Significance of Community Support in Nonacute Emergency Department Patients with Chronic Conditions

Emergency departments (EDs) in the United States often face avoidable, non-emergent visits by patients with chronic conditions. Current literature supports that social risks are associated with inappropriate ED utilization. Additionally, mental health, housing stability, and community support are related to health outcomes. Two key components of community support are loneliness and access to help. Therefore, we investigated how these factors correlate with mental health and housing stability in ED patients with chronic conditions presenting for non-urgent concerns.

We enrolled 387 adult patients with one or more chronic conditions presenting with a non-acute complaint at an urban safety-net ED. We excluded patients who were in police custody, on parole, with altered mental status or intoxicated. In the ED, patients completed a survey assessing social needs using REDCap. The survey included the PHQ-2, a short screening tool for depression, along with questions about community support and housing stability. Data was analyzed using Spearman, Chi-Square, and Kruskal-Wallis H tests.

384 patients were included in the final analysis. A Spearman’s rho correlation revealed that higher levels of loneliness significantly correlated with higher PHQ-2 scores (ρ = .542, p < .001). A Kruskal-Wallis H test determined that PHQ-9 scores significantly increased with higher levels of help needed (χ²(3)=35.15, p < .001). A chi-square test revealed that individuals with greater needs were significantly more likely to report housing instability (χ²(6) = 50.75, p < .001) A Spearman’s rho test indicated a significant positive association between loneliness and housing instability (ρ(382) = .36, p < .001).

In ED patients with chronic conditions, self-reported lack of community support significantly correlates with housing instability and worsened mental health. Interventions addressing community support may help to relieve the burden of inappropriate ED utilization.