Depressed Mood and Survival in Seriously Ill Hospitalized Adults

Roach, Mary Joan; Connors, Alfred F.; Dawson, Neal V.; Wenger, Neil S.; Wu, Albert W.; Tsevat, Joel; Desbiens, Norman A.; Covinsky, Kenneth E.; Schubert, Daniel

doi:10.1001/archinte.158.4.397

Cited by 40 publications

(28 citation statements)

References 41 publications

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“…11 Cognitive impairment and depressive symptoms may lead to an erosion of the physical skills needed to maintain functional independence and may leave a person less resistant to acute stressors, such as hospitalization, that often accelerate functional dependence in older people. [21][22][23] In participants with baseline ADL dependence, cognitive impairment predicted further loss of ADL function, but depressive symptoms did not predict further functional decline, and, in fact, subjects with depressive symptoms, on average, demonstrated a slight improvement in ADL function, similar to subjects with neither condition. This may reflect fundamental differences in the natural history of cognitive impairment and depressive symptoms.…”

Section: Discussionmentioning

confidence: 95%

Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People

Mehta

Yaffe

Covinsky

2002

J American Geriatrics Society

210

136

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OBJECTIVES-Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort. DESIGN-Prospective cohort study.SETTING-A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old.PARTICIPANTS-Five thousand six hundred ninety-seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995 MEASUREMENTS-Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity.RESULTS-Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2-year functional decline was 2.3 (95% confidence interval (CI) = 1.7-3.1) for participants with cognitive impairment, 1.9 (95% CI = 1.3-2.6) for participants with depressive symptoms, and 2.4 (95% CI = 1.4-3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2-year functional decline was 1.9 (95% CI = 1.2-2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3-1.3) for participants with depressive symptoms, and 1.5 (95% CI = 0.8-2.6) for participants with cognitive impairment and depressive symptoms.CONCLUSIONS-In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline. The relationship between cognitive status and depressive symptoms and their effect on functional decline is of significant clinical and public health importance because they are common, frequently coexist, and may be treatable. For example, depressive symptoms are thought to exacerbate cognitive problems in older people and may be an independent risk factor for cognitive impairment; conversely, cognitive impairment may lead to depression. [2][3][4] Prior studies on the effect of cognitive impairment or depressive symptoms on functional decline have suggested that depressive symptoms and cognitive impairment are independently associated with functional decline, 4-13 but prior studies are limited because they have not taken into consideration that cognitive impairment and depressive symptoms are interrelated, have not studied ethnical...

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Section: Discussionmentioning

confidence: 95%

Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People

Mehta

Yaffe

Covinsky

2002

J American Geriatrics Society

210

136

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“…For example, Rovner and colleagues (17) found a similarly elevated risk for death in nursing home patients, and Roach and coworkers (34) showed an association between depression and mortality in critically ill adults, mostly with terminal illness. In a study limited to patients hospitalized with myocardial infarction, FrasureSmith and associates (18) reported that patients with major depression were more than three times more likely to die over the subsequent 6 months than patients without depression.…”

Section: Discussionmentioning

confidence: 99%

Depressive Symptoms and 3-Year Mortality in Older Hospitalized Medical Patients

Covinsky¹,

Kahana²,

et al. 1999

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“…Concurrent and predictive validity were demonstrated with other symptoms and patient survival. 57,63,64 Second, the entire depression subscale of the Brief Symptom Inventory (BSI), a common measure in cancer research, 65 is composed entirely of positive and negative affect items similar to those from the CES-D. It has good psychometric properties with norm-based sub-scale scores for the general population 66 and in cancer patients.…”

Section: Comorbid Conditions and Specific Sites Of Primary Cancer Andmentioning

confidence: 99%

The Relationship of Cancer Symptom Clusters to Depressive Affect in the Initial Phase of Palliative Radiation

Francoeur

2005

Journal of Pain and Symptom Management

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Research on comorbidity across cancer symptoms, including pain, fatigue, and depression, could suggest if crossover effects from symptom-specific interventions are plausible. Secondary analyses were conducted on a survey of 268 cancer patients with recurrent disease from a northeastern U.S. city who were initiating palliative radiation for bone pain. Moderator regression analyses predicted variation in depressive affect that could be attributed to symptom clusters. Patients self-reported difficulty controlling each physical symptom over the past month on a Likert scale and depressive symptoms on a validated depression measure (Center for Epidemiologic Studies-Depression [CES-D]) over the past week on a four-category scale. An index of depressive affect was based on items of negative and positive affect from the CES-D. In predicting depressive affect, synergistic interactions of pain with fever, fatigue, and weight loss suggest separate pathways involving pain. A similar interaction with fever occurs when nausea was tested in place of pain. Further, the interaction between pain and fatigue is similar in form to the interaction between difficulty breathing and fatigue (when sleep is not a problem). Follow-up to the latter interaction reveals: 1) additional moderation by hypertension and palliative radiation to the hip/pelvis; and 2) a similar cluster not involving hypertension when appetite problems and weight loss were tested in place of fatigue. The significance and form of these interactions are remarkably consistent. Similar sickness mechanisms could be generating: 1) pain and nausea during fever; 2) pain and fatigue during weight loss; and 3) pain and breathing difficulty when fatigue is pronounced. Crossover effects from symptom-specific interventions appear promising.

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Depressed Mood and Survival in Seriously Ill Hospitalized Adults

Abstract: Seriously ill patients should be assessed for the presence of depressed mood even if they have not been given a diagnosis of depression. Further study is needed to determine whether interventions aimed at relieving depressed mood may improve prognosis.

Cited by 40 publications

References 41 publications

Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People

Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People

Depressive Symptoms and 3-Year Mortality in Older Hospitalized Medical Patients

The Relationship of Cancer Symptom Clusters to Depressive Affect in the Initial Phase of Palliative Radiation

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