Abstract
ObjectiveMore than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness. Method1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire. ResultsThe numbers of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital: having no partner (OR 1.49, 95% CI 1.04 to 2.15); having ischaemic heart disease (OR 1.60, 95% CI 1.04 to 2.46); having a threatening experience (OR 1.16, 95% CI 1.04 to 1.29); depression (OR 1.58, 95% CI 1.04 to 2.40); and emergency hospital admission in the year prior to questionnaire completion (OR 3.41, 95% CI 1.98 to 5.86). ConclusionTo prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and have had a recent emergency hospital admission.
Highlights
Healthcare systems in the Western world are struggling to cope with the increasing burden of people with chronic physical health conditions, such as diabetes, arthritis, asthma or cardiovascular disease
The following factors were independently associated with an increased risk of prospective emergency admission to hospital; having no partner OR 1.49; having ischaemic heart disease OR 1.60; having a threatening experience OR 1.16 per experience; depression OR 1.58; emergency hospital admission in year prior to questionnaire completion OR 3.41 (95% CI (1.98 to 5.86)
Depression is common in a range of cardiovascular diseases including heart failure, coronary artery disease, stroke, angina and post myocardial infarction.10;11 People living with diabetes are between 1.5 to 3 times more likely to have depression than the general population and the rates of depression12;13 may even be higher in people suffering from chronic obstructive pulmonary disease
Summary
Healthcare systems in the Western world are struggling to cope with the increasing burden of people with chronic physical health conditions, such as diabetes, arthritis, asthma or cardiovascular disease. States where over 80% of all healthcare spending was spent on the 50% of the population who have a chronic medical condition.2;3 Most people with a chronic physical health problem have more than one chronic disease .1;4-6, and multimorbidity, defined as the co-existence of two or more chronic conditions, is associated with increasing age and high rates of social deprivation.. Research evidence consistently demonstrates that people with chronic physical illness are two to three times more likely to experience depression than the general population.
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