Research paperDepressive symptoms and health care within 30 days after discharge from a cardiac hospital unit
Introduction
Depression is common among patients with coronary heart disease (CHD) and leads to more recurrent cardiovascular events and a higher risk for mortality [[1], [2], [3]]. This has been linked to biological mechanisms such as low heart rate variability and higher levels of inflammation [[4], [5], [6], [7]], but also to behavioral mechanisms such as physical inactivity and smoking [1,7,8]. At the same time, CHD is assumed to increase the risk for comorbid depression [9,10].
It is well known that depression plays an important role in health care utilization and costs, in cardiac as well as non-cardiac populations. It has been shown that depression leads to poor medication adherence and thus increases health care costs [[11], [12], [13]]. In addition, depression has a direct impact on health care costs. Depressed people living in the community have an increased general health care utilization compared to non-depressed people, even though this association cannot be linked to specific types of health care services [14]. In samples of older adults, depression has been associated with more hospitalizations, longer mean length of stay and higher utilization of outpatient services [[15], [16], [17], [18], [19]]. In the German general adult population, depression has been associated with an almost twofold increased risk for hospitalization [20]. Most of these studies showed that the association is mainly due to more somatic comorbidities and increased functional impairment in depressed patients. However, depressive symptoms remained an independent risk factor for higher health care utilization [[15], [16], [17], [18]].
Cardiac patients with depression tend to have more outpatient contacts and hospitalizations than those without depression [[21], [22], [23]]. However, studies showing these associations have focused on a 12-month follow-up period or longer, and have included only patients after myocardial infarction (MI) [[21], [22], [23]]. The impact of depressive symptoms on short-term usage of outpatient services, particularly general practitioner (GP) visits and specialist care following a hospitalization, as well as the association with short-term re-hospitalizations in patients hospitalized for any CHD-related condition has not been investigated.
The current study aims to determine the association between depressive symptoms in coronary heart disease patients and the use of inpatient and outpatient health care during the 30 days following treatment in a cardiac hospital unit. Specifically, associations between depressive symptoms and number of subsequent hospitalizations as well as outpatient hospital visits and physician visits were analyzed.
Section snippets
Study design
The current study was part of the CDCare (“Depression Care for Hospitalized Coronary Heart Disease Patients”) study. Patients were considered eligible if they had a diagnosis of CHD and were hospitalized in one of the two university hospitals in Germany (Universitätsklinikum Münster; Charité – Universitätsmedizin Berlin). Patients were excluded if they had a chart-documented dementia disorder, cognitive impairment, insufficient language proficiency, the presence of a terminal disease or if they
Sample characteristics
Participant characteristics in the overall sample are shown in Table 1. Out of the 1265 patients from the CDCare study, we included 949 with sufficient data on utilization of health care, 190 of those were female (20.0%). Mean age in the overall sample was 63.8 years (SD = 10.1; range 36-88 years). In the sample for hospital re-admissions, 38.9% scored 7 or higher on the PHQ-9, mean score of the PHQ-9 was 6.2 (SD = 4.8).
In the sample for hospital re-admissions, 97 patients (10.2%) were
Discussion
The present study analysed the effect of depressive symptoms on the utilization of health care services during the 30 days following a cardiac-related hospitalization. The results provide evidence that depressive symptoms lead to higher utilization of outpatient health care services.
Specifically, CHD patients with elevated depressive symptoms had more outpatient hospital visits and physician visits than non-depressed patients. These findings are consistent with previous studies which also
Declaration of Interest
Jakob Hornung: No conflict of interest.
Stella Linnea Kuhlmann: No conflict of interest.
Maria Radzimanowski: No conflict of interest.
Silke Jörgens: No conflict of interest.
Wilhelm Haverkamp has been a member of the advisory boards of or has given presentations on behalf of the following companies: Astra-Zeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Grünenthal, GlaxoSmithKline, Lundbeck, Medicines Company, MSD, Novartis, Pfizer, Trommsdorff and Servier.
Peter Martus: No conflict
Acknowledgements
The present study was part of the CDCare (“Depression Care for Hospitalized Coronary Heart Disease Patients”) study. CDCare was supported by the German Federal Ministry of Education and Research (grant number: 01GY1154). The sponsor was not involved in study design, data collection, analyses and interpretation, in writing the article, and in the decision to submit the article for publication.
References (43)
- et al.
Depression in patients with cardiac disease: a practical review
J Psychosom Res
(2000) - et al.
The relationships among heart rate variability, inflammatory markers and depression in coronary heart disease patients
Brain Behav Immun
(2009) - et al.
Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study
Am Heart J
(2015) - et al.
Depression and health-care costs during the first year following myocardial infarction
J Psychosom Res
(2000) - et al.
Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis
Gen Hosp Psychiatry
(2015) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Excess health care costs of late-life depression - Results of the AgeMooDe study
J Affect Disord
(2016) - et al.
Epidemiology of comorbid coronary artery disease and depression
Biol Psychiatry
(2003) - et al.
Determinants of receiving mental health care for depression in older adults
J Affect Disord
(2012) - et al.
Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease
JAMA
(2008)
Depression and the Risk of Myocardial Infarction and Coronary Death: A Meta-Analysis of Prospective Cohort Studies
Medicine (Baltimore)
Low heart rate variability and the effect of depression on post-myocardial infarction mortality
Arch Intern Med
Depressive symptoms, health behaviors, and subsequent inflammation in patients with coronary heart disease: prospective findings from the heart and soul study
Am J Psychiatry
Depression and coronary heart disease
Nat Rev Cardiol
Depression and smoking in coronary heart disease
Psychosom Med
Major depression and coronary artery disease in the Swedish twin registry: phenotypic, genetic, and environmental sources of comorbidity
Arch Gen Psychiatry
Depression as a risk factor for adverse outcomes in coronary heart disease
BMC Med
Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence
Arch Intern Med
The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review
Am J Med
Common mental disorders and use of general health services: a review of the literature on population-based studies
Acta Psychiatr Scand
Decomposing differences in utilization of health services between depressed and non-depressed elders in Europe
Eur J Ageing
Cited by (0)
- 1
both authors contributed equally.