Kartha et al.13 reported findings indicating that depression is a risk factor for rehospitalization in general medical inpatients, but the study sample was relatively small and the study design methodology significantly limited its generalizability.12 It would be useful to provide supporting evidence showing depression as an important risk factor for readmission in the general medical in‐patient population using more rigorous study methods and a larger cohort. is often used together with medicine to relieve depression. All rights reserved. Free Care is a Massachusetts state program for uninsured patients. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Permanent means you have a disqualifying medical condition that isn't going to change with time, such as a history of depression. Subjects who were unemployed, unmarried, or who reported earnings less than $10,000 per year were also more likely to screen positive for depression. Age, length of stay, and Charlson score were used as continuous variables. (%) No income61 (12)37 (16) <10K77 (15)61 (26) 1020K96 (19)35 (15) 2050K97 (19)34 (14) 50100K35 (8)7 (2) No answer132 (27)64 (27)0.002Employment status, No. Two‐sided significance tests were used. Depression screen determined by scoring of Patient Health Questionnaire‐9 (PHQ9). You can't enlist with a permanent medical disqualification unless you receive an approved waiver. (%) Private95 (19)22 (9) Medicare69 (14)30 (13) Medicaid214 (43)143 (61) Free care118 (24)40 (17)<0.001Education, No. Tell him or her about any side effects or problems you may have with your medicine. Is clinical depression a reason for medical discharge from the Army? *Depression screen determined by scoring of Patient Health Questionnaire‐9 (PHQ9). Indeed, projects to improve the discharge process and post‐hospital care have shown that as much as one‐third of hospital utilization in the month after discharge can be avoided.2 Consequently, the rate of early, unplanned hospital utilization after discharge has emerged as an important indicator of hospital quality and the Centers for Medicare and Medicaid Services (CMS) has proposed a policy to decrease payments to hospitals with high rates of early unplanned hospital utilization. There is a separate category of administrative discharges, ODPMC (Other Designated Physical and Mental Conditions) which covers issues that can make someone unfit for servcie even though they are not recognized as a disability. A positive screen for depressive symptoms during an inpatient hospital stay is associated with an increased rate of readmission within 30 days of discharge in an urban, academic, safety‐net hospital population. To evaluate potential interactions between depression and the Project RED intervention, interaction terms were included. A score of 5 or higher indicates a positive depression symptom screen.17Unmarried refers to subjects whose self‐reported marital status includes divorced, single, partnered or widowed.Frequent utilizer: 2 or more ED or hospital admissions visits in prior 6 months from index admission.Refers to Project RED study group assignment.∥Charlson Comorbity Index Score reflects the cumulative increased likelihood of 1‐year mortality. This may limit the generalizability of our findings; however, it seems likely that interventions relating to depression and transitions of care will need to be quite different for patients that reside in long‐term care facilities vs. patients that live in the community. The higher the score the more severe the comorbid condition. These findings are consistent with, and extend, prior reports regarding depression and rehospitalization in specific populations (ie, geriatrics) and specific diagnoses (ie, cardiovascular disease [CVD] and COPD).1012 We observed a 73% higher incidence rate for hospital utilization within 30 days of discharge for those with symptoms of depression. A score of 5 or higher indicates a positive depression symptom screen.17. In addition to referring to the patient’s GP, consider the following referrals: Maybe I'll try holistic medicine. Depression Friday, July 8, 2011. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you. a medical discharge is not going to result in a dishonorable discharge, NOT LEGAL ADVICE, NO ATTORNEY-CLIENT PRIVILEGE CREATED. Dates of hospital utilization occurring at Boston Medical Center were obtained from the EMR, while those at other hospitals were collected through subject report. (%) unmarried365 (73)201 (85)<0.001Charlson score, mean (SD)1.058 (1.6)1.56 (2.39)0.001RED study group,# No. These included age, gender, marital status, health literacy score (rapid estimate of health literacy in adult medicine tool [REALM]),21 Charlson score,22 insurance type, employment status, income level, homelessness status within past three months, hospital utilization within the 6 months prior to the index hospitalization, educational attainment, length of hospital stay and Project RED study group assignment. Patients with depression had the highest short-term rate of suicide (235 per 100,000 person-years), followed by patients with bipolar disorder … A statistical significance level of P = 0.10 was used for the stepwise regression. *Positive depressive symptom screen determined by PHQ9 screen tool, a nine‐item 4‐point Likert scale, standard scoring algorithm to screen for major and minor depression. More women (36%) had positive depression screens than men (28%). The chief reason for the young age of our cohort is that potential subjects were excluded if they came from a skilled nursing facility or other hospital. Call … Third, our results may not be generalizable to populations other than those served by urban safety‐net hospitals or other populations excluded from the Project RED trial (eg, non‐English speaking patients and patients from nursing homes). Fully 19% of Medicare patients are readmitted to the hospital within 30 days of discharge.1 This represents a large amount of potentially avoidable morbidity and cost. Future research should focus on further characterizing and stratifying populations at highest risk for depression. In patients with CVD, depression is associated with poor outcomes possibly related to decreased heart rate variability, hypercoagulability, high burdens of inflammatory markers, and severity of left ventricular dysfunction.3134 Similarly, depression among HIV/acquired immune deficiency syndrome (AIDS), diabetics and multiple sclerosis (MS) patients is linked to heightened levels of proinflammatory markers and less favorable outcomes that may signal a more severe form of the disease or an impaired response to treatment.3538 Indeed, MS investigators now hypothesize that the proinflammatory environment associated with the neurologic manifestations of MS are also causing depression symptoms among MS patients.34 This theory contrasts the common belief that depression in the chronically ill manifests independent of the chronic illness or in response to living with chronic disease. Of further note, is the relatively younger average age among both depressive patients (49.6 years) and non‐depressive patients (49.9) of these study subjects. My husband is currently in Iraq and is showing signs of clinical depression(I’m a nurse by the way), his self esteem is nothing and he has convinced himself that I should find someone new because He is not worthy of me. ISSN 1553-5606, Section of General Internal Medicine, Boston University School of Medicine/ Boston Medical Center, Boston, Massachusetts, Department of Family Medicine, Boston University School of Medicine/ Boston Medical Center, Boston, Massachusetts, Hospital Medicine Unit, Department of Medicine, Boston University School of Medicine/ Boston Medical Center, Boston, Massachusetts, Chief, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, Baseline Characteristics of Study Subjects by Depression Screen Status, Number of Hospital Utilizations, Hospital Utilization Rate, Unadjusted IRR at 30, 60 and 90 Days by Depression Screen Status*, Adjusted Incident Rate Ratio of Hospital Utilization Within 30 Days of Discharge, Rehospitalizations among patients in the Medicare fee‐for‐service program, The reengineered hospital discharge program to decrease rehospitalization, The impact of patient socioeconomic status and other social factors on readmission: a prospective study in four Massachusetts hospitals, Continuity of care and patient outcomes after hospital discharge, Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan, Readmission after hospitalization for congestive heart failure among Medicare beneficiaries, Chronic comorbidity and outcomes of hospital care: length of stay, mortality and readmission at 30 and 365 days, Social network as a predictor of hospital readmission and mortality among older patients with heart failure, Acute exacerbation of chronic obstructive pulmonary disease: influence of social factors in determining length of stay and readmission rates, Time course of depression and outcome of myocardial infarction, Medication use leading to emergency department visits for adverse drug events in older adults, A systematic literature review of factors affecting outcomes in older medical patients admitted to hospital, Depression is a risk factor for rehospitalization in medical inpatients, Risk factors for hospital readmission in patients with chronic obstructive pulmonary disease, Depression and healthcare costs during the first year following myocardial infarction, Relationship of depression to increased risk of mortality and rehospitalization, Single item on positive affect is associated with 1‐year survival in consecutive medical inpatients, Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions, The PHQ‐9: Validity of a brief depression severity measure, Rapid estimate of adult literacy in medicine: a shortened screening instrument, A new method of classifying prognostic comorbidity in longitudinal studies: development and validation, The association between the quality of inpatient care and early readmission: a meta‐analysis of the evidence, Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes, Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients, Symptoms of depression prospectively predict poorer self‐care in patients with Type 2 diabetes, The effect of adherence on the association between depressive symptoms and mortality among HIV‐infected individuals first initiating HAART, Self‐efficacy mediates the relationship between depressive symptoms and medication adherence, Patient self‐management of chronic disease in primary care, Effects of sertraline on the recovery rate of cardiac autonomic function in depressed patients after acute myocardial infarction, Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND‐IT, Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acugte coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet SubStudy, Depression and immunity: inflammation and depressive symptoms in multiple sclerosis, Synergistic effects of psychological and immune stressors on inflammatory cytokines and sickness responses in humans, Psychological distress, killer lymphocytes and disease severity in HIV/AIDS, Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function, Obama proposes $634 billion fund for health care, Choosing Wisely: Things We Do For No Reason. Third, our results may not be generalizable to populations other than those served by urban safety‐net hospitals or other populations excluded from the Project RED trial (eg, non‐English speaking patients and patients from nursing homes). Poisson models were used to test for significant differences between the predicted and observed number of hospitalization events at 30 days. Some other reasons for discharge could be demerits/punishments, criminal act, the poor quality of the person’s work, humanitarian or medical reasons, substance abuse, and dependency issues, inability to comply with suggestions for treatment or counseling. While this is possible, our model does include several variables (eg, Charlson score and length of stay) that are likely to adjust for disease severity, pointing to the likelihood that symptoms of depression truly predict hospital utilization in a fashion that is independent of disease severity. Hazard for hospital utilization among subjects with and without depressive symptoms in 30 days following hospital discharge. A score of 5 or higher indicates a positive depression symptom screen.17Free Care is a Massachusetts state program for uninsured patients.Health literacy categories correspond to total score as determined by REALM.18Have PCP refers to subject self‐identifying PCP at time of Project RED study enrollment.∥Unmarried marital status includes subjects identified as divorced, widow, single, partnered.Charlson Comorbity Index Score reflects the cumulative increased likelihood of 1‐year mortality. PURPOSE OF MEDICAL DISCHARGE ON GROUNDS OF INJURY OR ILLNESS Each year thousands of servicemembers are injured while on duty. P values of less than 0.05 were considered to indicate statistical significance. The same method was used to calculate hospital utilization rates within 60 and 90 days of discharge respectively. of hospital utilizations324275 1.79 (1.53,2.10)90‐day hospital utilization rate0.6481.165<0.001 Poisson regression analyses were conducted to control for potential confounding in the relationship between depressive symptoms and hospital utilization rate within 30 days after discharge (Table 3). It is also a potential marker for poor quality of care.24 Concerns for patient safety, escalating healthcare costs, and possible change in hospital reimbursement mechanisms are fueling the search for modifiable risk factors associated with early rehospitalization. Sum reflects cumulative number of events over 30, 60 and 90 days.No. It is accompanied by other problems like feelings of guilt, hel… DISCHARGE ACTIVITY: Resume activity as tolerated. For example, research shows that patients with depression following coronary artery bypass surgery are less likely to adhere with cardiac rehabilitation programs.25 Likewise, depression among chronically ill patients such as diabetics, asthmatics, or human immunodeficiency virus (HIV)‐positive patients impairs medication adherence and self‐care behavior which may lead to disease relapse or recurrence.2628 One study examining depression effects on hypertensive medicine adherence in African Americans identified self‐efficacy as a mediating factor between depression and nonadherence.29 This implies that interventions such as self‐management education, a program through which chronically‐ill patients learn to better manage their illnesses through enhanced self‐confidence and problem‐solving strategies (including mood disorder challenges) may reduce early rehospitalization among depressed patients.30. A major strength of the current study is the large dataset and the broad range of covariates available for analyses. Finally, social factors such as substance use and social support system variables may residually confound the relationship between depression and hospital reutilization demonstrated in this study. Abbreviations: CI, confidence interval; ED, emergency department; IRR, incident rate ratio. These feelings may interfere with your daily life. We comply with the HONcode standard for trustworthy health information -. We used the nine‐item Patient Health Questionnaire (PHQ‐9) depression screening tool to identify patients with depressive symptoms. Refers to Project RED study group assignment. Also called as unipolar major depression, major depression is a syndrome of a persistently sad mood lasting two (2) weeks or longer. Prospective cohort design consisting of an initial interview, and six‐weekly assessments for 24 weeks using a self‐report questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Among patients with a positive depression screen, 58% had a history of depression and 53% were currently taking medications at the time of enrollment, compared with 25% and 22% respectively for subjects with a negative depression screen. DO NOT RELY ON ANY ADVICE YOU RECEIVE FROM ME OR ANY OTHER ATTORNEY ON THIS FORUM. Second, we do not know the direction of the associations we report. The unadjusted incident rate ratio (IRR) was calculated as the ratio of the rate of hospital utilizations among patients with depressive symptoms versus patients without depressive symptoms. You need to document it because you *may* qualify for a Medical Discharge and/or lifetime VA benefits. Patients were not enrolled if they were admitted from a skilled nursing facility or other hospital, transferred to a different hospital service prior to enrollment, admitted for a planned hospitalization, on hospital precautions, on suicide watch, deaf or blind. Positive depressive symptom screen determined by PHQ9 screen tool, a nine‐item 4‐point Likert scale, standard scoring algorithm to screen for major and minor depression. Any ED visit in which a subject was subsequently admitted to the hospital was only counted as a readmission. It is not intended as medical advice for individual conditions or treatments. Gender, marital status, frequent prior utilization (01 vs. 2 or more), and homelessness were treated as dichotomous variables. While this dataset does not include a measure of social support other than marital status and housing status, data is available on substance use. Racemic ketamine, which is most often given as an infusion into the bloodstream. Thus, there is great interest in identifying modifiable risk factors for rehospitalization that could be used to refine intervention models and lead to improvements in quality of care, patient outcomes, and cost savings. I'm currently on my 3rd type of med's trying to get it fixed but nothing is working. Poisson regression was used to control for confounding variables. Among patients with a positive depression screen, 58% had a history of depression and 53% were currently taking medications at the time of enrollment, compared with 25% and 22% respectively for subjects with a negative depression screen. Consider an ODPMC discharge if you: 1. are frequently depressed, or find yourself crying; 2. have feelings of helplessness; 3. lack self-confidence or feel worthless; 1. have ever thought, even fleetingly, of suicide; 2. tend to feel out of control; 1. have physical problems for which there are not obvious physical answers (headaches, pre-ulcero… Project RED was a two‐armed randomized controlled trial of English‐speaking adult patients, 18 years or older, admitted to the teaching service of Boston Medical Center, a large urban safety‐net hospital with an ethnically diverse patient population. Available for Android and iOS devices. Depressive symptom score of 5 points or higher is designated as positive.17. Frequent Utilizer is defined as a subject with 2 or more hospital utilizations in 6 months prior to Project RED clinical trial index admission. Subjects who could not be reached within 60 days of discharge were assumed alive. Depression screening: utility of the Patient Health Questionnaire in patients with acute coronary syndrome. (%) <8th grade33 (7)21 (9) Some high school82 (17)52 (22) High school grad192 (38)90 (38) Some college126 (25)51 (22) College grad67 (13)22 (9)0.135Health Literacy Grade 3 and below64 (13)44 (19) Grade 4654 (11)22 (10) Grade 78156 (32)73 (32) Grade 9 and above213 (44)89 (39)0.170Income, $, No. Interaction term of Project RED study group assignment and depressive symptom category (positive or negative). DATE OF ADMISSION: MM/DD/YYYY. DISCHARGE DIET: Cardiac diet. AbstractBACKGROUND:Little evidence exists to determine whether depression predicts hospital utilization following discharge among adult inpatients on a general medical service.OBJECTIVE:We aimed to determine whether a positive depression screen during hospitalization is significantly associated with an increased rate of … A similar trend was found among subjects at 60 and 90 days post‐discharge.Table 2.Number of Hospital Utilizations, Hospital Utilization Rate, Unadjusted IRR at 30, 60 and 90 Days by Depression Screen Status*Hospital UtilizationDepression Screen*P ValueIRR (CI)Negative, n = 500 (68%)Positive, n = 238 (32%)Abbreviations: CI, confidence interval; ED, emergency department; IRR, incident rate ratio. There is no maximum score.19Interaction term of Project RED study group assignment and depressive symptom category (positive or negative).Depression symptoms* <0.001Positive1.731.272.36 NegativeREF1.0 Gender <0.001Male1.871.472.40 FemaleREF1.0 Marital status 0.005Married0.6250.440.89 Unmarried1.0REF Frequent utilizer <0.0012+ prior visits2.451.923.15 <2 prior visits1.0REF Study group 0.054Intervention0.760.551.06 Control1.0REF Employment Part time1.400.852.300.095Not working1.671.152.440.003Other0.520.073.850.262Full time1.0REF Charlson Score∥0.980.921.040.250Group* depression0.840.521.360.236Age1.000.991.010.375Figure 1 depicts the Kaplan‐Meier hazard curve generated for time to first hospital utilization, stratified by depression status. Number of hospital utilizations include all ED visits and hospital readmissions following discharge from Project RED index admission. Will those mental health services be readily available? It may also be done with family members or a significant other. I've had no issues using my GI Bill and it was just like I … For example, if a patient screens positive for depressive symptoms during a hospitalization for COPD exacerbation, will the proposed payment reforms allow for mental health services during the immediate post‐discharge period in order to reduce the likelihood of hospital readmission? Submitted by lagringa00@yahoo.com on Sun, 2016-09-18 14:12. Patients were required to have a telephone, be able to comprehend study details and the consent process in English, and have plans to be discharged to a US community. The Institutional Review Board of Boston University approved all study activities. Subjects with Medicaid for insurance had a higher rate of depression (61%) than subjects with Medicare (13%), private insurance (9%), or those who qualified for the Free Care pool (17%) which is the Massachusetts state funding for healthcare to uninsured persons. Figure 1 Hazard for hospital utilization among subjects with and without depressive symptoms in 30 days following hospital discharge. © Copyright IBM Corporation 2020 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. At 30 days post‐discharge, those with depressive symptoms had a higher rate of hospital utilization than those without depressive symptoms (0.563 vs. 0.296). Therefore, we conducted a secondary analysis of the Project RED clinical trial dataset to assess the association between a positive depression screen during inpatient hospitalization and the rate of subsequent hospital utilization.MethodsData from the Project RED clinical trial were reviewed for inclusion in a secondary analysis. B. Last updated on Nov 16, 2020. The loss to follow up was minimal. Major depression is classified under mood disorders which are characterized by disturbances in the regulation of mood, behavior, and affect that go beyond the normal fluctuations that most people experience. Timely depression therapy during the hospitalization or following hospital discharge might reduce costly readmissions and enhance patient safety. Abbreviations: PCP, primary care provider; PHQ9, Patient Health Questionnaire‐9; REALM, Rapid Estimate of Health Literacy in Adult Medicine tool; SD, standard deviation. The above information is an educational aid only. The main medical treatment for depression is antidepressant medication. While 21% of participants without symptoms of depression had a hospital utilization within 30 days, fully 29% of participants with symptoms of depression had a hospital utilization within 30 days (P = 0.011). *Positive depressive symptom screen determined by PHQ9 screen tool, a nine‐item 4‐point Likert scale, standard scoring algorithm to screen for major and minor depression. You have done something on purpose to hurt yourself. A secondary analysis was performed using data from 738 English‐speaking, hospitalized adults from the Project RED randomized controlled trial (clinicaltrials.gov Identifier: NCT00252057) conducted at an urban academic safety‐net hospital. He or she will also monitor your medicine if you take antidepressants. Following an injury, the military’s first priority is to provide medical treatment to the servicemember with the goal of returning him or her to duty as soon as possible. Design. Second, we do not know the direction of the associations we report. 2013;22(1):12-19. In addition, depressed subjects had a higher severity of co‐morbid disease and longer length of stay for the index hospitalization. Payment reforms that account for all necessary transitional care services will indeed help reduce readmission costs with less risk for untoward consequences. Will those mental health services be readily available? Your healthcare provider will ask if the medicine is helping. In other words, 56 utilization events occurred per 100 patients with depressive symptoms, compared with 30 utilization events per 100 patients without depressive symptoms. You think about harming yourself or someone else. While this dataset does not include a measure of social support other than marital status and housing status, data is available on substance use. We do not know, however whether treating hospitalized patients who screen positive for depression will decrease early rehospitalization and emergency room utilization rates.Various physiologic and behavioral mechanisms may link symptoms of depression to hospital utilization after discharge. Of further note, is the relatively younger average age among both depressive patients (49.6 years) and non‐depressive patients (49.9) of these study subjects.The unadjusted hospital utilization rate at 30, 60, and 90 days post‐discharge by depression status is shown in Table 2. Process factors included self caring process, medical care after discharge, resumption of work and managing daily life. PTSS, anxiety, and depression symptoms were assessed by telephonic or face to face interviews by using the Impact of Events-r (IES-r) and Hospital anxiety and depression (HADS), respectively, at 0, 7,14, 30, 90 and 180 days from ICU discharge. The primary independent variable of interest was depressive symptoms defined as a positive score for minor or major depression on the nine‐item Patient Health Questionnaire (PHQ‐9) depression screening tool.20 A dichotomized variable was created using a standardized scoring system to determine the screening cut‐off for major or minor depressive symptoms.19. Table 1 presents the means or percentages for baseline characteristics by depression status in the analytic cohort. A backward stepwise regression was conducted to identify and control for relevant confounders and construct the final, best‐fit model for the association between depression and hospital reutilization. More information: Lori L. Popejoy et al, Testing Re-Engineered Discharge Program Implementation Strategies in SNFs, Clinical Nursing Research (2020).DOI: 10.1177/1054773820982612 Depression is a medical condition that causes feelings of sadness or hopelessness that do not go away. All data were analyzed with S‐Plus 8.0 (Seattle, WA).In addition, a Kaplan‐Meier hazard curve was generated for the first hospital utilization event, ED visit or readmission, for the 30‐day period following discharge and compared with a log‐rank test.ResultsA total of 28% of subjects were categorized as having a positive depression screen. Outcome data were collected by reviewing the hospital's electronic medical records (EMRs) and by contacting subjects by telephone 30 days after discharge. The unadjusted hospital utilization within 30 days of discharge was 56 utilizations per 100 depressed patients compared with 30 utilizations per 100 non‐depressed patients, incident rate ratio (IRR) (confidence interval [CI]), 1.90 (1.51–2.40). If symptoms of depression are merely the consequence of having a higher disease burden, treatment of the underlying disease may be the most important response. Examples of non disability conditions include bedwetting, seasickness, and mild depression. If symptoms of depression are merely the consequence of having a higher disease burden, treatment of the underlying disease may be the most important response. The same method was used to calculate hospital utilization rates within 60 and 90 days of discharge respectively. For example, depressed patients with features of somatization may be more likely to experience worrisome physical symptoms after discharge and present prematurely for reevaluation. In patients with CVD, depression is associated with poor outcomes possibly related to decreased heart rate variability, hypercoagulability, high burdens of inflammatory markers, and severity of left ventricular dysfunction.3134 Similarly, depression among HIV/acquired immune deficiency syndrome (AIDS), diabetics and multiple sclerosis (MS) patients is linked to heightened levels of proinflammatory markers and less favorable outcomes that may signal a more severe form of the disease or an impaired response to treatment.3538 Indeed, MS investigators now hypothesize that the proinflammatory environment associated with the neurologic manifestations of MS are also causing depression symptoms among MS patients.34 This theory contrasts the common belief that depression in the chronically ill manifests independent of the chronic illness or in response to living with chronic disease.A major strength of the current study is the large dataset and the broad range of covariates available for analyses.