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Depressive Symptoms and Short-term Outcomes after Medical Hospitalization

  • Author / Creator
    Pederson, Jenelle L
  • 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 In Project 1, 18 papers were reviewed, including published and unpublished data retrieved for up to 3397 patients with 30-day follow-up.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.

  • Subjects / Keywords
  • Graduation date
    2015-11
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/R3SN0191G
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Master's
  • Department
    • Department of Medicine
  • Supervisor / co-supervisor and their department(s)
    • Majumdar, Sumit (Medicine)
    • McAlister, Finlay (Medicine)
  • Examining committee members and their departments
    • Forhan, Mary (Rehabilitation Medicine)
    • Kingston, Dawn (Nursing)