Impact of preexisting depression on length of stay and discharge destination among patients hospitalized for acute stroke: linked register-based study.
OBJECTIVE
There exists limited knowledge regarding the relation between depression and healthcare utilization in stroke patients. The objective of this register-based study was to examine the impact of having preexisting depression at the time of hospital admission for acute stroke on length of hospital stay and discharge destination.


METHODS
Data from a general-practice database were linked to those of a hospital database to identify patients hospitalized for stroke and were used to categorize these patients into 3 groups based on preexisting mental health (MH) status at admission, ie, those with preexisting depression, those with another preexisting MH condition, and those without any preexisting MH condition. Multilevel analyses controlling for several potentially important covariates were performed to estimate the associations under study.


RESULTS
Both patients with preexisting depression (n=41) and those with another preexisting MH condition (n=62) did not differ significantly from patients without any preexisting MH condition (n=211) regarding length of hospital stay for acute stroke. Among patients who survived hospitalization, those with preexisting depression had significantly higher odds of being discharged to an institution instead of their home than did patients without any preexisting MH condition. Having another preexisting MH condition had no significant effect on discharge destination.


CONCLUSIONS
Having preexisting depression at admission seems to be a relevant factor in determining discharge to institutional care after acute stroke hospitalization. Further research is needed to determine the mechanism(s) through which preexisting depression decreases the chances of being discharged to home.
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. jnuijen@trimbos.nl
Jasper
J
Nuyen
Peter M
PM
Spreeuwenberg
Peter P
PP
Groenewegen
Geertrudis A M
GA
van den Bos
François G
FG
Schellevis
D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications* / Q000523:psychology*; D005260:Female; D018574:Home Care Agencies; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010351:Patient Discharge; D012042:Registries / Q000706:statistics & numerical data; D012047:Rehabilitation Centers; D012111:Residence Characteristics; D012189:Retrospective Studies; D020521:Stroke / Q000523:psychology*