Key result
Patients meeting screening criteria for both depression and anxiety symptoms received a post-discharge DSM diagnosis more frequently than those with anxiety symptoms only (61.9% vs 49.0%, p=0.017).
Why the study?
Does screening for symptoms of depression and anxiety using the Mental Health Inventory predict post-discharge DSM diagnoses in elderly hospitalized veterans?
Cohort (n=839)
Randomized to UPBEAT Care
Does screening for symptoms of depression and anxiety using the Mental Health Inventory predict post-discharge DSM diagnoses in elderly hospitalized veterans?
Absolute Event Rate: 61.9% vs 49%
p-value: p=0.017
Screening hospitalized elderly veterans for symptoms of depression and anxiety helps identify those at increased risk for subsequent psychiatric diagnoses.
May support screening for comorbid symptoms in elderly veterans; leaves open whether it improves outcomes or warrants practice change.
OBJECTIVE: We addressed the relatively unexplored use of screening scores measuring symptoms of depression and/or anxiety to aid in identifying patients at increased risk for post-discharge DSM-IV Axis I diagnoses. We were unable to find such studies in the literature. METHOD: Elderly veterans without recent psychiatric diagnoses were screened for depression and anxiety symptoms upon admission to acute medical/surgical units using the Mental Health Inventory (MHI). Following discharge, those who had exceeded cut-off scores and had been randomized to UPBEAT Care (Unified Psychogeriatric Biopsychosocial Evaluation and Treatment, a clinical demonstration project) were evaluated for DSM diagnoses. We report on 839 patients, mostly male (96.3%; mean age 69.6 +/- 6.7 years), comparing three groups, i.e. those meeting screening criteria for symptoms of (i) depression only; (ii) anxiety only; and (iii) both depression and anxiety. RESULTS: Despite absence of recent psychiatric history, 58.6% of the 839 patients received a DSM diagnosis post-discharge (21.8% adjustment; 15.4% anxiety; 7.5% mood; and 14.0% other disorders). Patients meeting screening criteria for both depression and anxiety symptoms received a DSM diagnosis more frequently than those meeting criteria for anxiety symptoms only (61.9% vs 49.0%, p = 0.017), but did not differ significantly from those meeting criteria for depressive symptoms only (61.9% vs 56.8%, p = 0.174). Although exceeding the MHI screening cut-off scores for depression, anxiety, or both helped to identify patients with a post-discharge DSM diagnosis, the actual MHI screening scores failed to do so. CONCLUSION: Screening hospitalized medical/surgical patients for symptoms of depression, anxiety, and particularly for the combination thereof, may help identify those with increased risk of subsequent DSM diagnoses, including adjustment disorder.
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Gerson et al. (2004) conducted a cohort in Depression and anxiety symptoms (n=839). Screening positive for both depression and anxiety symptoms vs. Screening positive for anxiety symptoms only or depressive symptoms only was evaluated on Post-discharge DSM-IV Axis I diagnosis (p=0.017). Patients meeting screening criteria for both depression and anxiety symptoms received a post-discharge DSM diagnosis more frequently than those with anxiety symptoms only (61.9% vs 49.0%, p=0.017).
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