Jenelle L Pederson1, Sumit R Majumdar2, Mary Forhan3, Jeffrey A Johnson4, Finlay A McAlister5. 1. Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3. 2. Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3; Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3. 3. Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3. 4. Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3; School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2R3. 5. Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3. Electronic address: Finlay.McAlister@ualberta.ca.
Abstract
OBJECTIVE: Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter "depression") are associated with short-term readmission or mortality after discharge from medical wards. METHODS: Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥ 11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90 days postdischarge. RESULTS: Of 495 medical patients [median age 64 years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30 days and 46 (36%) vs. 91 (25%) within 90 days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25-3.17, P=.004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64-1.72, P=.84). Depression persisted in 40% of patients at 30 days and 17% at 90 days. CONCLUSIONS: Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules.
OBJECTIVE: Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter "depression") are associated with short-term readmission or mortality after discharge from medical wards. METHODS:Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥ 11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90 days postdischarge. RESULTS: Of 495 medical patients [median age 64 years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30 days and 46 (36%) vs. 91 (25%) within 90 days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25-3.17, P=.004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64-1.72, P=.84). Depression persisted in 40% of patients at 30 days and 17% at 90 days. CONCLUSIONS:Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules.
Authors: Shail Rawal; Janice L Kwan; Fahad Razak; Allan S Detsky; Yishan Guo; Lauren Lapointe-Shaw; Terence Tang; Adina Weinerman; Andreas Laupacis; S V Subramanian; Amol A Verma Journal: JAMA Intern Med Date: 2019-01-01 Impact factor: 21.873
Authors: Suzanne E Mitchell; Matthew Reichert; Jessica Martin Howard; Katherine Krizman; Alexa Bragg; Molly Huffaker; Kimberly Parker; Mary Cawley; Hannah Webb Roberts; Yena Sung; Jennifer Brown; Larry Culpepper; Howard J Cabral; Brian W Jack Journal: Ann Fam Med Date: 2022 May-Jun Impact factor: 5.707