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      Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness

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          Abstract

          Objective

          More than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness.

          Method

          1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire.

          Results

          The numbers of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital: having no partner (OR 1.49, 95% CI 1.04 to 2.15); having ischaemic heart disease (OR 1.60, 95% CI 1.04 to 2.46); having a threatening experience (OR 1.16, 95% CI 1.04 to 1.29); depression (OR 1.58, 95% CI 1.04 to 2.40); and emergency hospital admission in the year prior to questionnaire completion (OR 3.41, 95% CI 1.98 to 5.86).

          Conclusion

          To prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and have had a recent emergency hospital admission.

          Highlights

          • •

            Depression significantly predicts prospective emergency hospital admissions over 12 months.

          • •

            Severe depression increases the likelihood of emergency hospital admissions by more than two fold.

          • •

            Emergency admission in the previous 12 months increases the risk of admission by 3 and a half times.

          • •

            Having no partner, heart disease and threatening experiences also predict emergency admissions.

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          Most cited references40

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          The Hospital Anxiety And Depression Scale

          R Snaith (2003)
          There is a need to assess the contribution of mood disorder, especially anxiety and depression, in order to understand the experience of suffering in the setting of medical practice. Most physicians are aware of this aspect of the illness of their patients but many feel incompetent to provide the patient with reliable information. The Hospital Anxiety And Depression Scale, or HADS, was designed to provide a simple yet reliable tool for use in medical practice. The term 'hospital' in its title suggests that it is only valid in such a setting but many studies conducted throughout the world have confirmed that it is valid when used in community settings and primary care medical practice. It should be emphasised that self-assessment scales are only valid for screening purposes; definitive diagnosis must rest on the process of clinical examination.
          Article 0 comments Cited 372 times – based on 0 reviews     Review now
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            International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results.

            C. Herrmann (1997)
            More than 200 published studies from most medical settings worldwide have reported experiences with the Hospital Anxiety and Depression Scale (HADS) which was specifically developed by Zigmond and Snaith for use with physically ill patients. Although introduced in 1983, there is still no comprehensive documentation of its psychometric properties. The present review summarizes available data on reliability and validity and gives an overview of clinical studies conducted with this instrument and their most important findings. The HADS gives clinically meaningful results as a psychological screening tool, in clinical group comparisons and in correlational studies with several aspects of disease and quality of life. It is sensitive to changes both during the course of diseases and in response to psychotherapeutic and psychopharmacological intervention. Finally, HADS scores predict psychosocial and possibly also physical outcome.
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              Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes.

              Simon Gilbody, Peter Bower, Janine Fletcher … (2006)
              Depression is common in primary care but is suboptimally managed. Collaborative care, that is, structured care involving a greater role of nonmedical specialists to augment primary care, has emerged as a potentially effective candidate intervention to improve quality of primary care and patient outcomes. To quantify the short-term and longer-term effectiveness of collaborative care compared with standard care and to understand mechanisms of action by exploring between-study heterogeneity, we conducted a systematic review of randomized controlled trials that compared collaborative care with usual primary care in patients with depression. We searched MEDLINE (from the beginning of 1966), EMBASE (from the beginning of 1980), CINAHL (from the beginning of 1980), PsycINFO (from the beginning of 1980), the Cochrane Library (from the beginning of 1966), and DARE (Database of Abstracts of Reviews of Effectiveness) (from the beginning of 1985) databases from study inception to February 6, 2006. We found 37 randomized studies including 12 355 patients with depression receiving primary care. Random effects meta-analysis showed that depression outcomes were improved at 6 months (standardized mean difference, 0.25; 95% confidence interval, 0.18-0.32), and evidence of longer-term benefit was found for up to 5 years (standardized mean difference, 0.15; 95% confidence interval, 0.001-0.31). When exploring determinants of effectiveness, effect size was directly related to medication compliance and to the professional background and method of supervision of case managers. The addition of brief psychotherapy did not substantially improve outcome, nor did increased numbers of sessions. Cumulative meta-analysis showed that sufficient evidence had emerged by 2000 to demonstrate the statistically significant benefit of collaborative care. Collaborative care is more effective than standard care in improving depression outcomes in the short and longer terms. Future research needs to address the implementation of collaborative care, particularly in settings other than the United States.
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                Author and article information

                Contributors
                Elspeth A. Guthrie
                Chris Dickens
                Amy Blakemore
                Jennifer Watson
                Carolyn Chew-Graham
                Karina Lovell
                Cara Afzal
                Navneet Kapur
                Barbara Tomenson
                Journal
                Journal ID (nlm-ta): J Psychosom Res
                Journal ID (iso-abbrev): J Psychosom Res
                Title: Journal of Psychosomatic Research
                Publisher: Pergamon Press
                ISSN (Print): 0022-3999
                ISSN (Electronic): 1879-1360
                Publication date PMC-release: 1 March 2016
                Publication date (Print): March 2016
                Volume: 82
                Pages: 54-61
                Affiliations
                [a ]Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK
                [b ]Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
                [c ]Research Institute, Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
                [d ]School of Nursing, Midwifery and Social Work, The University of Manchester, Room 6.322a, Jean McFarlane Building, University Place, Oxford Road, Manchester, UK
                [e ]Centre for Suicide Prevention, University Place, The University of Manchester, Oxford Road, Manchester, UK
                [f ]Biostatistics Unit, Institute of Population Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
                [g ]Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Room 007, Salmon Pool Lane, Exeter, UK
                [h ]National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
                Author notes
                [* ]Corresponding author at: Manchester Mental Health and Social Care Trust, Rawnsley Buidling, Hathersage Road, Manchester Royal Infirmary, Manchester M13 9WL, UK. Fax: + 1 161 273 2135. elspeth.a.guthrie@ 123456manchester.ac.uk
                Article
                Publisher ID: S0022-3999(14)00354-7
                DOI: 10.1016/j.jpsychores.2014.10.002
                PMC ID: 4796037
                PubMed ID: 26919799
                SO-VID: efbe5f9c-d137-4d5a-8ff8-bdffd2f4b0cf
                Copyright © © 2016 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).

                History
                Date received : 19 May 2014
                Date revision received : 12 September 2014
                Date accepted : 3 October 2014
                Categories
                Subject: Article

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: depression,chronic physical illness,urgent care,hospital admission,primary care
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: depression, chronic physical illness, urgent care, hospital admission, primary care

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