Research paperMajor depression in hospitalized Argentine general medical patients: Prevalence and risk factors
Introduction
Clinical depression is a leading cause of disability worldwide, and a major contributor to the global burden of disease (Vos et al., 2015). Patients hospitalized for medical illnesses have greater risk of depression than the general population (Katon and Ciechanowski, 2002, Olver and Hopwood, 2013). However, reported estimates of the prevalence of major depression among medically hospitalized patients has varied from 5.9% to 81% (Arolt et al., 1998, Conde Martel et al., 2013, Dal Bó et al., 2011, Frazier et al., 2012, Freedland et al., 2003, Gascón et al., 2012, Helvik et al., 2012, Hosaka et al., 1999, Kok et al., 1995, Lesman-Leegte et al., 2006, Lesman-Leegte et al., 2009, McCusker et al., 2005, Mendes-Chiloff et al., 2008, Michopoulos et al., 2010, Pakriev et al., 2009, Pelletier et al., 2014, Suzuki et al., 2011, Unsar and Sut, 2010, Zhang et al., 2008, Zhong et al., 2010). This extraordinarily wide, 14-fold, range (Table 1) may be related to differences in case-ascertainment methods. Most of these reports have involved diagnosis based on symptom rating scales or simple diagnostic screening questionnaires. In contrast, when depression has been identified by structured clinical interviews, reported prevalence ranged only from 14% to 45% (3.2-fold) (Michopoulos et al., 2009; Polo-Gascon et al., 2012); the range was much larger when based on symptom-rating scales: 5.9% to 81% (14-fold) (Helvik et al., 2012, Zhang et al., 2008). Another source of variance is subject-sampling. In addition, many of the cited studies considered only one type of illness or selected age groups, and so are unlikely to be representative of all medically hospitalized patients (Evans et al., 2005, Olver and Hopwood, 2013, Stoner et al., 1998).
The presence of depression is reported to worsen medical prognosis, increase symptom burden, complicate self-care and treatment-adherence, increase length of hospitalization and the costs of care, and probably also increases mortality (Katon and Ciechanowski, 2002, Katon, 2011, Olver and Hopwood, 2013). Identification and treatment of depression in general medical settings should have important beneficial effects associated with lessening of the risks and impact of such adverse outcomes. However, identifying depression in medically ill patients is complicated by the overlap and interactions of general medical and psychiatric manifestations of illness (Olver and Hopwood, 2013). Case identification may be improved by use of appropriate screening methods for depression and estimating individual levels of risk of adverse outcomes.
The present study aimed to estimate the prevalence of major depressive episodes (MDE) among patients hospitalized for a general medical illness, and to compare prevalence estimates based on psychiatric examination guided by the Mini International Neuropsychiatric Interview (MINI) with scores of widely employed, standardized rating scales, including the Beck Depression Scale version 2 (BDI-II), the Hospital Anxiety and Depression Scale (HADS), and the nine-item Patient Health Questionnaire (PHQ-9). We also evaluated associations between the presence of MDE and selected clinical and demographic variables.
Section snippets
Study design
The study was observational and cross-sectional, involving three sites in Buenos Aires, Argentina, at : Bernardo Houssay Hospital in the Vicente Lopez district, Eva Peron Hospital in the San Martín district, and Bernardino Rivadavia Hospital in the Autonomous City district. These general hospitals serve in the metropolitan area of Buenos Aires which has 12.8 M population, and particularly serves low-income patients without health insurance. The study protocol was approved by the Ethics
Study population
The 257 subjects included 152 (59.1%) men and 105 (40.9%) women, of average age 54.2 [95%CI: 52.1–56.2] years; of these, 69 (26.85%) were considered to have a current MDE by expert clinical assessment. Identification of MDE by other methods yielded the following prevalences: [a] HADS, 25.1%; [b] BDI-II, 43.9%; [c] PHQ-9, 55.5% (Table 2), indicating close accord of clinical assessments and HADS ratings and higher estimates with BDI-II and PHQ-9. Rates of identification of depression by
Discussion
Major depression has been found to be quite prevalent among medically hospitalized patients. Based on a standardized, structured psychiatric interview guided by the MINI, we found an overall prevalence of MDE of 26.85% among patients hospitalized for medical illnesses at three general hospitals in metropolitan Buenos Aires, Argentina. The reported findings are unusual in providing comparisons among adult inpatients of varied ages with unselected medical disorders, assessing for depression with
Conclusions
The present study, based in three large urban general hospitals in Buenos Aires, found a prevalence of major depressive episode of 27% among medical inpatients. The HADS questionnaire estimated a prevalence of depression that was closest to psychiatric examination, whereas the BDI-II and PHQ-9 screening questionnaires yielded higher rates that are probably over-estimates. Factors strongly associated with current depression were previous treatment with prescribed psychotropic drugs, being
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