Patients hospitalized for a variety of illnesses are almost twice as likely to die during the next two years if they were depressed, German researchers report.
The effect was strongest among patients with cardiovascular disease, and it persisted among all patients even after controlling for their age, diagnoses, and severity of their illness, according to Christoph Herrmann, MD, and his colleagues at the University of Göttingen, writing in the September-October issue of Psychosomatic Medicine.
"Depressed mood is a risk factor (for subsequent death) even when a specific disorder, such as major depression, has not been diagnosed," the researchers write.
The investigators conducted brief interviews with 454 patients who had been admitted to a German teaching hospital for a variety of conditions, including heart, lung, gastrointestinal, and hematological diseases, as well as cancer.
They used a short, seven-item questionnaire to screen for symptoms of depression while the patients remained hospitalized, then followed the patients' status for approximately two years after they were released.
Age and a diagnosis of cancer or a hematological disease were the strongest predictors of death over the follow-up period. The researchers also found, however, that high symptoms of depression had an additional and significant effect on the risk of death.
When they controlled for a range of medical and demographic variables, they found that people who were depressed were 1.9 times as likely to die as were people who were not depressed. And, when they analyzed the relationship diagnosis by diagnosis, they found that depression had its strongest effects on those with cardiovascular disease and its weakest effects on those with gastrointestinal disease.
Although previous research has documented that depression can have an impact on survival of specific illnesses, such as heart disease, "our data show that depression also predicts mortality in typical medical inpatients with a variety of medical diagnoses," Dr. Herrmann and colleagues say.
The depression questionnaire they used can be administered in one or two minutes, they say, making it possible to screen for patients at high risk for death. Given the toll that depression can take on patients' quality of life and survival, efforts to improve their care are justified.
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