Psychiatric–Medical ComorbidityMajor depression in older medical inpatients predicts poor physical and mental health status over 12 months☆
Introduction
Despite its frequent occurrence [1] and poor prognosis [2], major depression in older medical inpatients is usually not detected or treated [3], [4]. In part, this failure to detect and treat may reflect lack of clear knowledge about whether a diagnosis of depression in this population affects patients' long-term physical and mental health outcomes, independently of severity of physical illness and other factors. To date, most studies in hospitalized samples have used an outcome measure of physical disability [e.g., dependence in activities of daily living (ADL)] [5], [6], [7]. Use of a generic health status measure such as the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) is a useful means of assessing the impact of a health problem on different dimensions of health status [8] and comparing this impact with population norms [9]. Although the SF-36 appears to perform well as a tool for monitoring the effect of outpatient treatment of depression on mental health outcomes [10], only one study to our knowledge has investigated the use of a generic health status measure among depressed older hospitalized patients [11]. This study was limited by a short (1 month) follow-up period, and the outcomes were not adjusted for comorbidity. Thus, the primary objective of this study was to determine the impact of major or minor depression on a generic health status measure, the SF-36, during the 12 months after admission, independent of baseline physical disability, comorbidity and other confounding variables. There is some evidence from community but not from inpatient samples that social network and support can buffer the negative effects of late life depression [12], [13]. Therefore, a secondary objective was to determine whether the patient's social network or support modified the effects of depression diagnosis on the health status outcomes. Because we have reported separately on the effects of depression diagnosis on survival [14], patients who died during follow-up have been excluded from this study.
Section snippets
Study design
The study was an observational, prospective study of a cohort of older medical inpatients, with oversampling of patients with a diagnosis of major or minor depression. Recruitment methods have been described in detail previously [1]. The study was conducted at two university-affiliated acute care Montreal hospitals, using random sampling from lists of consecutive, nonelective admissions of patients 65 years and older to the medical services (we focused on these admissions because of our
Results
A total of 1718 patients met study eligibility criteria, and 1686 (98.0%) of these consented to depression screening (Fig. 1). The prevalence of depression (major or minor) was 27.9% (471/1686) at screening. Study participation rates were 73.0% (344/471) among patients with a depression diagnosis and 72.7% (186/256) in the sample of nondepressed patients invited to participate. Subsequently, 210 patients completed the baseline research interview and at least one follow-up, 145 patients died and
Interpretation
This observational 12-month prospective study found that major depression in a sample of older medical inpatients is an important independent predictor of poorer physical and mental health status after discharge, even after adjustment for baseline disability, the nature and severity of physical illness and other patient characteristics. Neither minor depression nor a history of depression predicted physical or mental health status scores at follow-up, either in univariate or multivariate
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This study was funded by Canadian Institutes for Health Research, Grants MOP82494 and MCT-15476.