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Depression as an Independent Risk Factor for Mortality in Critically Ill Patients

Wewalka, Marlene MD; Warszawska, Joanna MD; Strunz, Volker Dpsy; Kitzberger, Reinhard MD; Holzinger, Ulrike MD; Fuhrmann, Valentin MD; Zauner, Christian MD; Miehsler, Wolfgang MD; Moser, Gabriele MD

doi: 10.1097/PSY.0000000000000137

Objective Mortality on medical intensive care units (ICU) is approximately 25%. It is associated with age, severity of illness, and comorbidities. Preexisting depression is a risk factor for worse outcome in many diseases. The impact of depression on outcome of ICU patients has not been investigated. We assessed a possible association between mortality and preexisting depressive mood at the time of ICU admission. The primary end point was 28-day mortality.

Methods This single-center cohort study was conducted in a tertiary medical ICU. Two hundred patients were evaluated for preexisting depressive mood at ICU admission, determined by Hospital Anxiety and Depression Scale (HADS) score ≥8 in the depression dimension in patients with appropriate cognitive function. Patients with insufficient cognitive function were assessed using observer rating by next of kin by Hammond scale (cutoff ≥4) and/or a modified version of the Hospital Anxiety and Depression Scale for observer rating (cutoff ≥10).

Results In total, 66 (33%) of 200 patients were classified with preexisting depressive mood. Forty-nine (24.5%) of 200 patients had died by day 28. Of these, 23 (47%) had preexisting depressive mood as compared with 43 of 151 (29%) 28-day survivors (p = .017). Multiple logistic regression analysis revealed that preexisting depressive mood at the time of ICU admission is an independent risk factor for 28-day (odds ratio = 2.2, 95% confidence interval = 1.08–4.5, p = .030) and in-hospital mortality (median time till death = 20.5 [2–186] days, odds ratio = 2.58, 95% confidence interval = 1.31–5.1, p = .006).

Conclusion Preexisting depressive mood might be an independent risk factor for 28-day mortality in medical ICU patients. This could have diagnostic and therapeutic implications for critically ill patients.

From the Department of Medicine III (Wewalka, Warszawska, Strunz, Kitzberger, Holzinger, Fuhrmann, Zauner, Miehsler, Moser), Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; and Department of Medicine (Miehsler), Hospital Barmherzige Brüder, Salzburg, Austria.

Address correspondence and reprint requests to Wolfgang Miehsler, MD, Department of Medicine, Hospital Barmherzige Brüder, Kajetanerplatz 1, 5020 Salzburg, Austria. E-mail:

Received for publication October 3, 2013; revision received November 16, 2014.

Copyright © 2015 by American Psychosomatic Society
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