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Permanent link (DOI): https://doi.org/10.7939/R3SN0191G

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Depressive Symptoms and Short-term Outcomes after Medical Hospitalization Open Access

Descriptions

Other title
Subject/Keyword
mortality
inpatient
screening
depression
readmission
adults
Type of item
Thesis
Degree grantor
University of Alberta
Author or creator
Pederson, Jenelle L
Supervisor and department
Majumdar, Sumit (Medicine)
McAlister, Finlay (Medicine)
Examining committee member and department
Kingston, Dawn (Nursing)
Forhan, Mary (Rehabilitation Medicine)
Department
Department of Medicine
Specialization

Date accepted
2015-09-09T13:38:26Z
Graduation date
2015-11
Degree
Master of Science
Degree level
Master's
Abstract
This thesis consists of 2 closely linked projects that evaluate the importance of depressive symptoms (hereafter, for brevity, referred to as “depression”) for short-term prognosis after general medical hospitalizations. Project 1 systematically reviews the literature to examine whether depression identifies increased risk of short-term adverse events (such as the composite endpoint of death or readmission within 30-days) post-discharge. Using prior literature and potential confounders identified in Project 1, Project 2 uses primary data collection to overcome limitations of previous studies and evaluates the prognostic utility and independent association between depression as defined by the PHQ-9 and the carefully adjusted risk of short-term adverse events post-discharge from general internal medicine (GIM) wards. In Project 1, 18 papers were reviewed, including published and unpublished data retrieved for up to 3397 patients with 30-day follow-up. It was determined that depression affected one-third of patients hospitalized for an acute medical reason (median 32%) and predicted both higher rates of readmission (20% vs. 14%, RR 1.73, 95%CI 1.16-2.58, n=2433) and mortality (3% vs. 2%, RR 2.13, 95%CI 1.31-3.44, n=3397) within 30-days post-discharge, with similar results observed at 90-days; that relatively few valid studies have examined short-term outcomes, and that most prior studies are limited to disease-specific patient populations (vs. unselected general medical cohorts) and lack repeated depression measures post-discharge. In Project 2, it was found that depression was common (26% of inpatients), largely unrecognized, often persisted for months post-discharge, and independently predicted an adjusted 2-fold increased risk of short-term death or readmission post-discharge over and above the best available risk-prediction tools. The findings from my thesis support the concept that clinicians should systematically screen patients for depression before discharge using validated tools and highlights two future directions for research: (1) designing post-discharge interventions that target depressed patients and (2) determining if treating depression reduces rates of short-term death or readmission in these patients.
Language
English
DOI
doi:10.7939/R3SN0191G
Rights
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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