The relationship between clinically relevant depressive symptoms and episodes and duration of all cause hospitalization in Southern Chinese elderly.
ABSTRACT Identification of depression as an independent factor for increased hospital service utilization, or as part of other factors, is important for primary healthcare in possibly preventing use of hospitals. The objective of this study was to study the effects of having clinically relevant depressive symptoms in community dwelling elderly on all cause hospitalization in the elderly.
We administered the validated Chinese version of Geriatric Depression Scale on 3770 men and women aged 65 years and over. Duration and episodes of hospitalization were assessed using 4-monthly telephone interviews and database from the Hospital Authority over a 4-year period. The associations between the presence of clinically relevant depressive symptoms and the number of hospitalizations and duration of hospitalization were studied by multiple Poisson regression analysis.
The presence of clinically relevant depressive symptoms was independently associated with increased episodes (RR: 1.29; CI: 1.16-1.43) and increased length of stay (RR: 1.18; CI: 1.10-1.25) for all cause hospitalization in those with and without chronic conditions at baseline.
Our study relied on self report of chronic medical conditions. As a result, under-diagnosis of diseases and misclassification of disease status could not be excluded.
It was shown that clinically relevant depressive symptoms are independently associated with inpatient utilization over a 4-year period after adjustment for socioeconomic and health status in these elderly subjects. Identification and effective management of depression in primary care may be one way to reduce hospital service utilization in the elderly in China.
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ABSTRACT: Objectives: 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% Cl: 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. (C) 2014 The Authors. Published by Elsevier Inc.Journal of psychosomatic research 11/2014; DOI:10.1016/j.jpsychores.2014.11.002 · 2.91 Impact Factor
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ABSTRACT: Background Many of the assessment tools used to study depression among older people are adaptations of instruments developed in other cultural setting. There is a need to validate those instruments in low and middle income countries (LMIC)MethodsA one-phase cross-sectional survey of people aged [greater than or equal to] 65 years from LMIC. EURO-D was checked for psychometric properties. Calibration with clinical diagnosis was made using ICD-10. Optimal cutpoint was determined. Concurrent validity was assessed measuring correlations with WHODAS 2.0Results17,852 interviews were completed in 13 sites from nine countries. EURO-D constituted a hierarchical scale in most sites. The most commonly endorsed symptom in Latin American sites was depression; in China was sleep disturbance and tearfulness; in India, irritability and fatigue and in Nigeria loss of enjoyment. Two factor structure (affective and motivation) were demonstrated. Measurement invariance was demonstrated among Latin American and Indian sites being less evident in China and Nigeria. At the 4/5 cutpoint, sensitivity for ICD-10 depressive episode was 86% or higher in all sites and specificity exceeded 84% in all Latin America and Chinese sites. Concurrent validity was supported, at least for Latin American and Indian sites.Conclusions There is evidence for the cross-cultural validity of the EURO-D scale at Latin American and Indian settings and its potential applicability in comparative epidemiological studies.BMC Psychiatry 02/2015; 15(1):12. DOI:10.1186/s12888-015-0390-4 · 2.24 Impact Factor
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ABSTRACT: There is lack of information of the hospital costs related to depression. Here, we compare the costs associated with general hospital admissions over 2 years between older men with and without a documented past history of depression. A community-based cohort of older men living in Perth, Western Australia, was assessed at baseline between 2001 and 2004 and followed up for 2 years by prospective data linkage. The participants were selected randomly from the Australia electoral roll. Two-year hospital costs were estimated. Among 5411 patients, 75% of 339 men with depressive symptoms had at least one hospital admission compared with 61% of 5072 men without depression (P<.001). Two-year median hospital costs in the depressed group were A$4153 compared with A$1671 in participants free from depression (P<.001). In multivariate analysis, the presence of clinically significant depressive symptoms remained an independent predictor of higher cost [incident rate ratios (RR)=1.44, 95% confidence interval (CI): 1.23-1.68] and was associated with being a high-cost user of health services (RR=2.04, 95% CI: 1.43-2.92). The estimation of costs was solely based on the main diagnosis, potentially leading to underestimates of the real cost differences. Hospital care cost was higher for older men with documented evidence of past depression than those without. The issue of depression in later life must be tackled if we want to optimize the use of limited hospital resources available.General hospital psychiatry 10/2013; 36(1). DOI:10.1016/j.genhosppsych.2013.08.009 · 2.67 Impact Factor