all patients, 27 percent experienced moderate to severe depression, 15 percent reported having moderate to severe PTSD symptoms; and 7.5 percent were suicidal.
If a patient is suicidal, he or she is immediately taken in for treatment. "So far, there have been no adverse outcomes, and it seems that even with brief intervention, we're able to affect our patients lives," Dr. Houry says. "In terms of domestic violence, many patients didn't realize they were victims until we told them that being beaten is not a normal ralationship behavior. A lot of them are now taking more ownership and they feel more empowered, and that's something I'm very pleased with. I hope this kiosk is something that all of our patients, especially those suffering from mental health issues, can benefit from."