Depressive symptoms and health care within 30 days after discharge from a cardiac hospital unit.

Objective: To determine the association between depressive symptoms in CHD patients and in- and outpatient health care utilization during the 30 days following treatment in a cardiac hospital unit.

Method: The study sample consisted of 949 CHD patients who completed a measure of depressive symptom severity (the Patient Health Questionnaire [PHQ-9]). Cardiac disease severity and medical comorbidities were assessed by chart review. Follow-up questionnaires were mailed to patients assessing in- and outpatient health care.

Results: Among patients with elevated depressive symptoms (PHQ-9 score of ≥7), 19.9% had at least one outpatient hospital visit (hospital-based medical centers, outpatient clinics, and emergency departments) within the first 30 days after the initial hospitalization, compared to 11.8% of patients without depressive symptoms (p = 0.002). This association remained significant after adjustment for sociodemographic and medical covariates. Elevated depressive symptoms also predicted a higher number of outpatient physician visits (adjusted OR = 2.36; 95% CI 1.75 - 3.18; p < 0.001). Results were similar for the PHQ-9 continuous score. There was no association between depressive symptoms and re-hospitalizations.

Conclusions: After hospitalization for cardiac care, patients with elevated depressive symptoms may be at higher risk for utilizing outpatient physician and outpatient hospital care. This is not explained by more severe cardiac disease or more comorbidities.