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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 7/2013

01-07-2013 | Original Research

Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

Authors: Dimitry S. Davydow, MD MPH, Wayne J. Katon, MD, Elizabeth H. B. Lin, MD, Paul Ciechanowski, MD, MPH, Evette Ludman, PhD, Malia Oliver, BA, Michael Von Korff, ScD

Published in: Journal of General Internal Medicine | Issue 7/2013

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ABSTRACT

BACKGROUND

Hospitalizations for ambulatory care-sensitive conditions (ACSCs), conditions that should not require inpatient treatment if timely and appropriate ambulatory care is provided, may be an important contributor to rising healthcare costs and public health burden.

OBJECTIVE

To examine if probable major depression is independently associated with hospitalization for an ACSC in patients with diabetes.

DESIGN

Secondary analysis of data from a prospective cohort study.

PARTICIPANTS

Population-based cohort of 4,128 patients with diabetes ≥ 18 years old seen in primary care, who were enrolled between 2000 and 2002 and followed for 5 years (through 2007).

MAIN MEASURES

Depressive symptoms were assessed with the Patient Health Questionnaire-9. Outcomes of interest included time to initial hospitalization for an ACSC and total number of ACSC-related hospitalizations. We used Cox proportional hazards regression models to ascertain an association between probable major depression and time to ACSC-related hospitalization, as well as Poisson regression for models examining probable major depression and number of ACSC-related hospitalizations.

KEY RESULTS

Patients’ mean age at study enrollment was 63.4 years (Standard Deviation: 13.4 years). Over the 5-year follow-up period, 981 patients in the study were hospitalized a total of 1,721 times for an ACSC, comprising 45.1 % of all hospitalizations. After adjusting for baseline demographic, clinical and health-risk behavioral factors, probable major depression was associated with initial ACSC-related hospitalization (Hazard Ratio: 1.41, 95 % Confidence Interval [95 % CI]: 1.15, 1.72) and number of ACSC-related hospitalizations (Relative Risk: 1.37, 95 % CI: 1.12, 1.68).

CONCLUSIONS

Probable major depression in patients with diabetes is independently associated with hospitalization for an ACSC. Additional research is warranted to ascertain if effective interventions for depression in patients with diabetes could reduce the risk of hospitalizations for ACSCs and their associated adverse outcomes.
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Metadata
Title
Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes
Authors
Dimitry S. Davydow, MD MPH
Wayne J. Katon, MD
Elizabeth H. B. Lin, MD
Paul Ciechanowski, MD, MPH
Evette Ludman, PhD
Malia Oliver, BA
Michael Von Korff, ScD
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 7/2013
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-013-2336-1

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