Depression In Hospitalized Patients Research Articles

Feasibility of Utilizing Transforming Growth Factor Beta as a Biomarker of Depression in Hospitalized Patients

Several mental conditions and depression, have been linked to immune response disorganization. However, it is unclear if particular immune mediators play a part in the etiopathogenesis of depression. Although there are no definite biomarkers to diagnose depression, the current study sought to logically evaluate the possibility and feasibility of checking a biomarker for depression to be utilized for hospitalized patients suspected of depression. In this narrative review, related articles were gathered through a search of PubMed, Scopus, and ScienceDirect databases as well as a manual search of full-text paper references. The reviewed studies demonstrated the potential role of the transforming growth factor beta (TGF-β) in depressive disorders. Previous studies represented a negative role for TGF-β in depression pathophysiology and an increase in TGF-β after depression treatment. Elevated plasma TGF-alpha acted controversial to TGF-β. The level of TGF-β in maternal plasma increased getting close to delivery, and researchers found that it might be associated with postpartum depression. In addition, researchers reported extreme elevations in TGF-β levels in the brain cells of subjects who died by suicide. Although the results of this study revealed a plausible link between TGF-β and depression based on the literature, sensitivity and specificity studies needed before TGF-β as a biomarker may be extensively employed in clinical practice. Depression appears to be down-regulating TGF-β and its signaling or the underlying mechanisms of the pathogenesis of consequent neurological disorders, while further studies are required for the application of the TGF-β assessment in clinical practice.

Suicidal Ideation and Depression in Hospitalized Patients With Metabolic Syndrome

Background and Objective The increase in the global prevalence of metabolic syndrome has become a major public health problem. Few studies have been conducted on the relationship between psychiatric disorders and metabolic syndrome in Iran; therefore, we investigated the association between depression and suicidal ideation amongst patients with metabolic syndrome. Materials & Method This study was a descriptive cross-sectional study to determine the prevalence of depression and suicidal ideation among 150 patients with metabolic syndrome referred to the Endocrinology Department of Afzalipour General Hospital, Kerman City, Iran, in 2019. The study data were obtained using the Beck scale for suicide ideation, Beck Depression Inventory (BDI-II), and demographic information questionnaire. The last hemoglobin (Hb)A1C test, body mass index (BMI), blood pressure, high-density lipoprotein (HDL), cholesterol, triglyceride test, and waist circumference were gathered according to ATP III guidelines. Analyses of variance, the t test, the Pearson test, multiple regression, and the Spearman test were performed for statistical analyses. Results About 52.6% of participants were male, 87.3% were married, and 77.4% lived in the city. Also, 59.4% had depression, and suicidal ideation was prevalent among them: 50% of the samples had suicide ideation, and 8% were ready to commit suicide. There were significant positive correlations between suicide ideation and mean age, duration of illness, BMI, mean HbA1C level, fasting blood sugar (FBS), and depression, but there was a significant negative correlation between suicide score and HDL level. Conclusion Awareness of these factors can help identify high-risk people. It is suggested that particular consideration be given to the various dimensions of psychiatric issues related to people with metabolic syndrome.

Prevalence, Temporal Change, and Determinants of Anxiety and Depression in Hospitalized Patients With Heart Failure

BackgroundAnxiety and depression may be under-recognized in patients with heart failure (HF). We therefore investigated the prevalence and temporal change of these symptoms in hospitalized patients with HF. Methods and ResultsWe prospectively evaluated consecutive hospitalized patients with HF using the Hospital Anxiety and Depression Scale (HADS) on admission and at discharge. The HADS-A (anxiety) and HADS-D (depression) scores were categorized as follows; 0–7, no symptoms; 8–10, mild; and 11–21, significant anxiety or depression. Symptom worsening was defined as the HADS category at discharge being poorer than that on admission. Of 224 patients (mean age 77.5 years), 35 (16%) and 62 (28%) had significant symptoms of anxiety and depression, respectively. During hospitalization, the HADS-A significantly decreased (on admission; median 6 [interquartile range (IQR) 3–9] vs at discharge; median 4 [IQR 2–7], P < .01), whereas the HADS-D did not improve (on admission; median 8 [IQR 5–11] vs at discharge; median 8 [IQR 4–11], P =.82). Anxiety and depression worsened during hospitalization in 19 (10%) and 40 (21%) patients, respectively. Advanced age, higher natriuretic peptide levels, and acute-on-chronic HF were associated with worsening anxiety, and longer hospitalization length was associated with worsening depression. ConclusionsAnxiety and depression were common and depression persisted during HF hospitalization.

Predicting Risk for Opioid-Induced Sedation and Respiratory Depression in Hospitalized Patients

<h3>Introduction</h3> Pain assessment and management is a fundamental part of nursing care. Opioids are one of the interventions utilized to manage pain within the hospital setting and have a known adverse effect called Opioid-Induced Sedation and Respiratory Depression (OSRD). <h3>Identification of the problem</h3> There is a lack of consensus regarding the risk factors that predict OSRD. Therefore, this study served as a first step in the creation of a risk screen tool for OSRD. <h3>Purpose of the Study</h3> The purpose of this quantitative study was to create a prediction model with the known risk factors, present on admission, for OSRD to determine how well they predict OSRD. <h3>Methodology</h3> The combination of factors that most accurately predict the risk of OSRD in patients on admission to an acute care healthcare institution was determined through a retrospective case control analysis. Risk factors present on admission of a case group who had succumbed to OSRD after an opioid administration were compared to a control group who did not. A binary logistic regression analysis determined how well age, body mass index, obstructive sleep apnea, pulmonary disease, respiratory disease, renal failure, and no opioid use (i.e., being opioid naïve) predicted OSRD. <h3>Results</h3> The presence of pulmonary disease, renal disease, cardiac disease, diabetes, and being opioid naïve most accurately predicted OSRD. Pulmonary and renal disease were statistically significant, while cardiac disease, diabetes and being opioid naïve increased patient odds of OSRD, but were not statistically significant. <h3>Discussion</h3> The advantage of only examining risk factors present on admission substantiates the purpose of this study and narrowed the focus from all the risk factors in the literature throughout the continuum of care. This allowed for a magnified view of factors to be screened on admission in a simplified tool. <h3>Conclusion</h3> The results extend the knowledge in the field on the topic and confirm other the findings of similar studies that used the case-control design to predict the risk factors for OSRD. <h3>Implications for perianesthesia nurses and future research</h3> Through understanding the factors that predict OSRD, a screening tool was created for future research, that could save lives in hospital institutions by supporting better clinical decision making and care.

Left Ventricular Dysfunction and Depression in Hospitalized Patients with Heart Failure.

This study examined whether the severity of left ventricular systolic dysfunction is associated with depression in patients with heart failure (HF). Other factors were also studied to identify independent correlates of depression in HF. The sample consisted of 400 hospitalized patients with HF. Left ventricular ejection fraction and other medical data were obtained from medical records. Depression and other psychosocial characteristics were assessed by an interview and questionnaires. Proportional odds models were used to test the relationships of these characteristics to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) depressive disorders, and analysis of covariance was used to test relationships with continuous measures of depression in secondary models. The models produced no evidence of an association between left ventricular ejection fraction and depression. The adjusted odds ratio (95% confidence interval) was 1.00 (0.98-1.01; p = .87) for depression diagnosis. Analysis of covariance estimates (standard errors) were -0.01 (0.02; p = .54) for the Hamilton Rating Scale for Depression and -0.01 (0.01; p = .59) for the Patient Health Questionnaire. The odds of depression were higher in African American patients and in those with high levels of anxiety or stress. Other characteristics that have been associated with depression in previous studies, including sex and age, were not consistently associated with depression in this study. There is no relationship between the severity of left ventricular systolic dysfunction and depression in hospitalized patients with HF. In contrast, African American patients and those with a high level of anxiety or perceived stress are more likely than other patients to have a comorbid depressive disorder.

Trends of Co-Morbid Depression in Hospitalized Patients with Failed Back Surgery Syndrome: An Analysis of the Nationwide Inpatient Sample.

IntroductionCo-morbid depression has been associated with poor outcomes following spine surgery and worsening of low back pain symptoms leading to failed back surgery syndrome (FBSS). Given the increasing focus of healthcare utilization and value-based care, it is essential to understand the demographic and economic data surrounding co-morbid depression amongst patients with FBSS.MethodsOur study investigated the NIS database for FBSS patients who had co-morbid depression (ICD-9 CM codes 300.4, 301.12, 309.0, 309.1, 311; ICD-10 M96.1) between 2011 and 2015 across 44 states. We obtained demographic and economic data such as age, sex, ethnicity, location, number of in-patient procedures, hospital length of stay, cost of hospital stay, and frequency of routine discharge dispositions. The NIS database represents approximately a 20% sample of discharges from hospitals in the United States. These data are weighted to provide national estimates for the total United States population. National administrative databases (NADs) like National Inpatient Sample (NIS) are a common source of data for spine procedures. This database is appealing to investigators because of ease of data access and large patient sample. The NIS database is a de-identified database that consists of a collection of billing and diagnostic codes used by participating hospitals with the goal of quality control, population monitoring, and tracking procedures. The NIS does not require institutional review board (IRB) approval or exempt determination.ResultsBetween 2011 and 2015, a total number of 115,976 patients with FBSS were identified. Of these patients, about 23,425 had co-morbid depression. The rate of co-morbid depression in 2015 was 23% with the lowest reported rate being 20% in 2011. Females and Caucasians had consistently higher rates of co-morbid depression compared to males and other ethnic groups respectively. The average length of stay for patients with co-morbid depression fluctuated between 2011 and 2015, with the highest reported at 4.81 days in 2015. The number of procedures increased steadily from 2011 to 2015 with a dip in 2013. The highest number of procedures was reported as 3.94 in 2015. The mean total hospital charges remained stable over time with the largest change being the decrease from 2011 (mean $93,939; 95% CI $80,064–$107,815) to 2012 (mean 82,603; 95% CI $75,127–$90,079). Additionally, patients with FBSS and co-morbid depression were more often discharged home than home with healthcare or to another healthcare facility.ConclusionsThe occurrence of co-morbid depression in hospitalized patients with FBSS increased from 20% in 2011 to 23% in 2015. While direct hospital costs and length of stay remained relatively stable, the number of inpatient procedures performed trended upwards. The exact etiology for this increase in depression prevalence is unknown; additional studies are needed to shed further insight.

Depression screening and referral in cardiac wards: A 12-month patient trajectory.

Depression is common among patients with coronary heart disease (CHD) and has a major impact on their quality of life, morbidity and mortality. The aim of this study was to map the 12-month psychosocial outcomes of patients with CHD who were screened positive for depression in an acute cardiac ward. A prospective cohort study was conducted of the psychosocial trajectory (depression, anxiety, wellbeing, social support, mental health service access) of 212 patients with CHD who were screened for depression after being admitted to acute cardiac wards of a major metropolitan hospital. Outcomes were assessed before hospital discharge and at one, three, six and 12 months post-discharge. Linear mixed models identified that those patients screened at 'moderate to high' risk of depression at baseline had higher levels of depression ( F(1,173)=53.93, p<0.0001) and anxiety ( F(1,180)=67.01, p<0.001), and lower levels of wellbeing ( F(1,186)=42.47, p<0.001) and social support ( F(1,177)=25.40, p<0.0001), compared to those at 'no to low' risk of depression. Levels of depression and wellbeing remained fairly constant over the 12-month trajectory. Surgical and medical treatment groups were of similar psychological composition over the 12-month period. These findings attest to the effectiveness and predictive validity of a simple nurse-administered screening tool designed to identify depression in hospital patients with CHD and also indicate that a screening and referral tool alone is not sufficient to achieve optimal disease management. A collaborative care model involving family members and integrated pathways to primary care is recommended.

Investigation on the level of hopelessness,anxiety and depression in hospitalized patients with cancer

Objective To investigate the suicide related psychological status of cancer patients in hospital. Methods 508 cancer patients in the Affiliated-Tumor-Hospital-of-Guangxi-Medical-University were recruited and using the hospital anxiety and Depression Scale (HADS) and Beck Hopelessness Scale (BHS) for evaluating cancer patients' anxiety, depression, hopelessness. According to age, the patients were divided into three groups, comparing the differences in three groups' scores of anxiety, depression, hopelessness. Results Of all the respondents, there were 38.7% (172/445) patients with anxiety, and 26.3% (117/445) patients with depression, and 59.1% (263/445) patients with different degrees of hopelessness. In the comparison of three groups of patients, anxiety scores existed differences (U=7.083, P 0.05). Conclusions Many people have anxiety /depression in cancer patients, most cancer patients have varying degrees of hopelessness. The health care workers should get attention to these suicide related psychology, take appropriate intervention, in order to avoid the occurrence of hospitalized cancer patients committing suicide. Key words: Tumor; Anxiety; Depression; Hopelessness; Investigation

Trends in the prevalence of depression in hospitalized patients with type 2 diabetes in Spain: analysis of hospital discharge data from 2001 to 2011.

BackgroundThis study aims to describe trends in the prevalence of depression among hospitalized patients with type 2 diabetes in Spain, 2001–2011.MethodsWe selected patients with a discharge diagnosis of type 2 diabetes using national hospital discharge data. Discharges were grouped by depression status. Prevalence of depression globally and according to primary diagnoses based on the Charlson comorbidity index (CCI) were analyzed. We calculated length of stay (LOHS) and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year and comorbidity.ResultsFrom 2001 to 2011, 4,723,338 discharges with type 2 diabetes were identified (4.93% with depression). Prevalence of depression in diabetic patients increased from 3.54% in 2001 to 5.80% in 2011 (p<0.05). The prevalence of depression was significantly higher in women than in men in each year studied and increased from 5.22% in 2001 to 9.24% in 2011 (p<0.01). The highest prevalence was observed in the youngest age group (35–59 years). The median LOHS decreased significantly over this period. Men with diabetes and depression had higher IHM than women in all the years studied (p<0.05). Older age and greater comorbidity were significantly associated with a higher risk of dying, among diabetic patients with concomitant depression.ConclusionsPrevalence of depression increased significantly among hospitalized diabetic patients from 2001 to 2011 even if the health profile and LOHS have improved over this period. Programs targeted at preventing depression among persons with diabetes should be reinforced in Spain.

Screening and Assessment Help to Identify Depression in Hospitalized Patients with Chronic HF

Heart failure (HF) is the most common cause for hospitalization in adults aged >?65 years. In patients with HF, depression is common and is associated with adverse outcomes. This article discusses the use of screening to identify depression in hospitalized patients with congestive HF.

Effectiveness of Controlled Breathing Techniques on Anxiety and Depression in Hospitalized Patients With COPD: A Randomized Clinical Trial

Anxiety and depression are prevalent comorbidities in patients with COPD. Breathing techniques can improve anxiety and depression in patients hospitalized for COPD exacerbation. We conducted a randomized clinical study with 46 male subjects, 67-86 years old, hospitalized with acute COPD exacerbation. Subjects were randomly and equally divided into a control group and a controlled breathing intervention group. We measured baseline and post-intervention dyspnea, anxiety and depression, quality of life (with the St George's Respiratory Questionnaire and the European Quality of Life questionnaire), maximum inspiratory and expiratory pressure, hand-grip strength, and sleep quality. The cohort had high dyspnea and low overall quality of life. Controlled breathing techniques significantly improved dyspnea, anxiety, and mobility. All the measured variables improved in the intervention group. The control group had poorer values in all the variables after the hospitalization period. Controlled breathing exercises improve anxiety and depression in patients hospitalized for COPD exacerbation. (ClinicalTrials.gov NCT01826682).

Methodological artifacts in dimensionality assessment of the Hospital Anxiety and Depression Scale (HADS)

ObjectiveThe Hospital Anxiety and Depression Scale (HADS) is a brief, self-administered questionnaire for the assessment of anxiety and depression in hospital patients. A recent review [7] discussed the disagreement among different studies with respect to the dimensionality of the HADS, leading Coyne and Van Sonderen [8] to conclude from this disagreement that the HADS must be abandoned. Our study argues that the disagreement is mainly due to a methodological artifact, and that the HADS needs revision rather than abandonment. MethodWe used Mokken scale analysis (MSA) to investigate the dimensionality of the HADS items in a representative sample from the Dutch non-clinical population (N=3643) and compared the dimensionality structure with the results that Emons, Sijtsma, and Pedersen [11] obtained in a Dutch cardiac-patient sample. ResultsWe demonstrated how MSA can retrieve either one scale, two subscales, or three subscales, and that the result not only depends on the data structure but also on choices that the researcher makes. Two 5-item HADS scales for anxiety and depression seemed adequate. Four HADS items constituted a weak scale and contributed little to reliable measurement. ConclusionsWe argued that several psychometric methods show only one level of a hierarchical dimensionality structure and that users of psychometric methods are often unaware of this phenomenon and miss information about other levels. In addition, we argued that a theory about the attribute may guide the researcher but that well-tested theories are often absent.

Anxiety and depression in hospitalized patients in resistant organism isolation.

Previous studies have reported an increase in psychiatric symptoms in seriously ill patients who were placed in resistant organism isolation. We conducted this study to assess whether there is an increase in symptoms of anxiety and depression in patients who are not critically ill and are placed in isolation. Patients hospitalized with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus species infections were evaluated with the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale at baseline and again during hospitalization. The results were then compared with the results of patients who were hospitalized for infectious diseases that did not require isolation. Patients in isolation had significantly higher scores on both the anxiety and depression scales at the time of follow-up than did patients who were not isolated. There was no significant difference between the scores of the two groups before isolation. The results of this preliminary study suggest that placement in resistant organism isolation may increase hospitalized patients' levels of anxiety and depression.

Prevalence of depression in hospitalized patients with congestive heart failure.

Prevalence estimates of depression in hospitalized patients with congestive heart failure (CHF) differ considerably across studies. This article reports the prevalence of depression in a larger sample of hospitalized patients with CHF and identifies demographic, medical, psychosocial, and methodological factors that may affect prevalence estimates. A modified version of the Diagnostic Interview Schedule was administered to a series of 682 hospitalized patients with CHF to determine the prevalence of DSM-IV major and minor depression; 613 patients also completed the Beck Depression Inventory. Medical, demographic, and social data were obtained from hospital chart review, echocardiography, and patient interview. In the sample as a whole, 20% of the patients met the DSM-IV criteria for a current major depressive episode, 16% for a minor depressive episode, and 51% scored above the cutoff for depression on the Beck Depression Inventory (>or=10). However, the prevalence of major depression differed significantly between strata defined by the functional severity of heart failure, age, gender, employment status, dependence in activities of daily living, and past history of major depression. For example, the prevalence ranged from as low as 8% among patients in New York Heart Association class I failure to as high as 40% among patients in class IV. The prevalence of depression in hospitalized patients with CHF is similar to rates found in post-myocardial infarction patients. However, it is considerably higher in certain subgroups, such as patients with class III or IV heart failure. Further research is needed on the prognostic importance and treatment of comorbid depression in CHF.

The Relationship between the Perception of Social Support and Post-Stroke Depression in Hospitalized Patients

In our study we examined the relationship between the perceived adequacy of social support and post-stroke depression in 76 hospitalized Australian patients. Social support or the perception of its lack, particularly from a spouse care-giver, was associated significantly with both the presence and severity of depressive disorder. Furthermore, depressed patients who perceived their support to be inadequate had a longer duration of depressive illness than depressed patients who perceived their support in a more favorable light. We conclude that following stroke, perception of social support from key relationships may mediate the emotional response to this life crisis. The implications of these findings are discussed.