Journal
PSYCHOSOMATIC MEDICINE
Volume 79, Issue 3, Pages 273-282Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PSY.0000000000000390
Keywords
depressive symptoms; major depressive disorder; mortality; medical comorbidity
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Funding
- Spanish Ministry of Health's Health Research Fund (Fondo de Investigaciones Sanitarias [FIS]) [97/1184]
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Background: Depression has been associated with higher rates of mortality in medical patients. The aim of the study was to evaluate the impact of depression in medical inpatients on the rate of mortality during a prolonged follow-up period. Method: This is a prospective follow-up study of a cohort of medical inpatients assessed during 1997-1998 in medical and surgical units at a tertiary university hospital in Spain and followed-up for a period ranging between 16.5 and 18 years. Eight hundred three patients were included; 420 (52.3%) were male, and the mean (SD) age was 41.7 (13.8) years. Main outcome was death for any cause during follow-up. The original full Patient HealthQuestionnaire (PHQ) was administered at baseline as self-report from which the PHQ-9 was derived. Depressive disorders were assessed using PHQ-9 and a structured clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition). Results: Depressive disorders as defined by PHQ-9 were detected in 206 patients (25.7%), 122 (15.2%) of them fulfilling criteria for major depression. During follow-up, 152 patients (18.9%) died. A PHQ score indicating the presence of major depressive disorder predicted increased mortality (hazard ratio [HR], 2.44; 95% CI, 1.39-4.29), even after adjusting for important demographic and clinical variables. Similarly, the PHQ-9 score as a continuous measure of depression severity predicted increased mortality (HR, 1.06; 95% CI, 1.02-1.10). Results were similar for clinical interview diagnoses of major depression (HR, 2.07; 95% CI, 1.04-4.09). Conclusions: Medical inpatients with a PHQ depressive disorder had a nearly 2-fold higher risk of long-termmortality, even after adjustment for several confounders. Depression severity as represented by the PHQ-9 score was also a risk factor.
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