Symptoms of depression and anxiety (MHI) following acute medical/surgical hospitalization and post-discharge psychiatric diagnoses (DSM) in 839 geriatric US veterans.
OBJECTIVE
We addressed the relatively unexplored use of screening scores measuring symptoms of depression and/or anxiety to aid in identifying patients at increased risk for post-discharge DSM-IV Axis I diagnoses. We were unable to find such studies in the literature.


METHODS
Elderly veterans without recent psychiatric diagnoses were screened for depression and anxiety symptoms upon admission to acute medical/surgical units using the Mental Health Inventory (MHI). Following discharge, those who had exceeded cut-off scores and had been randomized to UPBEAT Care (Unified Psychogeriatric Biopsychosocial Evaluation and Treatment, a clinical demonstration project) were evaluated for DSM diagnoses. We report on 839 patients, mostly male (96.3%; mean age 69.6 +/- 6.7 years), comparing three groups, i.e. those meeting screening criteria for symptoms of (i) depression only; (ii) anxiety only; and (iii) both depression and anxiety.


RESULTS
Despite absence of recent psychiatric history, 58.6% of the 839 patients received a DSM diagnosis post-discharge (21.8% adjustment; 15.4% anxiety; 7.5% mood; and 14.0% other disorders). Patients meeting screening criteria for both depression and anxiety symptoms received a DSM diagnosis more frequently than those meeting criteria for anxiety symptoms only (61.9% vs 49.0%, p = 0.017), but did not differ significantly from those meeting criteria for depressive symptoms only (61.9% vs 56.8%, p = 0.174). Although exceeding the MHI screening cut-off scores for depression, anxiety, or both helped to identify patients with a post-discharge DSM diagnosis, the actual MHI screening scores failed to do so.


CONCLUSIONS
Screening hospitalized medical/surgical patients for symptoms of depression, anxiety, and particularly for the combination thereof, may help identify those with increased risk of subsequent DSM diagnoses, including adjustment disorder.
Gerson
Sylvia
S
UCLA Department of Psychiatry and Biobehavioral Sciences and Neuropsychiatric Institute and Hospital, Los Angeles, California, USA.
Mistry
Ritesh
R
Bastani
Roshan
R
Blow
Fred
F
Gould
Robert
R
Llorente
Maria
M
Maxwell
Annette
A
Moye
Jennifer
J
Olsen
Edwin
E
Rohrbaugh
Robert
R
Rosansky
Joel
J
Van Stone
William
W
Jarvik
Lissy
L
D000208:Acute Disease; D000275:Adjustment Disorders / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D014481:United States; D014728:Veterans / Q000523:psychology*