DIAGNOSTIC GROUPS AND DEPRESSED MOOD AS PREDICTORS OF 22-MONTH MORTALITY IN MEDICAL INPATIENTS

Objective: While depression has been found to predict mortality in acu te myocardial infarction, results from many other groups of medical pa tients are inconclusive. It is, therefore, unclear whether depression also predicts mortality in the typical mixed patient populations treat ed on medical hospital wards and whether an increased risk can be iden tified by means of patients' self ratings of depression. Method: The H ospital Anxiety and Depression scale was used as a routine screening t ool in consecutive admissions to the general medical wards of a univer sity hospital. The official survival data were obtained 22 months late r. For all 454 patients who completed the screening questionnaire, com plete survival data were available. Results: High depression scores si gnificantly predicted mortality in univariate comparisons (odds ratio 3.2; 95% CI 1.9-5.5) and in multivariate Cox regression analyses contr olling for demographic and medical baseline variables (multivariate od ds ratio 1.9; 95% CI 1.2-3.1; p <.01). Other significant predictors in the multivariate model were having a principal diagnosis of hematolog ical disease or cancer, and older age. Disability, as assessed by nurs es' ratings, and gender were not related to mortality. Subgroup analys es showed that the effect of depression scores was greatest in cardiop ulmonary patients, but there was also a uniform trend toward higher mo rtality in depressed patients with other diagnoses. Conclusion: Depres sed mood is an independent risk factor for all-cause mortality in medi cal inpatients. Identifying patients at risk does not require formal p sychiatric diagnoses, but can be achieved by means of a short, routine ly administered self-rating questionnaire.