title: Depressive symptoms are associated with higher rates of readmission or mortality after medical hospitalization: A systematic review and meta-analysis.
abstract: Depressive symptoms during a medical hospitalization may be an overlooked prognostic factor for adverse events postdischarge. Our aim was to evaluate whether depressive symptoms predict 30-day readmission or death after medical hospitalization. We conducted a systematic review of studies that compared postdischarge outcomes by in-hospital depressive status. We assessed study quality and pooled published and unpublished data using random effects models. Overall, one-third of 6104 patients discharged from medical wards were depressed (interquartile range, 27%-40%). Compared to inpatients without depression, those discharged with depressive symptoms were more likely to be readmitted (20.4% vs 13.7%, risk ratio [RR]: 1.73, 95% confidence interval [CI]: 1.16-2.58) or die (2.8% vs 1.5%, RR: 2.13, 95% CI: 1.31-3.44) within 30 days. Depressive symptoms were common in medical inpatients and are associated with an increased risk of adverse events postdischarge. Journal of Hospital Medicine 2016;11:373-380. © 2016 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine.
authors.affiliation: Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Jenelle L
authors.identifier: 0000-0001-7047-7590
authors.initials: JL
authors.lastname: Pederson
authors.affiliation: Division of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: Warkentin
authors.affiliation: Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.|Alberta Diabetes Institute, Edmonton, Canada.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.|The Patient Health Outcomes Research and Clinical Effectiveness Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
mesh_terms: D003863:Depression / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D009026:Mortality; D010351:Patient Discharge; D010359:Patient Readmission; D012307:Risk Factors
references.citation: Eur Respir J. 2013 Apr;41(4):815-23
references.pmid: 22878874
references.citation: J Gen Intern Med. 2008 Jan;23(1):25-36
references.pmid: 17968628
references.citation: Can J Psychiatry. 2012 Dec;57(12):752-8
references.pmid: 23228234
references.citation: Cardiovasc Psychiatry Neurol. 2013;2013:695925
references.pmid: 23653854
references.citation: Prim Care Companion J Clin Psychiatry. 2007;9(4):256-62
references.pmid: 17934548
references.citation: Open Med. 2011;5(2):e104-11
references.pmid: 21915234
references.citation: Ann Intern Med. 2011 Oct 18;155(8):520-8
references.pmid: 22007045
references.citation: Syst Rev. 2014 Dec 30;3:151
references.pmid: 25551437
references.citation: J Card Fail. 2012 Mar;18(3):238-45
references.pmid: 22385945
references.citation: J Hosp Med. 2014 Jun;9(6):358-64
references.pmid: 24604881
references.citation: PLoS One. 2013;8(1):e52654
references.pmid: 23308116
references.citation: Annu Rev Clin Psychol. 2005;1:255-91
references.pmid: 17716089
references.citation: Psychosom Med. 1999 Jan-Feb;61(1):26-37
references.pmid: 10024065
references.citation: J Hosp Med. 2010 Sep;5(7):378-84
references.pmid: 20577971
references.citation: Int J Epidemiol. 2010 Jun;39(3):932; author reply 933
references.pmid: 19349478
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721
references.citation: Am Heart J. 2005 Nov;150(5):961-7
references.pmid: 16290972
references.citation: Biol Psychiatry. 2003 Aug 1;54(3):317-29
references.pmid: 12893107
references.citation: Respiration. 2012;84(1):36-43
references.pmid: 21996555
references.citation: J Am Board Fam Med. 2008 Sep-Oct;21(5):398-407
references.pmid: 18772294
references.citation: BMJ. 2013 Apr 23;346:f2231
references.pmid: 23613540
references.citation: CMAJ Open. 2013 Dec 17;1(4):E159-67
references.pmid: 25077118
references.citation: Ann Intern Med. 1999 Apr 6;130(7):563-9
references.pmid: 10189325
references.citation: JAMA. 2009 Feb 11;301(6):603-18
references.pmid: 19211468
references.citation: J Clin Nurs. 2009 Jul;18(13):1871-7
references.pmid: 19374689
references.citation: Arch Intern Med. 2000 May 8;160(9):1354-60
references.pmid: 10809041
references.citation: Gen Hosp Psychiatry. 2010 May-Jun;32(3):268-75
references.pmid: 20430230
references.citation: JAMA. 2011 Oct 19;306(15):1688-98
references.pmid: 22009101
references.citation: Ann Intern Med. 2009 Aug 18;151(4):W65-94
references.pmid: 19622512
references.citation: Psychosomatics. 2003 Sep-Oct;44(5):367-73
references.pmid: 12954910
references.citation: Am J Geriatr Psychiatry. 1999 Winter;7(1):48-56
references.pmid: 9919320
references.citation: Br J Psychiatry. 2010 Jul;197(1):61-6
references.pmid: 20592436
references.citation: BMC Med Res Methodol. 2012 Feb 01;12:9
references.pmid: 22297116
references.citation: Circulation. 2014 Mar 25;129(12):1350-69
references.pmid: 24566200
references.citation: Ann Intern Med. 2002 May 21;136(10):765-76
references.pmid: 12020146
references.citation: Arch Intern Med. 2001 Aug 13-27;161(15):1849-56
references.pmid: 11493126
references.citation: Gen Hosp Psychiatry. 2011 May-Jun;33(3):203-16
references.pmid: 21601716
references.citation: Am Heart J. 2012 Sep;164(3):365-72
references.pmid: 22980303
references.citation: Chest. 2002 May;121(5):1441-8
references.pmid: 12006426
references.citation: Age Ageing. 2012 Mar;41(2):148-54
references.pmid: 22236655
references.citation: CMAJ. 2011 Apr 19;183(7):E391-402
references.pmid: 21444623
references.citation: JAMA. 2009 Feb 11;301(6):668-70
references.pmid: 19211475
references.citation: Arch Intern Med. 2001 Nov 26;161(21):2609-15
references.pmid: 11718593
references.citation: Am J Cardiol. 2013 May 15;111(10):1432-6
references.pmid: 23433760
references.citation: Int J Epidemiol. 2008 Oct;37(5):1158-60
references.pmid: 18832388
references.citation: JAMA. 1993 Oct 20;270(15):1819-25
references.pmid: 8411525
references.citation: J Gen Intern Med. 2013 Feb;28(2):269-82
references.pmid: 23054925