Research paper
Major depression in hospitalized Argentine general medical patients: Prevalence and risk factors

https://doi.org/10.1016/j.jad.2016.02.066Get rights and content

Highlights

  • This cross-sectional study evaluated the prevalence and risk factors for major depression in general hospitals.

  • An average prevalence of 27% based on psychiatric examination guided by use of the MINI was found.

  • The rate was most similar with HADS (25%), and much higher with the BDI (44%) and the PHQ (56%).

  • Factors associated with depression included: prior psychotropic-drug treatment, female sex, more children, and smoking.

  • The high prevalence of depression in patients with medical illness should encourage assertive identification.

Abstract

Background

Depression is not uncommon among medically hospitalized patients, though reported prevalence has varied widely, often in samples involving elderly patients with particular illnesses. Accordingly, we evaluated risk of major depression in three metropolitan general hospitals in Buenos Aires, in subjects with a range of medical disorders and ages, comparing several standard screening methods to expert clinical examinations.

Methods

Consecutively hospitalized general medical patients were evaluated over a six-months. Excluded were subjects under age 18 and those unable to participate in assessments because of illness, medication, sensory or speech impairment, or lack of language fluency, or scored <25 on the Mini Mental State Examination (MMSE). Consenting participants were examined for DSM-IV-TR major depression by psychiatrists guided by MINI examinations, compared with other standard screening methods. Risk factors were assessed by preliminary bivariate analyses followed by multivariate logistic regression modeling.

Results

Overall prevalence of major depression in 257 subjects was 27% by psychiatric examination. The rate was most similar (25%) with the Hospital Anxiety & Depression Scale (HADS), and much higher with the Beck Depression Inventory-II (BDI, 44%) and Patient Health Questionnaire (PHQ, 56%). Factors associated independently with depression by multivariate modeling included: prior psychotropic-drug treatment, female sex, more children, and heavy smoking. Depression was associated most with neoplastic, urological, and infectious disorders, least with pulmonary, neurological, and hematologic conditions.

Limitations

Modest numbers limited power to test for associations of depression with specific medical conditions.

Conclusions

Major depression was identified in over one-quarter of Argentine, general medical inpatients, with marked differences among screening methods. Several risk factors were identified. The findings encourage assertive identification of depression in hospitalized medical patients using valid, reliable, and cost-effective means of improving their care.

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

References (42)

  • S.C. Stoner et al.

    Psychiatric comorbidity and medical illness

    Med. Update Psychiatr.

    (1998)
  • S. Unsar et al.

    Depression and health status in elderly hospitalized patients with chronic illness

    Arch. Gerontol. Geriatrics

    (2010)
  • J. Zhang et al.

    Depression of chronic medical inpatients in China

    Arch. Psychiatr. Nurs.

    (2008)
  • B.L. Zhong et al.

    Prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China

    Gen. Hosp. Psychiatry

    (2010)
  • L. Andrade et al.

    The epidemiology of major depressive episodes: results from the international consortium of psychiatric epidemiology (ICPE) surveys

    Int. J. Methods Psychiatr. Res.

    (2003)
  • F.A. Augustovski et al.

    The Argentine-Spanish SF-36 health survey was successfully validated for local outcome research

    J. Clin. Epidemiol.

    (2008)
  • M. Brenlla et al.

    Adaptación Argentina del Inventario DE Depresión DE beck (BDI-II). BDI-II. Inventario DE Depresión DE beck

    Segunda Ed. Man. Buenos Aires: Paidós

    (2006)
  • M.A. Cigognini et al.

    Diagnosis and pharmacological treatment of depressive disorders in a general Hospital

    Rev. Bras. Psiquiatr.

    (2006)
  • J.A. Cleland et al.

    Associations of depression and anxiety with gender, age, health-related quality of life and symptoms in primary care COPD patients

    Fam. Pract.

    (2007)
  • J. Charan et al.

    How to calculate sample size for different study designs in medical research?

    Indian J. Psychol. Med.

    (2013)
  • M.J. Dal Bó et al.

    Prevalência DE sintomas depressivos em pacientes internados em enfermarias DE clínica médica DE um Hospital geral No Sul DE Santa Catarina

    Rev. Bras. Clin. Med.

    (2011)
  • Cited by (17)

    • Understanding the impact of expert by experience roles in mental health education

      2022, Nurse Education Today
      Citation Excerpt :

      These attitudes reflect stigmatised views of people diagnosed with mental illness, including perceptions they are dangerous, and not responsive to support and treatment (Sølvhøj et al., 2021). People diagnosed with mental illness experience physical health problems at a higher rate than the general population (Jayatilleke et al., 2018), therefore health professionals will work closely with people experiencing mental illness irrespective of the healthcare setting they choose to work in (de la Torre et al., 2016). Stigmatised attitudes towards people with mental illness adversely impact the quality of support they receive and ultimately effects treatment outcomes (Sølvhøj et al., 2021).

    • Health-related quality of life in hospitalized non-psychiatric medical patients: The impact of depressive symptoms

      2021, Journal of Affective Disorders Reports
      Citation Excerpt :

      Its prevalence is even higher among non-psychiatric medical illnesses patients (Katon and Ciechanowski, 2002; Katon, 2011; Olver and Hopwood, 2013; Yanzon de la Torre et al., 2016). Almost one out of four patients hospitalized for a non-psychiatric medical condition has a comorbid major depressive episode (MDE) with a much higher prevalence of subsyndromal depressive symptoms (Yanzon de la Torre et al., 2016). Depression in the context of a non-psychiatric medical illness worsens the prognosis (Ludman et al., 2004), increases symptom burden (Gureje et al., 2001; Katon et al., 2007, 2001), complicates self-care and treatment-adherence (Ciechanowski et al., 2000; DiMatteo et al., 2000; Lin et al., 2004), and increases hospitalization time (Saravay et al., 1991), costs of care, and mortality (Ciechanowski et al., 2000; Katon et al., 2003; Sullivan et al., 2002; Unutzer et al., 1997).

    • Determinants and geographical variation in the distribution of depression in the Southern cone of Latin America: A population-based survey in four cities in Argentina, Chile and Uruguay

      2017, Journal of Affective Disorders
      Citation Excerpt :

      Here we observed an association between MDE and smoking, however, no association with alcohol abuse was found. Several studies have shown a relationship between depression and physical illness (Fryers et al., 2003; Yanzon de la Torre et al., 2016). Here, we observed that the probability of having an MDE among chronically ill patients with histories of cancer, cardiovascular diseases or respiratory diseases was almost 50% higher than those without chronically illness.

    • Psychometric properties of the Patient Health Questionnaire nine-item version (PHQ-9) for use among hospitalized non-psychiatric medical patients

      2019, General Hospital Psychiatry
      Citation Excerpt :

      Depression is a highly prevalent and disabling condition among the general population [1,2], and its prevalence is even higher among patients hospitalized due to medical illnesses [3–6]. It has been estimated that one out of four patients hospitalized for medical illness has a comorbid major depressive episode (MDE) [3]. The presence of depression in a patient hospitalized due to a medical illness worsens the medical prognosis [7], increases symptom burden [8–10], complicates self-care and treatment-adherence [11–13], extends the hospitalization stay [14], and inflates the costs of care and mortality [11,15–17].

    View all citing articles on Scopus
    View full text