Poster Talk: Obstacles to mental health screening in hospitalized COVID-19 patients

Erin Reed, PhD1 and Paula Zimbrean, MD, FAPA, FACLP2

1MD-PhD Program, Yale School of Medicine, New Haven, CT, USA.

2Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.

Introduction & Objectives: COVID-19 patients face numerous stressors to mental health, including social isolation, uncertainty, fear of transmission, and prolonged, life-threatening physical illness. Initial studies suggest that patients treated for COVID-19 exhibit elevated prevalence of depression (Lei, Huang et al. 2020) and Post Traumatic Stress Disorder (PTSD) Symptoms (PTSS; Liu, Zhang et al. 2020), as high as 96% in one Chinese population (Bo, Li et al. 2020). Further evidence suggests that disruptions in routine care have delayed diagnosis and treatment of psychiatric illness (Zhou, Liu et al. 2020). We aimed to implement systematic screening for depression and PTSS in patients hospitalized with COVID-19.

Methods: From May 18 through June 12, 2020, we identified patients hospitalized with COVID-19 at Yale New Haven Hospital (New Haven, CT, USA) who were marked for imminent discharge in the electronic medical record. Patients were invited for screening remotely via InTouch, facetime, or in room phone. Screening measures included the Patient Health Questionnaire 2 (PHQ 2) for depression and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Patients who screened positive were offered further psychiatric consultation, educational materials, and list of outpatient resources. All procedures were completed in accordance with IRB approval.

Results: 141 patients were identified for mental health screening. A total of 28 (19.9%) were screened for PTSS and depression. Four patients refused. Screening was unable to be completed in the remaining 109 patients. Inability to establish contact (busy phone line or no answer; 19.9%), altered mental status (confusion, delirium; 17.0%), and English language barrier (non-English speaking patients; 13.5%) were the three leading obstacles to screening. Additional challenges included pre-existing disability or co-morbid neurologic conditions (“hard of hearing,” 2.1%; dementia, 2.8%; aphasia / “non-verbal,” 7.8%). Thirteen patients (9.2%) were discharged before screening could occur, and seven (5.0%) were excluded for other reasons (e.g., psychiatric hospitalization, prior screening by social worker).

Conclusions: Less than 20% of patients hospitalized with COVID-19 completed mental health screening prior to discharge. In addition to difficulties establishing contact, we encountered challenges associated with cognitive status (acute delirium, dementia) and with populations who have preexisting communication challenges (hearing impairment, aphasia or language barriers). Past studies showing high rates of mental illness may have differed demographically and relied on online questionnaires (e.g., Bo, Li et al. 2020; Zhou, Liu et al., 2020). Online measures may facilitate screening by lengthening the interval for participation and mitigating communication obstacles.

Disclosures: No conflicts of interest. E.R. supported by NIH Medical Scientist Training Program Grant GM007205.