Disclosure: Dr. Suzanne Mitchell is a speaker on Relationship-centered Care and Cross-cultural communications for Manhattan Cross Cultural Group, Inc. and Merck & Co.
Post-discharge hospital utilization among adult medical inpatients with depressive symptoms†
Article first published online: 23 JUN 2010
Copyright © 2010 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 5, Issue 7, pages 378–384, September 2010
How to Cite
Mitchell, S. E., Paasche-Orlow, M. K., Forsythe, S. R., Chetty, V. K., O'Donnell, J. K., Greenwald, J. L., Culpepper, L. and Jack, B. W. (2010), Post-discharge hospital utilization among adult medical inpatients with depressive symptoms. J. Hosp. Med., 5: 378–384. doi: 10.1002/jhm.673
Dr. Mitchell's participation on this project was supported by a National Research Service Award (NRSA) Fellowship Grant. Support for Project RED is funded by the Agency for Healthcare Research and Quality.
- Issue published online: 9 SEP 2010
- Article first published online: 23 JUN 2010
- Manuscript Accepted: 24 JAN 2010
- Manuscript Revised: 8 DEC 2009
- Manuscript Received: 17 JUN 2009
- hospital discharge;
- patient safety;
Little evidence exists to determine whether depression predicts hospital utilization following discharge among adult inpatients on a general medical service.
We aimed to determine whether a positive depression screen during hospitalization is significantly associated with an increased rate of returning for hospital services.
A secondary analysis was performed using data from 738 English-speaking, hospitalized adults from the Project RED randomized controlled trial (clinicaltrials.gov Identifier: NCT00252057) conducted at an urban academic safety-net hospital.
We used the nine-item Patient Health Questionnaire (PHQ-9) depression screening tool to identify patients with depressive symptoms. The primary endpoint was hospital utilization, defined as the number of emergency department (ED) visits plus readmissions within 30 days of discharge. Poisson regression was used to control for confounding variables.
Of the 738 subjects included in the analysis, 238 (32%) screened positive for depressive symptoms. The unadjusted hospital utilization within 30 days of discharge was 56 utilizations per 100 depressed patients compared with 30 utilizations per 100 non-depressed patients, incident rate ratio (IRR) (confidence interval [CI]), 1.90 (1.51–2.40). After controlling for potential confounders, a higher rate of post-discharge hospital utilization was observed in patients with depressive symptoms compared to patients without depressive symptoms (IRR [CI], 1.73 [1.27–2.36]).
A positive screen for depressive symptoms during an inpatient hospital stay is associated with an increased rate of readmission within 30 days of discharge in an urban, academic, safety-net hospital population. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.