Elsevier

General Hospital Psychiatry

Volume 29, Issue 5, September–October 2007, Pages 425-430
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Does depression in older medical inpatients predict mortality? A systematic review

https://doi.org/10.1016/j.genhosppsych.2007.07.002Get rights and content

Abstract

Objective

To determine whether depression in older medical inpatients predicts mortality.

Method

Medline, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles; the bibliographies of relevant articles were searched for additional references. Retrieved studies were screened to meet five inclusion criteria. Validity of studies was assessed according to four criteria adapted from the Evidence-Based Medicine Working Group. Data were abstracted from each study and tabulated. Data synthesis involved a qualitative meta-analysis.

Results

Many of the studies had methodological limitations. Six reported that depression predicted increased mortality, five reported that depression did not predict mortality, and one reported that depression predicted decreased mortality when there was a history of prior depression. Unadjusted risk ratios for death ranged from 0.60 to 12.6; adjusted risk ratios ranged from 0.42 to 7.4. The disparate findings may be explained in part by differences in the proportions of young older patients and men enrolled in the different studies.

Conclusion

The evidence that depression in older medical inpatients predicts mortality is inconclusive. There is a need for further studies that pay attention to design, populations enrolled, and analysis.

Introduction

Depressive disorders in older medical inpatients are frequent and disabling. The prevalence of major depression in this population ranges from 10% to 30% [1], [2], [3], [4]; the prevalence of minor depression ranges from 9% to 50% [4], [5], [6]. The prognosis of these disorders is poor: up to 75% of patients have a protracted course over 12 months [7], [8]. Moreover, depression in this population appears to predict decreased function and quality of life [9], [10] and increased use of health care services [11], [12], [13].

Studies of depression and mortality, however, have yielded conflicting results. For example, one study reported that depression predicted a dramatic increase in mortality [14] but another reported that depression predicted a decrease in mortality when there was a history of prior depression [15]. Because increased mortality risk may justify increased efforts to prevent or detect and treat depression and because there have been no systematic reviews of depression and mortality in this population, this study proposed to systematically review original research to determine whether depression in older medical inpatients predicts mortality. The review process, modified from the one described by Oxman et al. [16], involved systematic selection of articles, assessment of validity, abstraction of data, and qualitative synthesis of results.

Section snippets

Selection of articles

The selection process involved four steps. First, four computer databases, Medline (January 1966 to September 2006), PsycINFO (January 1967 to September 2006), Embase (January 1980 to September 2006), and the Cochrane Database of Systematic Reviews (until September 2006) were searched for potentially relevant articles using the keywords “depression” and “mortality or survival,” and “medical inpatients.” Second, relevant articles (based on the title and abstract) were retrieved for more detailed

Selection of articles

The search strategy yielded 40 potentially relevant articles; 26 were retrieved for more detailed evaluation. Twelve studies [11], [14], [15], [18], [19], [20], [21], [22], [23], [24], [25], [26], involving 3346 inpatients (at least 750 of whom had clinically significant depressive symptoms), met all the inclusion criteria. The other 14 studies were excluded for the following reasons: 8 were not studies of medical inpatients (or medical inpatients only); in 1, the mean age was less than 50

Discussion

To date, 12 disparate studies have examined whether or not depression in older medical inpatients predicts mortality. Many had methodological limitations and reported disparate findings. Six studies reported that depression predicted increased mortality, five reported that depression did not predict mortality, and one reported that depression predicted decreased mortality when there was a history of prior depression. The disparate findings may be explained in part by differences in the

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