Depression and Anxiety Linked to Higher Hospital Readmission Rates

By Will Boggs MD

NEW YORK (Reuters Health) - Depression, anxiety, and dementia are associated with higher 30-day readmissions after hospitalization for heart failure, acute myocardial infarction (AMI), and pneumonia, according to new research.

"We need to include mental health screening, assessment, and treatment within our readmissions-reduction programs," Dr. Brian K. Ahmedani, from Henry Ford Health System, Detroit, Michigan, told Reuters Health by email. "We believe mental health conditions may be under-diagnosed among many people. It may be that undetected mental health conditions are also having an impact on readmissions."

Dr. Ahmedani and colleagues in the Mental Health Research Network used data from the HMO Research Network Virtual Data Warehouse to investigate the influence of prior psychiatric diagnoses on 30-day all-cause readmissions following hospitalizations for heart failure, AMI, and pneumonia, three conditions whose "excessive" readmission rates have been targeted for penalties by the Centers for Medicare and Medicaid Services (CMS).

Among the 160,169 individuals hospitalized for one of these conditions between 2009 and 2011, 29.4% had a recorded psychiatric condition, including, most commonly, 15.8% with depression, 11.3% with substance use disorder, and 7.1% with anxiety.

The rate of 30-day all-cause readmission was 32% higher among individuals with a psychiatric condition (21.7%) than among individuals without a psychiatric condition (16.5%, p<0.001), according to the February 1 Psychiatric Services report.

Anxiety, dementia, and depression were associated with significantly higher readmission rates, whereas schizophrenia was not (although the subgroup sample size was insufficient to reach definitive conclusions).

Over the three years of the study, readmission rates declined from 24.3% to 18.3% among patients with any psychiatric diagnosis and from 18.3% to 14.2% among patients without a mental health condition, with the gap between the two groups narrowing from 6.0% in 2009 to 4.1% in 2011.

"The biggest surprise was that readmissions declined overall during the study from 2009 to 2011," Dr. Ahmedani said. "We estimate that some of this decline is in part due to the implementation of readmission reduction programs within hospitals in response to the new CMS policies."

"Most current programs do not include mental health components," Dr. Ahmedani explained. "However, there are some projects testing models to include mental health. For example, the COMPASS project (funded by CMS) has developed a care-management model for patients with multiple chronic conditions, including depression. One of the aims of this project is to reduce hospital readmissions."

Dr. A. Matthew Prina from Cambridge University, UK, who recently reviewed the association between depressive symptoms and nonpsychiatric hospitalizations, told Reuters Health by email, "It has been shown in several studies that comorbid psychiatric illnesses are associated with increased readmission rates. The sample size in most studies so far has been modest, so it is good to see the findings replicated in a larger study."

"Careful monitoring after discharge and improving medication compliance (which is often poor in adults with mental disorders) is the key," Dr. Prina said. "The other main issue is that often there is no mental health screening carried out in medical wards, and doctors may not pick up any underlying mental health problems. Those people are then discharged and return to their communities with no support whatsoever."

"We need an increased awareness of underlying mental health issues (this includes potential referral to a psychiatrist or to liaison psychiatry services if needed)," Dr. Prina concluded. "After all, 'there is no health without mental health,' as the famous quote says."

The National Institute of Mental Health and the Fund for Henry Ford Hospital supported this research. The authors reported no disclosures.

SOURCE: https://bit.ly/1FmQ9Iu

Psychiatr Serv 2015.

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