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Do-not-resuscitate (DNR) status and major depressive disorder (MDD): Clinical association and hospitalization outcomes
Published online by Cambridge University Press: 27 April 2022
Abstract
Objectives
To understand (1) the association of Major Depressive Disorder (MDD) and do-not-resuscitate (DNR) status among hospitalized patients and (2) the association of MDD and hospitalization outcomes among DNR patients.
Methods
This was a cross-sectional analysis of United States Healthcare Cost and Utilization Project, Nationwide Inpatient Sample data from 2009 to 2013 for patients >18 years. To address the first objective, we used multivariable logistic regression among all hospitalized patients to compute the adjusted odds ratio (aOR) of having DNR status if patients have active MDD of varying severities after controlling for age, sex, race, suicidal ideation, and Elixhauser Comorbidity Index. To address the second objective, we used multivariable regression among patients with DNR status to compute aOR of having hospitalization outcomes such as increased length of stay, higher total charges, leaving against medical advice, and mortality if patients have MDD.
Results
Among all hospitalizations, 2.3% had DNR status. There was an inverse association between severity of MDD and having DNR status. Relative to those without MDD, patients with moderate recurrent MDD episode (aOR 0.74 (95% confidence interval (CI): 0.65–0.85) and severe recurrent MDD episode (aOR of 0.42 (95% CI: 0.37–0.48)) were significantly less likely to have DNR status. Among DNR patients, those with all severities of MDD except mild single episode MDD were >40% less likely to die during hospitalization. Among DNR patients, patients with MDD had 0.7 day longer length of stay, and >$4,500 higher total charges.
Significance of results
Patients are less likely to have DNR status if they have active MDD. Among patients with DNR status, those with MDD are less likely to die during hospitalization than those without MDD. With current practice, depression is not associated with increased likelihood of death due to foregoing resuscitation prematurely, though the exact mechanisms of these findings need further investigation.
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- Copyright © The Author(s), 2022. Published by Cambridge University Press
References
REFERENCES
Coyne, JC (1976a) Depression and the response of others. Journal of Abnormal Psychology 85(2), 186–193.CrossRefGoogle Scholar
Coyne, JC (1976b) Toward an interactional description of depression. Psychiatry 39(1), 28–40.CrossRefGoogle Scholar
Currie, SR, Patten, SB, Williams, JV, et al. (2005) Comorbidity of major depression with substance use disorders. Canadian Journal of Psychiatry 50(10), 660–666.CrossRefGoogle ScholarPubMed
Davis, L, Uezato, A, Newell, JM, et al. (2008) Major depression and comorbid substance use disorders. Current Opinion in Psychiatry 21(1), 14–18.CrossRefGoogle ScholarPubMed
Eisner, MD, Katz, PP, Lactao, G, et al. (2005) Impact of depressive symptoms on adult asthma outcomes. Annals of Allergy, Asthma & Immunology 94(5), 566–574.CrossRefGoogle ScholarPubMed
Elixhauser, A, Steiner, C, Harris, DR, et al. (1998) Comorbidity measures for use with administrative data. Medical Care 36(1), 8–27.CrossRefGoogle ScholarPubMed
Frasure-Smith, N, Lespérance, F, Gravel, G, et al. (2000) Depression and health-care costs during the first year following myocardial infarction. Journal of Psychosomatic Research 48(4), 471–478.CrossRefGoogle ScholarPubMed
Frasure-Smith, N, Lespérance, F, Habra, M, et al. (2009) Elevated depression symptoms predict long-term cardiovascular mortality in patients with atrial fibrillation and heart failure. Circulation 120(2), 134–140, 3p following 140.CrossRefGoogle ScholarPubMed
Hall, MJ, Levant, S and DeFrances, CJ (2013) Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000–2010. NCHS databrief, no 118. Hyattsville, MD: National Center for Health Statistics.Google ScholarPubMed
Hare, DL, Toukhsati, SR, Johansson, P, et al. (2013) Depression and cardiovascular disease: A clinical review. European Heart Journal 35(21), 1365–1372.CrossRefGoogle ScholarPubMed
Healthcare Cost and Utilization Project (2015) Using the HCUP National Inpatient Sample to Estimate Trends. Retrieved from: https://www.hcup-us.ahrq.gov/reports/methods/2006_05_NISTrendsReport_1988-2004.pdf.Google Scholar
Healthcare Cost and Utilization Project (2021) Overview of the National (Nationwide) Inpatient Sample (NIS). Retrieved April 21, 2022 from: https://www.hcup-us.ahrq.gov/nisoverview.jsp.Google Scholar
Hosaka, T, Aoki, T, Watanabe, T, et al. (1999) Comorbidity of depression among physically ill patients and its effect on the length of hospital stay. Psychiatry and Clinical Neuroscience 53(4), 491–495.CrossRefGoogle ScholarPubMed
Houchens, R and Elixhauser, A (2015a) Final Report on Calculating National Inpatient Sample (NIS) Variances for Data Years 2012 and Later (No. HCUP Method Series Report # 2003-02), Online. December 14, 2015: U.S. Agency for Healthcare Research and Quality.Google Scholar
Houchens, R and Elixhauser, A (2015b) Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances for Data Years 2011 and Earlier (No. HCUP Method Series Report # 2003-02), Online December 14, 2015: U.S. Agency for Healthcare Research and Quality. Retrieved from: http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp.Google Scholar
Jiang, W, Alexander, J, Christopher, E, et al. (2001) Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Archives of Internal Medicine 161(15), 1849–1856.CrossRefGoogle ScholarPubMed
Kato, N, Kinugawa, K, Yao, A, et al. (2009) Relationship of depressive symptoms with hospitalization and death in Japanese patients with heart failure. Journal of Cardiac Failure 15(10), 912–919.CrossRefGoogle ScholarPubMed
Kim, YS, Escobar, GJ, Halpern, SD, et al. (2016) The natural history of changes in preferences for life-sustaining treatments and implications for inpatient mortality in younger and older hospitalized adults. Journal of the American Geriatrics Society 64(5), 981–989.CrossRefGoogle ScholarPubMed
Moore, BJ, White, S, Washington, R, et al. (2017) Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: The AHRQ Elixhauser comorbidity index. Medical Care 55(7). Retrieved from: https://journals.lww.com/lww-medicalcare/Fulltext/2017/07000/Identifying_Increased_Risk_of_Readmission_and.9.aspx.Google ScholarPubMed
Prina, AM, Deeg, D, Brayne, C, et al. (2012) The association between depressive symptoms and non-psychiatric hospitalisation in older adults. PLoS One 7(4), e34821.CrossRefGoogle ScholarPubMed
Rafiq, A, Ullah, W, Naglak, M, et al. (2019) Characteristics and outcomes of patients with partial do not resuscitate orders in a large community hospital. Cureus 11(11), e6048.Google ScholarPubMed
Rand, KL, Banno, DA, Shea, AM, et al. (2016) Life and treatment goals of patients with advanced, incurable cancer. Supportive Care in Cancer 24(7), 2953–2962.Google ScholarPubMed
Shantna, K, Chaudhury, S, Verma, AN, et al. (2009) Comorbid psychiatric disorders in substance dependence patients: A control study. Industrial Psychiatry Journal 18(2), 84–87.CrossRefGoogle ScholarPubMed
Strain, JJ, Lyons, JS, Hammer, JS, et al. (1991) Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients. The American Journal of Psychiatry 148(8), 1044–1049.Google ScholarPubMed
van Walraven, C, Austin, PC, Jennings, A, et al. (2009) A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 47(6), 626–633.CrossRefGoogle ScholarPubMed
Walker, J, Burke, K, Wanat, M, et al. (2018) The prevalence of depression in general hospital inpatients: A systematic review and meta-analysis of interview-based studies. Psychological Medicine 48(14), 2285–2298.CrossRefGoogle ScholarPubMed
Weinberger, AH, Gbedemah, M, Martinez, AM, et al. (2018) Trends in depression prevalence in the USA from 2005 to 2015: Widening disparities in vulnerable groups. Psychological Medicine 48(8), 1308–1315.CrossRefGoogle ScholarPubMed
Oh et al. supplementary material
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Oh et al. supplementary material
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