Abstract:Cognitive symptoms of depression can help to distinguish medical inpatients with and without MDD. In older adults, however, somatic symptoms cannot be ignored and may be more important for diagnosing MDD than previously realized. These findings will help clinicians identify patients with MDD and differentiate them from non-depressed patients with medical illness.
“…For example, our estimates of the frequency of comorbid psychiatric conditions generated from prior outpatient visits are consistent with previous reports that relied on interviews of patients to identify comorbid psychiatric conditions. 7,[13][14][15][16] For example, Koenig et al 13 reported rates of depressive disorders as high as 45% among geriatric patients admitted to critical care settings. Similar results were reported in 2 other studies 14,15 in which researchers estimated the prevalence of anxiety and depression.…”
Section: Discussionmentioning
confidence: 99%
“…Researchers in several studies [13][14][15][16] have examined the potential adverse effects of the intensive care unit (ICU) on the development of psychiatric disorders, whereas few have examined the effects of existing psychiatric disorders on the outcomes of patients admitted to ICUs. Most of this work has been focused on patients who have had an AMI.…”
Purpose To examine the effects of preexisting comorbid psychiatric conditions on mortality in a large cohort of patients admitted to a nonsurgical intensive care unit. Methods This retrospective cohort study involved 66 672 consecutive eligible nonsurgical patients admitted to intensive care units in 129 Veterans Health Administration hospitals during 2005 and 2006. Preexisting comorbid psychiatric conditions were identified by using diagnoses from outpatient encounters in the prior year for depression, anxiety, psychosis, bipolar disorders, and posttraumatic stress disorder. Generalized estimating equations were used to adjust the risks of inhospital and 30-day mortality for demographics, comorbid medical conditions, markers of severity, and abnormal findings on laboratory tests at admission. Results Comorbid psychiatric conditions were identified in 28% (n = 18 698) of patients. Patients with preexisting comorbid psychiatric conditions had lower (P < .001) unadjusted inhospital mortality (7.3% vs 8.7%) and 30-day mortality (10.0% vs 12.8%) than did patients without such conditions. After demographics, comorbid medical conditions, and severity were adjusted for, risk of in-hospital mortality among patients with comorbid psychiatric conditions was somewhat higher (odds ratio, 1.07, 95% confidence interval, 1.01-1.14; P = .02), although differences in 30-day mortality (odds ratio, 1.01, 95% confidence interval, 0.94-1.08; P = .70) were no longer significant. Conclusion Preexisting comorbid psychiatric conditions are common among intensive care patients, but after comorbid medical conditions and severity were adjusted for, preexisting comorbid psychiatric conditions were not associated with a higher risk of 30-day mortality in a large national cohort of veterans.
“…For example, our estimates of the frequency of comorbid psychiatric conditions generated from prior outpatient visits are consistent with previous reports that relied on interviews of patients to identify comorbid psychiatric conditions. 7,[13][14][15][16] For example, Koenig et al 13 reported rates of depressive disorders as high as 45% among geriatric patients admitted to critical care settings. Similar results were reported in 2 other studies 14,15 in which researchers estimated the prevalence of anxiety and depression.…”
Section: Discussionmentioning
confidence: 99%
“…Researchers in several studies [13][14][15][16] have examined the potential adverse effects of the intensive care unit (ICU) on the development of psychiatric disorders, whereas few have examined the effects of existing psychiatric disorders on the outcomes of patients admitted to ICUs. Most of this work has been focused on patients who have had an AMI.…”
Purpose To examine the effects of preexisting comorbid psychiatric conditions on mortality in a large cohort of patients admitted to a nonsurgical intensive care unit. Methods This retrospective cohort study involved 66 672 consecutive eligible nonsurgical patients admitted to intensive care units in 129 Veterans Health Administration hospitals during 2005 and 2006. Preexisting comorbid psychiatric conditions were identified by using diagnoses from outpatient encounters in the prior year for depression, anxiety, psychosis, bipolar disorders, and posttraumatic stress disorder. Generalized estimating equations were used to adjust the risks of inhospital and 30-day mortality for demographics, comorbid medical conditions, markers of severity, and abnormal findings on laboratory tests at admission. Results Comorbid psychiatric conditions were identified in 28% (n = 18 698) of patients. Patients with preexisting comorbid psychiatric conditions had lower (P < .001) unadjusted inhospital mortality (7.3% vs 8.7%) and 30-day mortality (10.0% vs 12.8%) than did patients without such conditions. After demographics, comorbid medical conditions, and severity were adjusted for, risk of in-hospital mortality among patients with comorbid psychiatric conditions was somewhat higher (odds ratio, 1.07, 95% confidence interval, 1.01-1.14; P = .02), although differences in 30-day mortality (odds ratio, 1.01, 95% confidence interval, 0.94-1.08; P = .70) were no longer significant. Conclusion Preexisting comorbid psychiatric conditions are common among intensive care patients, but after comorbid medical conditions and severity were adjusted for, preexisting comorbid psychiatric conditions were not associated with a higher risk of 30-day mortality in a large national cohort of veterans.
“…Its prevalence is 1-5% among ambulatory patients, 13% among institutionalised patients [71] and 40% in patients with respiratory failure. YOANNES et al [72] showed that the rate of depression in a group of 96 elderly COPD patients was significantly higher than in healthy or otherwise disabled elderly subjects.…”
Section: Anxiety and Depression Disordersmentioning
By 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation.All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately. @ERSpublications Extrapulmonary comorbidities are common in COPD and influence prognosis; we propose an exhaustive comorbidities review
“…The authors of one of the reviews [7] and others [3,[10][11][12] have argued that existing studies linking depression to cardiac and all-cause mortality post-AMI have not adequately controlled for confounding in measurement of depressive symptoms related to overlap between somatic symptoms ofdepression and cardiac symptoms. Indeed, symptoms characteristically associated with depression, such as fatigue, anhedonia, changes in sleep patterns, changes in appetite, or poor concentration, for instance, could occur as a normal reaction to the AMI, from side effects of its treatment, or from the hospitalization itself [13,14]. The BD!…”
Objective: Reported links between depression and post-acute myocardial infarction (AMI) mortality may be due to confounding between somatic symptoms of depression and symptoms related to the AMI. The objective of this study was to assess the relationship between depressive symptoms and 12-month post-AMI mortality after removing potential bias from somatic symptoms of depression.Study Design and Setting: Four hundred seventy-seven hospitalized AMI patients from 12 cardiac care units. The relationship of a General Depression factor with mortality was assessed using a probit structural equation regression model, controlling for an uncorrelated somatic symptom factor, age, Killip class, previous AMI, and other potential confounders.Results: Mortality was significantly predicted by the General Depression factor (P = 0.009), controlling for age (P = 0.128), Killip class (P = 0.210), history of AMI (P = 0.001), and other predictors in a structural equation model that removed variance related to somatic factors, but unrelated to the General Depression factor.Conclusion: This study demonstrated that the use of structural equation modeling presents a viable mechanism to test links between symptoms of depression and health outcomes among patients with AMI after explicitly removing variance due to somatic symptoms that is unrelated to the General Depression factor.
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