title: Post-discharge hospital utilization among adult medical inpatients with depressive symptoms.
abstract: BACKGROUND
  Little evidence exists to determine whether depression predicts hospital utilization following discharge among adult inpatients on a general medical service.
  
  
  OBJECTIVE
  We aimed to determine whether a positive depression screen during hospitalization is significantly associated with an increased rate of returning for hospital services.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts 02118, USA. suzanne.mitchell@bmc.org
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Mitchell
authors.forename: Michael K
authors.initials: MK
authors.lastname: Paasche-Orlow
authors.forename: Shaula R
authors.initials: SR
authors.lastname: Forsythe
authors.forename: Veerappa K
authors.initials: VK
authors.lastname: Chetty
authors.forename: Julie K
authors.initials: JK
authors.lastname: O'Donnell
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Greenwald
authors.forename: Larry
authors.initials: L
authors.lastname: Culpepper
authors.forename: Brian W
authors.initials: BW
authors.lastname: Jack
mesh_terms: D016001:Confidence Intervals; D003863:Depression; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D020445:Hospitalists / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D015397:Program Evaluation; D012307:Risk Factors; D012449:Safety; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States