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