title: The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: a systematic review.
abstract: OBJECTIVE
  This paper aims to systematically review observational studies that have analysed whether depressive symptoms in the community are associated with higher general hospital admissions, longer hospital stays and increased risk of re-admission.
  
  
  METHODS
  We identified prospective studies that looked at depressive symptoms in the community as a risk factor for non-psychiatric general hospital admissions, length of stay or risk of re-admission. The search was carried out on MEDLINE, PsycINFO, Cochrane Library Database, and followed up with contact with authors and scanning of reference lists.
  
  
  RESULTS
  Eleven studies fulfilled our inclusion and exclusion criteria, and all were deemed to be of moderate to high quality. Meta-analysis of seven studies with relevant data suggested that depressive symptoms may be a predictor of subsequent admission to a general hospital in unadjusted analyses (RR=1.36, 95% CI: 1.28-1.44), but findings after adjustment for confounding variables were inconsistent. The narrative synthesis also reported depressive symptoms to be independently associated with longer length of stay, and higher re-admission risk.
  
  
  CONCLUSIONS
  Depressive symptoms are associated with a higher risk of hospitalisation, longer length of stay and a higher re-admission risk. Some of these associations may be mediated by other factors, and should be explored in more details.
authors.affiliation: Department of Public Health & Primary Care, Institute of Public Health, Cambridge University, UK; NIHR Collaboration for Leadership in Applied Health Research & Care for Cambridgeshire & Peterborough (CLAHRC-CP), UK; King's College London, Institute of Psychiatry, Health Service and Population Research Department, Centre for Global Mental Health, London, UK. Electronic address: matthew.prina@kcl.ac.uk.
authors.forename: A Matthew
authors.initials: AM
authors.lastname: Prina
authors.affiliation: Department of Public Health & Primary Care, Institute of Public Health, Cambridge University, UK.
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Cosco
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research & Care for Cambridgeshire & Peterborough (CLAHRC-CP), UK; Division of Psychiatry, Institute of Mental Health, University of Nottingham, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Dening
authors.affiliation: Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Aartjan
authors.initials: A
authors.lastname: Beekman
authors.affiliation: Department of Public Health & Primary Care, Institute of Public Health, Cambridge University, UK; NIHR Collaboration for Leadership in Applied Health Research & Care for Cambridgeshire & Peterborough (CLAHRC-CP), UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.affiliation: Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Sociology, VU University, Amsterdam, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Huisman
mesh_terms: D016208:Databases, Factual; D003863:Depression / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General; D006801:Humans; D057187:Independent Living; D007902:Length of Stay / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012307:Risk Factors
keywords: Comorbidity; Depression; Depressive symptoms; Hospitalisation; Length of stay; Patient re-admission