title: Current depressive symptoms but not history of depression predict hospital readmission or death after discharge from medical wards: a multisite prospective cohort study.
abstract: OBJECTIVE
  Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter "depression") are associated with short-term readmission or mortality after discharge from medical wards.
  
  
  METHODS
  Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥ 11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90 days postdischarge.
  
  
  RESULTS
  Of 495 medical patients [median age 64 years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30 days and 46 (36%) vs. 91 (25%) within 90 days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25-3.17, P=.004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64-1.72, P=.84). Depression persisted in 40% of patients at 30 days and 17% at 90 days.
  
  
  CONCLUSIONS
  Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3.
authors.forename: Jenelle L
authors.initials: JL
authors.lastname: Pederson
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3; Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3.
authors.forename: Mary
authors.initials: M
authors.lastname: Forhan
authors.affiliation: Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3; School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2R3.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3. Electronic address: Finlay.McAlister@ualberta.ca.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000401:mortality*
keywords: Depression; Inpatients; Interviews; Mortality; Patient readmission