Applied Research Collaboration Northwest London (ARC NWL), School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom.
Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom.
PLoS One. 2022 Apr 7;17(4):e0266605. doi: 10.1371/journal.pone.0266605. eCollection 2022.
Growing numbers of people with multimorbidity have a co-occurring mental health condition such as depression. Co-occurring depression is associated with poor patient outcomes and increased healthcare costs including unplanned use of secondary healthcare which may be avoidable.
To summarise the current evidence on the association between depression and unplanned secondary healthcare use among patients with multimorbidity.
We conducted a systematic review by searching MEDLINE, EMBASE, PsychINFO, Web of Science, CINAHL, and Cochrane Library from January 2000 to March 2021. We included studies on adults with depression and at least one other physical long-term condition that examined risk of emergency hospital admissions as a primary outcome, alongside emergency department visits or emergency readmissions. Studies were assessed for risk of bias using The National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool. Relevant data were extracted from studies and a narrative synthesis of findings produced.
Twenty observational studies were included in the review. Depression was significantly associated with different outcomes of unplanned secondary healthcare use, across various comorbidities. Among the studies examining these outcomes, depression predicted emergency department visits in 7 out of 9 studies; emergency hospital admissions in 19 out of 20 studies; and emergency readmissions in 4 out of 4 studies. This effect increased with greater severity of depression. Other predictors of unplanned secondary care reported include increased age, being female, and presence of greater numbers of comorbidities.
Depression predicted increased risk of unplanned secondary healthcare use in individuals with multimorbidity. The literature indicates a research gap in identifying and understanding the impact of complex multimorbidity combinations, and other patient characteristics on unplanned care in patients with depression. Findings indicate the need to improve planned care for patients with moderate-to-severe depression. We suggest regular reviews of care plans, depression severity monitoring and assessment of hospital admission risk in primary care settings.
患有多种疾病的人群数量不断增加，同时伴有心理健康问题，如抑郁症。共病抑郁症与患者预后不良和医疗保健费用增加有关，包括计划外使用二级医疗保健，而这些情况可能是可以避免的。
总结目前关于共病抑郁症与多种疾病患者计划外二级医疗保健使用之间关联的证据。
我们进行了系统评价，检索了 2000 年 1 月至 2021 年 3 月期间的 MEDLINE、EMBASE、PsychINFO、Web of Science、CINAHL 和 Cochrane Library。我们纳入了关于患有抑郁症和至少一种其他身体长期疾病的成年人的研究，这些研究检查了作为主要结局的急诊入院风险，以及急诊就诊或急诊再入院。使用美国国立卫生研究院国家心肺血液研究所质量评估工具评估研究的偏倚风险。从研究中提取相关数据，并进行发现的叙述性综合。
本综述纳入了 20 项观察性研究。抑郁症与不同共病情况下计划外二级医疗保健使用的各种结局显著相关。在研究这些结局的研究中，7 项研究中的 9 项预测了急诊就诊，20 项研究中的 19 项预测了急诊入院，4 项研究中的 4 项预测了急诊再入院。这种影响随着抑郁症严重程度的增加而增加。其他报告的计划外二级护理预测因素包括年龄较大、女性以及共病数量较多。
抑郁症预测了患有多种疾病的个体计划外二级医疗保健使用的风险增加。文献表明，在识别和理解复杂的多种疾病组合以及其他患者特征对抑郁症患者计划外护理的影响方面存在研究空白。研究结果表明，需要改善中度至重度抑郁症患者的计划护理。我们建议在初级保健环境中定期审查护理计划、监测抑郁严重程度并评估入院风险。
