Current depressive symptoms but not history of depression predict hospital readmission or death after discharge from medical wards: a multisite prospective cohort study.

Autor: Pederson JL; Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3., Majumdar SR; Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3; Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3., Forhan M; Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3., Johnson JA; Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3; School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2R3., McAlister FA; Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3. Electronic address: Finlay.McAlister@ualberta.ca.
Jazyk: angličtina
Zdroj: General hospital psychiatry [Gen Hosp Psychiatry] 2016 Mar-Apr; Vol. 39, pp. 80-5. Date of Electronic Publication: 2015 Dec 18.
DOI: 10.1016/j.genhosppsych.2015.12.001
Abstrakt: 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.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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