The association between depressive disorders and health care utilization: results from the São Paulo Ageing and Health Study (SPAH)

Background

Although depressive disorders are associated with increased health care utilization in the elderly living in high-income countries, few studies have examined this relationship in Latin America.

Method

The present study is part of the São Paulo Ageing and Health Study, a population-based epidemiological study of mental disorders in 2072 low-income adults ≥ 65 years old living in São Paulo, Brazil. Depressive disorders defined as major depressive disorder (MDD) and clinically relevant depressive symptoms (CRDS) were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We examined the association between depressive disorders/symptoms and health care utilization (outpatient visits, hospital admissions and medication use in the past 3 months) using count models.

Results

The prevalence of MDD and CRDS was 4.9% and 21.4%, respectively. In the fully adjusted model, older adults with MDD were 36% more likely to have one more outpatient visit (RM: 1.36, 95% CI: 1.11–1.67), while older adults with CRDS were 14% more likely to have one more outpatient visit (RM: 1.14, 95% CI: 1.02–1.28). Elderly individuals with MDD had a prevalence of hospital admissions in the previous 3 months that was twice that of those without depression (PR=2.02, 95% CI: 1.09–3.75). Significant differences were not found for medication use.

Conclusion

Among low-income older adults living in Brazil, those with MDD are more likely to have a recent hospital admission and outpatient service use than those without depression. Future studies are needed to examine the effectiveness of depression treatments for this population in order to both decrease the burden of illness as well as to minimize health care utilization related to depression.     

Newly diagnosed major depressive disorder and the risk of erectile dysfunction: A population-based cohort study in Taiwan

Introduction

The primary aim of this study was to explore the incidence rate of erectile dysfunction (ED) among major depressive disorder (MDD) patients in an Asian country. The second aim was to compare the risk of ED in MDD patients that were treated using antidepressants with a high risk-ED, antidepressants with a low risk-ED, or without treatment.

Methods

We identified 4339 male patients with newly diagnosed MDD using the National Health Database. Four matched controls per case were selected for the study.

Results

The mean age of the participants was 42.3±16.9. A higher crude HR of 3.6 (95% CI: 2.8–4.6) was seen in the male patients with MDD. After adjusting for obesity, monthly income, urbanization level, and comorbidity, the MDD patients had a 3.2-fold higher HR for an ED diagnosis than the controls. Patients with untreated depression had the highest risk of ED, compared to the control group (HR=3.9). Patients treated with IHiRA had a medium risk of developing ED (HR=3.6), and patients treated with ILoRA had the lowest risk of ED (HR: 2.5).

Conclusion

This prospective cohort study found an association between ED and prior MDD. Patients with untreated depression may have the highest risk of developing ED.     

Point prevalence and correlates of depression in a national community sample with multiple sclerosis

Objective

The prevalence of depression in multiple sclerosis (MS) is known to be elevated, but nearly all available studies have estimated period prevalence. The objective of this study was to estimate the point prevalence of depression in a representative community sample using the Patient Health Questionnaire, Brief (PHQ-9).

Methods

The data source for this study was the Survey of Living with Neurological Conditions in Canada, which was derived from a representative sample of household residents.

Results

The sample included 630 respondents with MS. With application of the standard PHQ-9 cut point (10 +), the prevalence of depression was 26.0% (95% confidence interval 18.9%–33.0%). Depressed subjects had lower quality of life; an increased frequency of suicidal ideation; and more often reported a negative disease course, high stress, low social support and stigmatization.

Conclusions

This study adds to the existing literature by providing point prevalence data: in any 2-week period, about one quarter of community residents with MS experience substantial levels of depressive symptoms.     

Increased risk of hyperlipidemia in patients with major depressive disorder: A population-based study

Objective

We conducted this study to examine the prevalence and incidence of hyperlipidemia among Taiwanese patients with major depressive disorder (MDD).

Methods

We used a random sample of 766,427 subjects who were ≥ 18 years old in 2005. Subjects with at least one primary diagnosis of MDD were identified. Individuals with a primary or secondary diagnosis of hyperlipidemia or medication treatment for hyperlipidemia were also identified. We compared the prevalence of hyperlipidemia in MDD patients with the general population in 2005. We followed this cohort from 2006 to 2010 to detect incident cases of hyperlipidemia in MDD patients compared with the general population.

Results

The prevalence of hyperlipidemia in patients with MDD was higher than in the general population (14.4% vs. 7.9%, odds ratio 1.67; 95% confidence interval, 1.53–1.82) in 2005. The average annual incidence of hyperlipidemia in patients with MDD was also higher than in the general population (3.62% vs. 2.55%, risk ratio 1.35; 95% confidence interval, 1.24–1.47) from 2006 to 2010. Higher incidence of hyperlipidemia was associated with MDD group, increased age, diabetes, hypertension, and higher socioeconomic status.

Conclusions

Patients with MDD had a higher prevalence and incidence of hyperlipidemia compared with the general population. Younger MDD patients and MDD patients with first-generation antipsychotic exposure or antidepressant exposure had an increased risk of hyperlipidemia compared with individuals in the general population.     

Primary care practice characteristics associated with the quality of care received by patients with depression and comorbid chronic conditions

Objective

This study aimed to identify primary care practice characteristics associated with the quality of depression care in patients with comorbid chronic medical and/or psychiatric conditions.

Method

Using data from cross-sectional organizational and patient surveys conducted within 61 primary care clinics in Quebec, Canada, the relationships between primary care practice characteristics, comorbidity profile, and the recognition and minimally adequate treatment of depression were assessed using multilevel logistic regression analysis with 824 adults with past-year depression and comorbid chronic conditions.

Results

Likelihood of depression recognition was higher in clinics where accessibility of mental health professionals was not viewed to be a major barrier to depression care [odds ratio (OR)=1.61; 95% confidence interval (CI) 1.13–2.30]. Four practice characteristics were associated with minimal treatment adequacy: greater use of treatment algorithms for depression (OR=1.77; 95% CI=1.18–2.65), high value given to teamwork (OR=2.48; 95% CI=1.40–4.38), having at least one general practitioner at the clinic devote significant time in practice to mental health (OR=1.54; 95% CI=1.07–2.21) and low perceived barriers to depression care due to inadequate payment models (OR=2.12; 95% CI=1.30–3.46).

Conclusions

Several primary care practice characteristics significantly influence the quality of care provided to patients with depression and comorbid chronic conditions and should be targeted in quality improvement efforts.     

The presence of a depressive episode predicts lower return to work rate after myocardial infarction

Context

No studies have evaluated whether the presence of a depressive episode is associated with an increased risk of not returning to work following myocardial infarction (MI).

Objectives

To examine the prospective associations between depressive episode and anxiety disorders with return to work (RTW) after MI at 3 and 12 months based on International Classification of Diseases, 10th Revision.

Design

Prospective cohort study.

Setting

Four hospitals in the North of The Netherlands.

Participants

From a sample of patients hospitalized for MI (n= 487), we selected those who had a paid job at the time of the MI (N= 200).

Main exposure measures

Presence of a depressive episode and presence of any anxiety disorder during the first 3 months post-MI.

Main outcome measures

RTW at 12 months post-MI.

Results

Of the patients with work prior to MI, 75% had returned to work at 12 months. The presence of a depressive episode during the first 3 months (prevalence: 19.4%) was a significant predictor of no RTW at 12 months post-MI, also after controlling for confounders [odds ratio (OR) 3.48; 95% confidence interval (CI): 1.45–8.37]. The presence of an anxiety disorder (prevalence: 11.9%) had a borderline significant association with no RTW as well. This association remained after controlling for confounders (OR 2.90; 95% CI: 1.00–6.38) but diminished when controlling for depression.

Conclusions

The presence of a depressive episode was associated with an increased risk of no RTW in MI patients. The association between anxiety and risk of no RTW could in part be explained by the presence of depression. Further studies may address the possibility of countering the effect of depression by effective treatment.     

The Distress Thermometer as an ultra-short screening tool: A first validation study for mixed-cancer outpatients in Singapore

Introduction

Research has shown that single-item tools, like the Distress Thermometer (DT), are comparable to longer ones, like the Hospital Anxiety and Depression Scale (HADS). In this study, we tested the validity of the DT in a population of Singapore cancer outpatients, and determined the cut-off scores on the DT for clinically relevant distress and an impaired quality of life (QOL). We also documented the prevalence of anxiety, depression, and QOL impairments in this population.

Methods

One hundred and five patients (Mdn age = 51–60 years, 64% female, and 71% Chinese) diagnosed with various cancers participated in this study. They completed a standard socio-demographic form, the DT and the Problem List, the HADS, and the EuroQOL Quality of Life Scale (EQ-5D).

Results

Almost a third of patients had clinically significant emotional distress, with 15%–16% having probable levels of anxiety and depression. Almost half (41%–55%) had an impaired QOL compared to Singapore population norms. Receiver operating characteristic curve analyses identified an area under the curve of 0.89 (SE = 0.36, 95% CI [0.82, 0.96], p < .001) when compared to the HADS cut-off score of 15. A cut-off score of 5 on the DT had the best sensitivity (0.88) and specificity (0.81). Participants above the DT cut-off score of 5 reported significantly more emotional problems (worry, nervousness, depression, sadness), insurance/finance-related problems, and sleep problems. They also scored significantly lower on EQ-5D, with more QOL impairments in the domains of carrying out their usual activities and anxiety/depression.

Conclusion

Levels of distress, anxiety, depression, and QOL impairments are high in this population. The DT was found to be a valid tool for distress screening in the Singapore cancer population, with a recommended cut-off score of 5.     

More excited for negative facial expressions in depression: Evidence from an event-related potential study

Objective

This study aims to investigate the intensity evaluation of social stimuli in depression.

Methods

Twenty-four never-disordered control participants (NC), 24 sub-clinically depressed individuals and 24 participants diagnosed with a current major depressive disorder (MDD) were recruited. All participants completed an emotional intensity evaluation task, in which they were required to judge the intensity of the facial expressions by pressing response keys, with the event-related potential (ERP) being recorded during the process.

Results

The MDD participants had higher intensity scores for sad faces compared with the NC group, longer reaction times (RTs) for all faces compared with other groups and higher P1 and P2 amplitude for sad faces compared with other faces. The sub-clinically depressed individuals had lower intensity scores for happy and neutral faces compared with other groups, longer RTs for happy faces compared with other faces and higher P1 and P2 amplitudes for happy faces compared with sad faces.

Conclusion

The findings suggest that the MDD participants are more excited for negative facial expressions, while the sub-clinically depressed individuals might have a disturbed perception for happy stimuli, which suggests a different cognitive pattern for facial expressions between MDD and sub-clinical depression. Moreover, the deep perception for sad faces is correlated with increased suicidal ideation.

Significance

The intensity effect of social stimuli (facial expressions) was observed in sub-clinically and clinically depressed (MDD) individuals simultaneously, which might suggest that the more excited perception for negative facial expressions is a stable cognitive vulnerability possibly associated with the occurrence or recurrence of depression.     

Implicit and explicit self-esteem and their reciprocal relationship with symptoms of depression and social anxiety: A longitudinal study in adolescents

Background and Objectives

A negative self-view is a prominent factor in most cognitive vulnerability models of depression and anxiety. Recently, there has been increased attention to differentiate between the implicit (automatic) and the explicit (reflective) processing of self-related evaluations. This longitudinal study aimed to test the association between implicit and explicit self-esteem and symptoms of adolescent depression and social anxiety disorder. Two complementary models were tested: the vulnerability model and the scarring effect model.

Method

Participants were 1641 first and second year pupils of secondary schools in the Netherlands. The Rosenberg Self-Esteem Scale, self-esteem Implicit Association Test and Revised Child Anxiety and Depression Scale were completed to measure explicit self-esteem, implicit self-esteem and symptoms of social anxiety disorder (SAD) and major depressive disorder (MDD), respectively, at baseline and two-year follow-up.

Results

Explicit self-esteem at baseline was associated with symptoms of MDD and SAD at follow-up. Symptomatology at baseline was not associated with explicit self-esteem at follow-up. Implicit self-esteem was not associated with symptoms of MDD or SAD in either direction.

Limitations

We relied on self-report measures of MDD and SAD symptomatology. Also, findings are based on a non-clinical sample.

Conclusions

Our findings support the vulnerability model, and not the scarring effect model. The implications of these findings suggest support of an explicit self-esteem intervention to prevent increases in MDD and SAD symptomatology in non-clinical adolescents.     

The use of 15-point hypomanic checklist in differentiating bipolar I and bipolar II disorder from major depressive disorder

Objectives

Individuals with bipolar disorder (BP) are often misdiagnosed with major depressive disorder (MDD). In this study, we developed a Chinese version of 15-point hypomania scale (HCL-15) in order to determine its sensitivity and specificity in the diagnosis of BP and BP-II in particular.

Methods

A total of 623 individuals suffering a major depressive episode (MDE) were systematically interviewed with both Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Patient Edition, and HCL-15. A cutoff score of 8 or more in HCL-15 was suggested for BP.

Results

Of the 623 depressed patients, 115 (18.5%) actually required a diagnosis of BP-I, and another 159 (25.5%) could be more appropriately diagnosed with BP-II, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The sensitivity of 15-HCL in detection of BP-II was 0.78 and 0.46 for BP-I; the specificity was 0.9 and 0.69, respectively. The specificity of HCL-15 for BP versus MDD was as high as 0.93. Approximately 60%–80% of all questions in the HCL-15 questionnaire revealed positive responses from patients, while items 11 and 12, measuring the consumption of alcohol, coffee and cigarettes, demonstrated a low positive response rate.

Conclusions

The HCL-15 assessment scale was fairly sensitive and highly specific for a BP-II diagnosis but not for a BP-I diagnosis. Some items in the HCL-15 symptom list need to be further modified to better fit Chinese culture and customs. The HCL-15 scale could be a useful tool in clinical practice for screening individuals with BP-II in order to avoid a misdiagnosis of MDD.     

The association of psychosocial factors and obstetric history with depression in pregnant women: focus on the role of emotional support

Objective

Depression during pregnancy can negatively affect both maternal and fetal health. The benefits of early detection and treatment for antenatal depression have been emphasized. Therefore, we investigated risk factors for antenatal depression with a focus on emotional support.

Methods

We conducted a cross-sectional study of pregnant women (n= 1262) enrolled from the local division of a community mental health center. All subjects completed self-report questionnaires that assessed depressive mood, emotional support and other risk factors. Associations between antenatal depression and potential risk factors including emotional support were analyzed by logistic regression analysis.

Results

Antenatal depression was associated with various biopsychosocial correlates: unmarried state, low education, cigarette smoking, low income, familial history of depression, past history of depression, physical abuse history, sexual abuse history, premenstrual syndrome, primiparity and unplanned pregnancy. When the associations of emotional support with antenatal depression were specified by its resources, current emotional support from partner [odds ratio (OR)=2.26, 95% confidence interval (CI)=1.94–2.64] and mother (OR=1.43, 95% CI=1.26–1.62) and past experience for emotional support from mother (OR=1.52, 95% CI=1.32–1.74), but not from father significantly influenced depression during pregnancy.

Conclusions

The multidimensional biopsychosocial approach would be needed to identify and assess antenatal depression. Promoting emotional support from the partner, family member and, possibly, the health provider could be a protective effect against the development of antenatal depression.     

Mood and anxiety disorders among inpatients of a university hospital in Turkey

Objective

The aim of the study was to assess the prevalence of mood and anxiety disorders among inpatients and the relationship between sociodemographic factors, medical illnesses and treatments.

Methods

In the present study, we selected 650 inpatients from all clinics except psychiatry and pediatrics in a general hospital by a simple random sampling method. Based on the exclusion criteria, 57 patients were excluded. Mood and anxiety disorders were determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Results

Of the participants, 226 (37.5%) had a psychiatric disorder, 87 (14.4) had a mood disorder and 146 (24.2%) had an anxiety disorder. The most common specific diagnoses were not otherwise specified as anxiety disorder (9.5%), major depression (8.6%) and generalized anxiety disorder (7.6%). While the overall prevalence was highest in the hematology clinic (60.0%), it was lowest in the clinic of infectious diseases (22.7%). Logistic regression analysis indicated that the independent factors associated with psychiatric disorders were being of the female gender and a personal history of psychiatric disorders.

Conclusions

In conclusion, results of the present study suggest that mood and anxiety disorders were frequently observed among inpatients, particularly in female patients and those with an individual history of psychiatric disorder. Successful treatment of these disorders may positively contribute to the course of the disease in inpatients. However, this assumption should be confirmed by further studies.     

Depression,aggression, and suicidal ideation in first graders: a school-based cross-sectional study

Objective

This study explored the clinical characteristics and risk factors of suicidal ideation in a sample of first graders from South Korea. Children's depression and aggression and maternal depression were examined as possible risk factors.

Methods

This study is a school-based, cross-sectional study of 5 elementary schools in Gunpo City, South Korea. Participants were 707 first graders (mean age, 6.54 years) and their mothers. We assessed children's depressive and aggressive symptoms using the Behavior Assessment System for Children-2 (BASC-2) and maternal depression using the Beck Depression Inventory (BDI). Two items from BASC-2 and 1 item from BDI identified children's and maternal suicidal ideation.

Results

Twenty-seven (3.8%) children evidenced suicidal ideation. Children with suicidal ideation had higher mean scores of depression domain (10.11 ± 5.34 vs 4.57 ± 3.44, P < .0001) and aggression domain (7.78 ± 3.84 vs 3.80 ± 2.85, P < .0001) on BASC-2 and maternal depression (9.78 ± 6.45 vs 7.28 ± 5.38, P = .02) on BDI. In regression analysis, children's depression (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.07-1.32; P = .001) and aggression (OR, 1.24; 95% CI, 1.08-1.41; P = .002) contributed significantly to children's suicidal ideation, whereas maternal depression was not significantly related to children's suicidal ideation (OR, 0.99; 95% CI, 0.92-1.06; P = .75).

Conclusions

This study demonstrated that even first graders had a considerable prevalence of suicidal ideation and that depression and aggression were associated with suicidal ideation in young children.     

Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression

Background

A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide.

Aims

To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state.

Method

Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety.

Results

The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode.

Conclusions

The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression.     

Prevalence and associated factors of comorbid skin diseases in patients with schizophrenia: a clinical survey and national health database study

Objectives

To examine the epidemiology of and possible risk factors for skin diseases in patients with schizophrenia.

Methods

All of 337 patients with schizophrenia were recruited from the therapeutic community of a psychiatric hospital and underwent a detailed skin examination. The National Health Insurance Research Database (NHIRD) was used to compare the prevalence of skin diseases between patients with schizophrenia and those without.

Results

In the clinical survey, fungal infection (61.4%) and dermatitis (46.9%) were the most common skin diseases. Clozapine users had a lower risk of fungal infection than those on typical antipsychotics [odds ratio (OR)=0.49, 95% confidence interval (CI)=0.30–0.81]. Obese patients were more likely to have fungal infections than those without (OR=1.93, 95% CI=1.20–3.09), and those with diabetes had an increased risk of bacterial infection than those without (OR=2.0, 95% CI=1.06–3.75). NHIRD revealed that the overall prevalence of skin diseases, including infections, dermatitis, hyperkeratosis, pilosebaceous disease, androgenic alopecia, xerosis and stasis, were higher in patients with schizophrenia than in those without (75.1% vs. 72.6%, P= .01).

Conclusions

The prevalence of skin diseases is high in patients with schizophrenia, for whom proper skin care is necessary to improve their life quality.     

Course of depression,mental health service utilization and treatment preferences in women receiving chemotherapy for breast cancer

Objective

This prospective study aimed to estimate the prevalence and course of depression during chemotherapy in women with Stage I–III breast cancer, identify potential risk factors for depression and determine which treatments for depression were being used and which were most preferred.

Method

Thirty-two women were followed over consecutive chemotherapy infusions, with 289 assessments conducted altogether (mean, 9.0 assessments/subject). Current depression, anxiety, physical symptoms and mental health service use were recorded during each assessment. A linear mixed effects model was used to identify factors associated with depression. Patients also ranked depression treatment preferences. We referred patients with more severe depression for treatment.

Results

Clinically significant depression was identified in 37.5% of patients. Depression severity tended to peak at 12–14 weeks and 32 or more weeks of chemotherapy. Depression severity was associated with anxiety severity, physical symptom burden, non-White race, receiving one's first chemotherapy regimen, Adriamycin-Cytoxan chemotherapy and chemotherapy duration. Most (65.5%) patients preferred evidence-based treatments for depression, and 66.7% of depressed patients were using such treatments.

Conclusions

Depression is common in women receiving chemotherapy for breast cancer. Most patients prefer evidence-based depression treatments. We recommend regular screening for depression during chemotherapy to ensure adequate detection and patient-centered treatment.     

A systematic review of studies of depression prevalence in university students

Background

Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. There is evidence to suggest that university students are at higher risk of depression, despite being a socially advantaged population, but the reported rates have shown wide variability across settings.

Purpose

To explore the prevalence of depression in university students.

Method

PubMed, PsycINFO, BioMed Central and Medline were searched to identify studies published between 1990 and 2010 reporting on depression prevalence among university students. Searches used a combination of the terms depression, depressive symptoms, depressive disorders, prevalence, university students, college students, undergraduate students, adolescents and/or young adults. Studies were evaluated with a quality rating.

Results

Twenty-four articles were identified that met the inclusion and exclusion criteria. Reported prevalence rates ranged from 10% to 85% with a weighted mean prevalence of 30.6%.

Conclusions

The results suggest that university students experience rates of depression that are substantially higher than those found in the general population. Study quality has not improved since 1990.     

The prevalence of suicidal ideation among the elderly in China: A meta-analysis of 11 cross-sectional studies

Objective

This study aimed to estimate the pooled prevalence of suicidal ideation among Chinese elderly aged ≥60 years.

Methods

Two reviewers independently searched the potentially relevant studies through electronic database (PubMed-Medline, Embase, Wanfang Data, Chinese National Knowledge Infrastructure and Chongqing VIP) using key terms ‘suicid*’, ‘suicidal ideation’ combined with ‘aged’, ‘elderly’ and ‘old people’. All selected studies should meet the eligibility criteria in this study. Chi-square based Q test and I² statistic assessed the heterogeneity. Forest plots were used to display results graphically. Potential publication bias was assessed by the funnel plot and Begg’s test. Prevalence rate was meta-analysed.

Results

In total, 11 studies were included with 11,526 subjects. The prevalence of suicidal ideation among Chinese elderly ranged from 2.2% to 21.5%. The pooled prevalence of all 11 studies was 11.5% (95% CI: 8.3%–14.8%). Subgroup analyses showed the prevalence for males was 11.0%, and for the females was 15.6%. In three subgroups for age, 60–69, 70–79 and ≥80, the prevalence was 9.1%, 12.1% and 18.9% respectively. A slightly higher prevalence in rural areas was calculated than in urban (14.7% vs. 11.8%). In mainland China, the prevalence was 12.6%. And in Taiwan and Hongkong, the pooled prevalence was 9.2%.

Conclusions

The prevalence of suicidal ideation was relatively high among elderly in China, and it should attract enough attention.     

Hospitalization,depression and dementia in community-dwelling older Americans: findings from the National Health and Aging Trends Study

Objective

The objective was to estimate the prevalence of both dementia and depression among community-dwelling older Americans and to determine if hospitalization is independently associated with dementia or depression in this population.

Method

This cross-sectional study utilized data from a nationally representative, population-based sample of 7197 community-dwelling adults ≥ 65 years old interviewed in 2011 as part of the National Health and Aging Trends Study. Information on hospitalizations was obtained from self- or proxy-report. Possible and probable dementia was assessed according to a validated algorithm. Depressive symptoms were assessed with the Patient Health Questionnaire-2.

Results

An estimated 3.1 million community-dwelling older Americans may have dementia, and approximately 5.3 million may have substantial depressive symptoms. After adjusting for demographic and social characteristics, medical diagnoses, smoking history, serious falls and pain symptoms, being hospitalized in the previous year was independently associated with greater odds of probable dementia (odds ratio [OR]: 1.42, 95% confidence interval [95% CI]: 1.16–1.73) and substantial depressive symptoms (OR: 1.60, 95% CI: 1.29–1.99).

Conclusions

Dementia and depression are common in community-dwelling older Americans, and hospitalization is associated with these conditions. Additional research increasing understanding of the bidirectional relationship between hospitalizations, dementia and depression, along with targeted interventions to reduce hospitalizations, is needed.