Veterans Affairs Ann Arbor Healthcare Research Articles

Staphylococcus aureus Bloodstream Infections: The Association Between Age and Mortality and Functional Status

To assess the association between Staphylococcus aureus (S. aureus) blood stream infections (BSIs) and morbidity and mortality in older adults. Retrospective review. Veterans Affairs Ann Arbor Healthcare System. All patients with S. aureus BSI during 2004/05. Outcomes included in-hospital and 6-month mortality, as well as need for subacute care. Sixty-eight patients with S. aureus BSI were identified (mean age 63.5+/-13.0). Outcomes of interest included in-hospital mortality (19.1%), 6-month mortality (33.8%), and need for subacute care (65.4%). Univariate analysis identified several predictors of death, including older age, chronic renal insufficiency, catheter-related infection, Charlson weighted index of comorbidity score, and infection with methicillin-resistant S. aureus (MRSA). Multivariable analysis demonstrated that older age (odds ratio (OR)=1.1, P<.01), chronic renal insufficiency (OR=16.6, P=.01), and MRSA infection (OR=5.1, P=.03) were independently associated with 6-month mortality. These results suggest that, for every decade increase in age, the odds of death within 6 months of S. aureus BSI doubles (OR=1.1). Chronic renal insufficiency was also independently associated with in-hospital mortality. Of the previously community-dwelling patients (n=50), 41 survived hospitalization, of whom 22 (53.7%) required subacute care after discharge. Better understanding of the epidemiology of S. aureus BSI in older patients and validation of risk factors for poor functional outcomes and death should be the focus of future prospective studies.

Diabetes Treatment Among VA Patients With Comorbid Serious Mental Illness

Diabetes Treatment Among VA Patients With Comorbid Serious Mental Illness

Patients' Views on Suicidality and Antidepressants

Back to table of contents Previous article Next article LettersFull AccessLettersJordana R. Muroff M.S.W., Ph.D.Scott Y. H. Kim M.D., Ph.D.Jordana R. Muroff M.S.W., Ph.D.Search for more papers by this authorScott Y. H. Kim M.D., Ph.D.Search for more papers by this authorPublished Online:1 May 2006https://doi.org/10.1176/ps.2006.57.5.723AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Patients' Views on Suicidality and AntidepressantsTo the Editor: Reports in the popular media and public health advisories issued by the U.S. Food and Drug Administration have raised concerns that antidepressant medications may heighten the risk of suicidal thoughts and behaviors ( 1 , 2 , 3 , 4 ). We explored how adult patients with a diagnosis of major depression from an academic ambulatory psychiatric clinic might be affected by these news stories about antidepressants. As part of a larger anonymous survey on quality of life and depression, we examined two questions. Are patients paying attention to these stories in the media? Is the news affecting their confidence in antidepressant medications? In the written survey, 630 patients were asked, "In the past several months, there have been several news stories about a potential unexpected effect of taking certain types of antidepressants. What has been the focus of these news stories?" This question was followed by, "How closely have you been following the stories?" A total of 278 patients returned the survey, for a 44 percent response rate. Of these, 242 (87 percent) completed the section on news stories about antidepressants. Those who completed this section did not differ from those who did not in gender, race, age, severity of depression, suicidality, and stigma concerns. A majority of respondents (191 respondents, or 79 percent) correctly endorsed "possible increase in suicidal thoughts and behaviors" as the focus of the news stories. Of these, 45 percent followed the news stories somewhat or very closely. Logistic regression models showed that how closely the patients followed the stories was not influenced by their demographic characteristics, quality of life, severity of depression, experiences with suicidality, or concerns about stigma. Severity of depression and experiences with suicidality were measured with use of the Beck Depression Inventory (BDI) ( 5 ). To measure how the news stories affected patients' attitudes toward taking antidepressants, we asked "Thinking back to the news stories, how have they affected your feelings about antidepressant medications?" and "Have you talked about the news stories with your psychiatrist?" Of the 191 respondents who correctly identified the content of the news stories, most (148 respondents, or 78 percent) reported that the news had "no effect" on their attitudes about taking antidepressants. In addition, the responses were not associated with demographic characteristics, current quality of life, experiences with suicidality, or stigma concerns.Twenty-nine patients who reported feeling less willing to take antidepressants because of the news stories differed from those who reported not being affected by the stories. The 29 patients had more severe depression as indicated by elevated BDI scores (β=.060, p<.01), followed the news stories more closely (β=.949, p=.03), and talked more often with their psychiatrists about the news stories (β=2.504; p<.001). However, only 14 of the 29 patients (48 percent) who felt less willing to take medications reported talking with their psychiatrists about the stories.In summary, a vast majority of patients being treated for depression in this clinic either did not pay attention to or were unaffected by recent news on antidepressants. However, the small minority who reported that they were less willing to take antidepressants because of the news stories seemed to have more severe depression, and only half of these patients reported talking with their psychiatrists about the news stories.We suggest that psychiatrists consider probing for patients' reactions to these news stories as a possible contributor to nonadherence, especially among patients with relatively severe symptoms.Dr. Muroff is affiliated with the Health Sciences Research and Development Center for Practice Management and Outcomes Research at the Veterans Affairs Ann Arbor Healthcare System in Ann Arbor, Michigan. She and Dr. Kim are with the Center for Behavioral and Decision Sciences in Medicine at the University of Michigan in Ann Arbor. Dr. Kim is also with the bioethics program and the department of psychiatry at the university.