Impact Of Comorbid Depression Research Articles

Impact of depression on self-efficacy, illness perceptions and self-management among people with type 2 diabetes: A systematic review of longitudinal studies.

Treating comorbid depression does not always improve outcomes for people with type 2 diabetes. Evidence is lacking on potential psychological and behavioural intermediaries of the impact of depression on diabetes outcomes. To synthesise evidence on the impact of comorbid depression on self-efficacy, illness perceptions, and self-management in people with type 2 diabetes. We searched PubMed, Embase, PsycINFO, and Global Health databases from inception up to 29th March 2023. Only prospective studies (cohort or intervention studies) were included, with no restrictions on language. The outcomes were self-efficacy, illness perceptions, and self-management. People with type 2 diabetes in community or health settings. Comorbid depression or depressive symptoms in people with type 2 diabetes. A narrative review of heterogeneous studies. The risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Twenty-five studies were included, all from high-income countries. Depression was associated with lower self-efficacy (2 studies), poor illness perception (1 study), and poor self-management practices (17 studies) in people with type 2 diabetes. In 6/7 studies, depressive symptoms predicted less adherence to dietary recommendations, 8/10 studies found depressive symptoms were associated with poor medication adherence, 1/3 study found that depressive symptoms were associated with poor weight control, 3/4 with less physical exercise, and 2/3 with general self-care practices. There were no studies from low- and middle-income countries and non-Western settings, and we cannot assume the mechanisms linking comorbid depression with diabetes outcomes are similar. Comorbid depression was associated with lower self-efficacy, poorer self-management, and less adaptive illness perceptions among people with diabetes.

Burden and impact of comorbid depression on in-hospital outcomes of Hypertrophic Cardiomyopathy patients in the USA: a nationwide analysis, 2020

Abstract Background Depression has emerged as a critical risk factor for development and progression of various cardiovascular diseases; however, the association between depression and Hypertrophic Cardiomyopathy (HCM) outcomes is less clear. We aimed to determine the impact of comorbid depression on patients hospitalized with HCM. Methods The National Inpatient Sample (2020) was assessed to identify patients hospitalized with HCM using relevant ICD-10 codes. Propensity score matching of 1:1 was performed and the cohort was divided into two - those with comorbid depression (HCM-D+) and those without (HCM-D-). Baseline characteristics and comorbidities were compared between the two cohorts. Impact of comorbid depression on hospitalized HCM patients was evaluated using a multivariate regression analysis adjusting for confounders. Results We identified a cohort of 15530 in-hospital HCM patients with a median age of 67 years (66.9% females, 33.1% males, 74.6% whites, 19.1% blacks, 4.3% hispanics, 1.7% Asians). Amongst 15530, 85.5% admissions were non-elective. The HCM-D+ cohort had significantly higher rates of comorbidities such as hypertension (76.4% vs 71.4%), hyperlipidemia (62.5% vs 52.4%), obesity (27.9% vs 24.9%), smoking (28.1% vs 25.7%), dementia (8.2% vs 4.4%) and cancer (7.5% vs 5.8%) (p<0.001). When in-hospital outcomes were compared, HCM-D+ cohort paradoxically appeared to have 44% lower risk of all-cause mortality (OR-0.56; 95%CI: 0.37- 0.84), 22% lower risk of composite end points (all-cause mortality, heart failure, atrial fibrillation, cardiac arrest including ventricular fibrillation, acute ischemic stroke) (OR-0.78; 95%CI:0.66-0.91), 21% lower risk of atrial fibrillation alone (OR-0.79; 95%CI:0.67-0.92) (p<0.001). Conclusion Despite having higher rates of comorbidities, comorbid depression in HCM patients appeared to improve in-hospital outcomes. Further studies are needed to uncover the paradoxical protection provided by underlying depression.

The effectiveness of transdiagnostic cognitive behavioural therapy for anxiety disorders: the role of and impact of comorbid depression

ABSTRACT Transdiagnostic Cognitive Behaviour Therapy (tCBT), an intervention designed to be applicable across multiple diagnoses, was introduced to improve limitations in traditional therapy such as cost and access to trained therapists. It has been established as an effective and efficacious treatment for anxiety disorders, though there has been little research focussed on the role of depression. The current study investigated the role of comorbid depression during tCBT for anxiety disorders in primary care settings as an outcome and a moderator of anxiety outcomes. Results of multi-level ANOVAs indicated no significant difference in anxiety outcomes regardless of whether there was a comorbid depression diagnosis in the tCBT condition, and that individuals with a comorbid depression diagnosis experienced significantly greater reduction in anxiety severity than those without. Depression symptom severity decreased to a significantly greater extent in the tCBT condition than in TAU when the outcome measure of Patient Health Questionnaire was utilised as the outcome measure, but this was not mirrored when the Clinician Severity Rating was utilised as the outcome measure. This study provides preliminary support for the effectiveness of Transdiagnostic Cognitive Behaviour therapy for those with both a principal anxiety disorder and comorbid depression in symptom reduction.

Abstract TP167: Burden And Impact Of Comorbid Depression On In-hospital Outcomes Of Acute Ischemic Stroke-related Admissions In Women Of Reproductive Age Group: A Propensity-matched Analysis

Background: Depression has been identified as a risk factor for acute cerebrovascular events. Due to limited data focused on young females, we studied the burden and impact of comorbid depression on outcomes of acute ischemic stroke (AIS)-related admissions in young women of the reproductive age group. Methods: We used the National Inpatient Sample (2018) to identify admissions of young females (age 18-44 years) with AIS; and further classified it into two demographically (age, race, payer status, income) matched (1:1) groups based on the presence of comorbid depression. Comorbidities and outcomes were compared using relevant ICD-10 codes. Multivariable regression was used to analyze the association of comorbid depression with in-hospital mortality. Results: In 15850 young females admitted with AIS in 2018, 2465 (15.6%) had comorbid depression. Post-matching, the study cohort consisted of 4610 women admitted with AIS (Median age: 37, 66.2% whites) and 2305 women in each cohort, with and without depression. The matched AIS-depression arm often had younger women (median 37 vs 39 years), patients from the lower-income quartile (47.3% vs. 34.5%), and higher rates of obesity, peripheral vascular disease, and prior history of stroke but a lower prevalence of CVD risk factors [Table 1]. The depression arm had a non-significant odd of all-cause mortality (OR 1.32, 95%CI:0.64-2.74) when adjusted for sociodemographic confounders and comorbid risk factors (p=0.452). The LOS was shorter (median 4 vs 5 days) with comparable hospital charges in the depression arm vs. no depression arm (p<0.001). Conclusion: This study revealed a nearly 15% burden of depression in young females admitted for AIS without significant impact on all-cause mortality when controlled for confounders. The impact of depression on long-term AIS outcomes needs further evaluation.

Comorbid Depression is Associated with Increased Major Adverse Limb Events in Peripheral Arterial Disease: A Systematic Review and Meta-analysis

Depression is a significant risk factor for death in coronary artery disease. Conversely, the research surrounding depression and peripheral arterial disease is limited. This review aimed to systematically evaluate the available literature on the impact of comorbid depression on adverse outcomes in peripheral arterial disease.

Trail Making Test Error Analysis in Subjective Cognitive Decline, Mild Cognitive Impairment, and Alzheimer's Dementia With and Without Depression.

Standard evaluation of the Trail Making Test (TMT) only incorporates completion times. However, the analysis of different error types may provide more insight into underlying cognitive processes and could also increase diagnostic accuracy. This cross-sectional observational study compared three different TMT error types and assessed their diagnostic utility in patients with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's dementia (AD) with or without depression. We evaluated 618 outpatients of a memory clinic with SCD (N = 190), MCI (N = 210), or AD (N = 218). Of these, 157 had comorbid depression. TMT completion times, total error rates, and the three error types "sequencing error," "perseverative error," and "proximity error" were examined. Results indicated that patients with MCI or AD committed more errors on TMT B, and specifically more perseverative errors than patients with SCD (p < 0.001). Depression was not associated with any TMT error type. Including TMT errors in models predicting diagnosis group by TMT completion times did not increase predictive accuracy, measured by areas under the curve. The findings do not indicate any impact of comorbid depression on TMT errors. Moreover, TMT error analysis does not seem to provide additional diagnostic utility for SCD, MCI, and AD diagnoses.

Abstract 222: Paradoxical Favorable Clinical In-hospital Outcomes In Geriatric HF(pEF) Patients With Depression

Background: Depression has been identified as a risk factor for acute cardiovascular events. Considering limited data on the subject, we studied the burden and impact of comorbid depression on heart failure with preserved affection fraction (HFpEF)-related hospitalizations and outcomes using a nationally representative sample. Methods: Elderly (≥65 years) patients’ hospitalizations with HFpEF (after excluding HFrEF) were extracted from the National Inpatient Sample 2018 (ICD-10) and divided into with or without comorbid depression. Demographics, clinical profile and major cardiovascular and cerebrovascular events (MACCE, all-cause mortality, AMI, cardiac arrest and stroke) were compared between cohorts. Multivariable regression analysis was performed controlling covariates to assess the risk of MACCE in geriatric HFPEF admissions with depression. Results: Of 1,599,220 HFpEF hospitalizations in elderly patients (median age 80 years, 61.1% females) 14.1% (n=224,970) had comorbid depression (median age 77 years, 70.6% females). Females had a higher depression prevalence than males (16.2 vs. 10.6%, p&lt;0.001). The HFpEF-depression arm often had relatively younger (77 vs. 80 years), white (83.1 vs. 76.1%), female (70.6 vs. 59.6%) patients with a significantly higher burden of CVD risk factors including hypertension, DM, hyperlipidemia, obesity, smoking, prior MI/TIA/stroke, alcohol abuse, anxiety-related and bipolar disorder vs. non-depression arm. Interestingly, the depression arm had a significantly lower rate (10.9% vs. 13.6%) and lower odds of MACCE (aOR 0.85, 95CI 0.82-0.88) when adjusted for sociodemographic confounders and comorbid risk factors (p&lt;0.001) [Table 1] . Conclusion: The elderly patients with HFpEF have a high burden (female&gt;males, whites&gt;non-whites) of comorbid depression, however, our analysis revealed the “depression paradox” effect for in-hospital MACCE in geriatric HFpEF admissions and needs further evaluation.

Comorbid depression and obesity, and its transition on the risk of functional disability among middle-aged and older Chinese: a cohort study

BackgroundEvidence has indicated that depression and obesity were associated with functional disability, independently. However, little is known about the detrimental impact of comorbid depression and obesity, as well as its transition on functional disability. This study investigated the association of baseline depression-obesity status and its dynamic change with incident functional disability among middle-aged and older Chinese.MethodsThis cohort study included 5507 participants aged ≥45 years from the 2011 and 2015 waves of China Health and Retirement Longitudinal Study. Depression was defined with a score ≥ 10 using the 10-item Centre for Epidemiologic Studies Depression Scale. Obesity was defined as body mass index ≥28 kg/m2. Participants were cross-classified by depression and obesity status at baseline, and its change during follow-up. Logistic regression models were constructed to evaluate the association of baseline depression-obesity status and its transition with incident functional disability defined by the Katz index of activities of daily living scale.ResultsOver four-year follow-up, 510 (9.3%) participants developed functional disability. Individuals with baseline comorbid depression and obesity had the highest risk of functional disability (OR = 2.84, 95% CI: 1.95–4.15) than non-depressive participants without obesity, or those with depression or obesity alone. When investigating the dynamic changes of depression-obesity status on functional disability incidence, those with stable comorbidity throughout two surveys had the greatest risk of functional disability (OR = 4.06, 95% CI: 2.11–7.80). Progression of depression-obesity status was associated with increased risk of functional disability, while regression from baseline to follow-up was linked to attenuated risk estimates.ConclusionsAmong middle-aged and older Chinese adults, the risk of functional disability was exaggerated with comorbid depression and obesity. Our data further suggest that transitions of depression and obesity over time are associated with the risk of developing functional disability.

Brain-derived neurotrophic factor in blood serum and lacrimal fluid of patients with focal epilepsy

ObjectiveTo evaluate brain-derived neurotrophic factor (BDNF) level in blood serum (BS) and lacrimal fluid (LF) of people with epilepsy (PWE). MethodsIt was a case-control study of 72 consecutive patients with focal epilepsy (cases, Epilepsy group) and 60 age- and gender-matched healthy volunteers (controls). Based on comorbid depression, two subgroups of PWE were formed. BDNF level was measured by enzyme-linked immunosorbent assay (ELISA) in BS and LF. ResultsCompared to controls, BDNF level (pg/mL) in PWE was lower both in BS (22,520 ± 3810 vs. 26,360 ± 3090, P < 0.000) and in LF (100.8 ± 23.3 vs. 113.4 ± 19.3, P = 0.001). However, no significant correlation was found between BDNF level in BS and LF either in the Epilepsy group or in controls. No impact of comorbid depression on BDNF level was found either in BS or LF of PWE. We revealed a higher BDNF level in LF of men as compared to women in controls and a similar non-significant trend in PWE. Higher BDNF level in BS of PWE receiving valproates versus other AEDs was found, however, a relatively small number of observations and use of polytherapy in most cases should be taken into account. SignificanceIn patients with focal epilepsy, BDNF level is decreased both in BS and LF, though with no correlation between them. No association of BDNF levels with age and epilepsy characteristics, as well as the occurrence of depression, was found. Low BDNF level in LF could be considered as a non-invasive biomarker of focal epilepsy.

Quality of life among patients with cardiac disease: the impact of comorbid depression

BackgroundPatients with cardiac disease with or without depression may also have major physical and mental problems. This study assesses and compares the quality of life (QOL) of patients with cardiac disease with and without depression and accompanying comorbidities.MethodsA cross-sectional study was conducted with a convenience sample of 388 patients with cardiac disease. The 12-item Short-Form (SF-12)-patient was used to measure physical component scale (PCS) and mental component scale (MCS) QOL, and the Patient Health Questionnaire (PHQ-9) was used to measure depression. The Charlson Comorbidity Index was used to estimate 10-year survival probability. Descriptive statistics, analysis of covariance (ANCOVA), chi-square tests, and binary logistic regression were used for analysis.ResultsThe prevalence of minimal to mild depression was 65.7% [(95% CI (60.8, 70.4)] and that of moderate to severe depression was 34.3% [95% CI (29.6, 39.2)]. There was no significant association between the level of PHQ-categorised depression and age (p = 0.171), sex (p = 0.079), or ethnicity (p = 0.407). The overall mean PCS and MCS QOL was 32.5 [95% CI (24.4, 40.64)] and 45.4 [95% CI (44.4, 46.4)], respectively, with no significant correlation between PCS and MCS [r (Pearson’s) = 0.011; p = 0.830)]. There were QOL differences among the five PHQ categories (PCS: p = 0.028; MCS: p ≤ 0.001) with both MCS and PCS decreasing with increasing depression. ANCOVA (with number of comorbidities as the covariate) showed a significant age × ethnicity interaction for PCS (p = 0.044) and MCS (p = 0.039), respectively. Young Indo-Trinidadians had significantly lower PCS than did Afro-Trinidadians, while the converse was true for MCS. Depression, age, and number of comorbidities were predictors of PCS, while depression, age, and sex were predictors of MCS.ConclusionsIncreasing severity of depression worsened both PCS and MCS QOL. Age and level of clinical depression predicted QOL, with number of comorbidities predicting only PCS and sex predicting only MCS. Efforts must be made to treat depression in all age groups of patients with cardiac disease.

The relationship of chronic rhinosinusitis and depression.

The aim of this article is to identify and describe the relationship between chronic rhinosinusitis (CRS) and comorbid depression, including the patient factors that may increase the risk of depression. The impact of comorbid depression on quality of life, response to treatment and healthcare utilization will also be assessed. CRS is associated with a significantly increased prevalence of depression, where 9-26% of patients with CRS will have physician-diagnosed depression. An additional 40% will have undiagnosed depression that can be identified through screening tools. Patients without polyps are more likely to experience comorbid depression, as are patients with significant sleep dysfunction, olfactory dysfunction, and pain. CRS symptoms do improve with medical and surgical therapy in depressed patients, though baseline and posttreatment scores are worse. A similar degree of benefit from therapy is seen in both depressed and nondepressed patients. CRS treatment does seem to improve depression, whereas the effect of depression specific therapy is unknown. Depressed patients have a significantly larger economic burden because of their increased healthcare utilization and productivity losses. Depression is a highly prevalent and impactful comorbidity in patients with CRS. Increased awareness of this relationship may improve patients' overall quality of care.

Impact of Depression on Health-Related Quality of Life among Skin Cancer Survivors

Introduction: Skin cancers are one of the most common cancers in the United States (US). Studies have reported depression to be a common comorbid condition among individuals with skin cancer. This study aimed to evaluate the relationship of depression with health-related quality of life (HRQOL) among individuals with a skin cancer diagnosis.Methods: A cross-sectional study design using the 2017 Behavioral Risk Factor Surveillance System (BRFSS) data, a nationally representative sample of non-institutionalized US adults, was utilized for the study. Multivariable logistic regression was used to assess the relationship between depression and the HRQOL domains (general health status, physical health, mental health, and activity limitations due to poor physical or mental health) among survivors of skin cancer.Results: Comorbid depression was identified in 20% of skin cancer survivors. After adjusting for covariates, skin cancer survivors with depression had higher odds of having poor general health status (Odds Ratio [OR] = 1.67, 95% Confidence Interval [CI] 1.41-1.98) as compared to skin cancer survivors without depression. Skin cancer survivors with depression also had greater odds of having poor physical HRQOL (OR = 1.82, 95% CI 1.53-2.15), poor mental HRQOL (OR = 6.38, 95% CI 5.26-7.74), and activity limitations (OR = 2.42, 95% CI 2.03-2.89) as compared to those without depression.Conclusion: This study highlights the significant negative impact of comorbid depression on HRQOL in a nationally representative sample of skin cancer survivors, and serves as evidence for the need for more active surveillance and management of depression in this population.

Using Cognitive-Behavioral Therapy to Treat Obsessive-Compulsive Disorder With Co-Occurring Depression.

Many individuals with obsessive-compulsive disorder (OCD) also experience co-occurring depression, which may complicate OCD treatment. Some data suggest that OCD patients with comorbid depression experience less improvement with cognitive-behavioral therapy (CBT), the recommended psychotherapy for OCD. In particular, depression may interfere with an individual's adherence to the tasks of CBT, particularly exposure and response prevention (ERP). However, successful interventions exist for depression within CBT, including both cognitive therapy and behavioral activation, which can be added in treating OCD patients with depression. This article reviews the literature on the impact of comorbid depression on OCD treatment and then describes the treatment of an adult with both conditions. This case history demonstrates how depression-specific interventions can be incorporated into standard ERP to maximize OCD treatment gains. We also review important practice points for treating clinicians and areas for future research.

The Impact of Comorbid Depression - Diabetes on Proteomic Outcomes among Community-Dwelling Mexican Americans with Mild Cognitive Impairment

The Impact of Comorbid Depression - Diabetes on Proteomic Outcomes among Community-Dwelling Mexican Americans with Mild Cognitive Impairment

The impact of comorbid depression in chronic rhinosinusitis on post-operative sino-nasal quality of life and pain following endoscopic sinus surgery

BackgroundDepression and chronic pain are debilitating disorders that co-exist with many chronic diseases. Chronic rhinosinusitis (CRS) is no exception. Nonetheless, little is known about the association between these co-related conditions and the treatment of CRS. The objective of this study is to measure outcomes following endoscopic sinus surgery (ESS) in CRS patients reporting significant pre-operative depression and pain.MethodsThis is a prospective longitudinal cohort study examining patients with CRS who had failed maximal medical therapy and subsequently underwent ESS. Participants completed a several patient-reported outcome (PRO) instruments pre-operatively and 6 months post-operatively. The PROs included the Sinonasal Outcome Test-22 (SNOT-22), the Patient Health Questionnaire (PHQ-9) measuring symptoms of depression and an assessment of chronic pain using the pain intensity (P), interference with enjoyment of life (E) and general (G) activity instrument, the PEG instrument.ResultsThe study had 142 participants complete their pre-operative and post-operative surveys. The participation rate was 40.1% among eligible patients. The prevalence of at least moderate depression was 22 patients (15.5%) among participants. Compared with non-depressed participants, the pre-operative sino-nasal disease burden and pain scores were higher among depressed participants (p < 0.001) and the gain in health following surgery was smaller (p < 0.001).ConclusionsPre-operative disease burden is higher among depressed patients. Post-operative gains in sino-nasal quality of life attributable to endoscopic sinus surgery were significantly smaller among depressed participants. Pre-operative screening for depression could identify opportunities for medical intervention and improve outcomes among CRS patients.

Neurocognitive dysfunctioning and the impact of comorbid depression and anxiety in patients with somatic symptom and related disorders: a cross-sectional clinical study.

The prevalence and severity of neurocognitive dysfunctioning of patients with somatic symptom and related disorders (SSRD) is unknown. Furthermore, the influence of comorbid depression and anxiety has not been evaluated. This study examines neurocognitive dysfunctioning of patients with SSRD and explores if comorbid depression and anxiety is associated with specific neurocognitive dysfunctioning. Cross-sectional study with consecutive patients suffering from SSRD visiting an outpatient specialty mental health care Centre of Excellence for SSRD. Extensive neuropsychological assessment and assessment of depression and anxiety symptom levels using the Patient-Health-Questionnaire-9 and General Anxiety Disorder questionnaire-7 were performed at intake. Multivariate analysis was performed. The study sample consisted of 201 SSRD patients, with a mean age of 43 years (Standard deviation = 13) years; 37.8% were male. Neurocognitive dysfunction in the domains information processing speed, sustained and divided attention, working memory, verbal and visual memory were reported, compared with normative data. Comorbid depression and anxiety occurred frequently within the sample (75.1% and 65.7%, respectively). Neurocognitive dysfunctioning was worse in patients suffering from comorbid depression [multivariate F (7,161) = 2.839, p = 0.008] but not in patients with comorbid anxiety. Poor neurocognitive performance of patients with SSRD is common and worsens in case of comorbid depression. This may explain treatment dropout of patients with SSRD from neurocognitive behavioral therapy. Research on novel interventions is needed targeting neurocognitive functioning of patients with SSRD, particularly those with comorbid depression.

P.4.d.006 - Neural plasticity following cognitive-behavioral therapy in panic disorder – the impact of comorbid depression

Panic disorder (PD) is an anxiety disorder characterized by recurrent panic attacks whose aetiology might be associated with alterations of the prefrontal-amygdala circuitry. The prefrontal cortex is a key region involved in executive functioning (EF) whose disturbance may imply harsh consequences over personal, social, and working aspects of PD patients. Indeed, defining the real involvement of EF in PD could lead to early assessment, better treatment, and rehabilitation options. These could have a substantial impact on the quality of life of these patients and their caregivers, thus reducing long-term health care needs.We reviewed findings from different studies that investigated executive functioning in PD patients using standardized neuropsychological measures. The review was conducted with the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA). In addition, peer-reviewed human-based research articles were selected and twelve studies were retrieved through a search on PubMed. Four uniquely focused on PD patients, two also included a sample of first-degree relatives, while six included a mixed sample of different psychiatric illnesses, including PD.The majority of the studies found no alterations in PD patients, suggesting that EF might not be a core deficit in this disorder. However, some studies (N = 4) found EF deficits in selective domains, which included attention and set-shifting processes, cognitive flexibility, decision-making abilities, and working memory in PD patients and/or in their first-degree relatives.Unbalanced and small samples, unmonitored therapies, and the heterogeneity of cognitive and diagnostic assessment measures might have limited the generalizability of the results.Overall, the results point towards the hypothesis that PD patients had preserved EF. However, future studies with standardized methodological procedures and with a gold standard assessment of EF will be required to finally exclude its involvement in the disease.

Prevalence and Economic Impact of Comorbid Depression Among Hospitalized Patients with Cardiac Events

Prevalence and Economic Impact of Comorbid Depression Among Hospitalized Patients with Cardiac Events

The Impact of Comorbid Depression on Educational Inequality in Survival after Acute Coronary Syndrome in a Cohort of 83 062 Patients and a Matched Reference Population.

BackgroundPatients with low socioeconomic position have higher rates of mortality after diagnosis of acute coronary syndrome (ACS), but little is known about the mechanisms behind this social inequality. The aim of the present study was to examine whether any educational inequality in survival after ACS was influenced by comorbid conditions including depression.MethodsFrom 2001 to 2009 all first-time ACS patients were identified in the Danish National Patient Registry. This cohort of 83 062 ACS patients and a matched reference population were followed for incident depression and mortality until December 2012 by linkage to person, patients and prescription registries. Educational status was defined at study entry and the impact of potential confounders and mediators (age, gender, cohabitation status, somatic comorbidity and depression) on the relation between education and mortality were identified by drawing a directed acyclic graph and analysed using multiple Cox regression analyses.FindingsDuring follow-up, 29 583(35.6%) of ACS patients and 19 105(22.9%) of the reference population died. Cox regression analyses showed an increased mortality in the lowest educated compared to those with high education in both ACS patients and the reference population. Adjustment for previous and incident depression or other covariables only attenuated the relations slightly. This pattern of associations was seen for mortality after 30 days, 1 year and during total follow-up.ConclusionIn this study the relative excess mortality rate in lower educated ACS patients was comparable with the excess risk associated with low education in the background population. This educational inequality in survival remained after adjustment for somatic comorbidity and depression.

Impact of comorbid depression on medication adherence and asthma-related healthcare costs in Texas Medicaid patients with asthma

AbstractObjectivesTo compare: (1) rates of adherence to asthma controllers (ACs) between patients with asthma alone (A) and patients with asthma and comorbid depression (A + D); (2) rates of adherence to AC between patients who adhere to antidepressants and patients who do not adhere to antidepressants; and (3) asthma-related healthcare costs between the A and A + D groups.MethodsTexas Medicaid insurance claims from 1 January 2007 to 31 October 2011 were extracted for adults (18–63 years) diagnosed with asthma with at least two fills of the same AC (inhaled corticosteroids, long-acting beta agonists, fixed-dose combinations (FDC) and leukotriene modifiers) in the A group, and at least two antidepressant claims in the A + D group. Proportion of days covered (PDC) was used to assess adherence to antidepressants and AC, while controlling for demographics, chronic disease score (CDS) and AC therapy type (monotherapy, FDC, dual therapy). Asthma-related healthcare costs included asthma-related prescriptions, inpatient and outpatient costs. Descriptive statistics, Wilcoxon test and regression analyses were used.Key findingsThe patients (n = 3626) were 40.1 ± 14.0 years, primarily women (75.0%), Caucasians (37.3%), FDC therapy users (56.3%), with CDS = 0 (74.2%). Results showed that compared to the A group (n = 3400), patients in the A + D group (n = 226) were 1.6 times more likely to adhere (PDC ≥50%) to their AC (odds ratio (OR) = 1.596; 95% confidence interval (CI) = 1.198–2.128; P &amp;lt; 0.001). Compared to patients who do not adhere to antidepressants (PDC &amp;lt; 80%) (n = 140), patients who adhered to antidepressants (PDC ≥80%) (n = 86) were 2.5 times more likely to adhere (PDC ≥50%) to AC, while controlling for covariates (OR = 2.517; 95% CI = 1.304–4.855; P = 0.006). After controlling for covariates, compared to the A group, the A + D disorder group had significantly lower total asthma-related healthcare costs (P &amp;lt; 0.001).ConclusionsIn the A + D group, the higher costs of asthma-related prescriptions was offset by the lower costs of inpatient and outpatient claims. Patients in the A + D group should be encouraged to adhere to both their ACs and antidepressants.