title: Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness.
abstract: OBJECTIVE
  More than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness.
  
  
  METHODS
  1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire.
  
  
  RESULTS
  The numbers of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital: having no partner (OR 1.49, 95% CI 1.04 to 2.15); having ischaemic heart disease (OR 1.60, 95% CI 1.04 to 2.46); having a threatening experience (OR 1.16, 95% CI 1.04 to 1.29); depression (OR 1.58, 95% CI 1.04 to 2.40); and emergency hospital admission in the year prior to questionnaire completion (OR 3.41, 95% CI 1.98 to 5.86).
  
  
  CONCLUSIONS
  To prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and have had a recent emergency hospital admission.
authors.affiliation: Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK. Electronic address: elspeth.a.guthrie@manchester.ac.uk.
authors.forename: Elspeth A
authors.initials: EA
authors.lastname: Guthrie
authors.affiliation: Institute of Health Service Research, University of Exeter Medical School, Exeter, UK; Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Room 007, Salmon Pool Lane, Exeter, UK. Electronic address: c.m.dickens@exeter.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Dickens
authors.affiliation: Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK; National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. Electronic address: amy.blakemore@manchester.ac.uk.
authors.forename: Amy
authors.initials: A
authors.lastname: Blakemore
authors.affiliation: Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK. Electronic address: jennifer.a.watson@stu.mmu.ac.uk.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Watson
authors.affiliation: Research Institute, Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK. Electronic address: c.a.chew-graham@keele.ac.uk.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Room 6.322a, Jean McFarlane Building, University Place, Oxford Road, Manchester, UK. Electronic address: karina.lovell@manchester.ac.uk.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.affiliation: Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK. Electronic address: cara.afzal@mhsc.nhs.uk.
authors.forename: Cara
authors.initials: C
authors.lastname: Afzal
authors.affiliation: Centre for Suicide Prevention, University Place, The University of Manchester, Oxford Road, Manchester, UK. Electronic address: nav.kapur@manchester.ac.uk.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
authors.affiliation: Biostatistics Unit, Institute of Population Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK. Electronic address: Barbara.tomenson@manchester.ac.uk.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology; D004630:Emergencies; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies
keywords: Chronic physical illness; Depression; Hospital admission; Primary care; Urgent care