Major Depressive Disorder Linked With Poorer Hospital Outcomes in Parkinson Disease
Patients with Parkinson disease and major depressive disorder have generally poorer hospital-related outcomes compared with patients with Parkinson disease alone.
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NEW YORK — Patients with Parkinson disease (PD) and major depressive disorder (MDD) have generally poorer hospital-related outcomes, including illness severity, comorbid conditions, risk for mortality, use of diagnostic and therapeutic procedures, and length of stay compared with patients with PD alone, according to data presented at 2018 American Psychiatric Association Annual Meeting, held May 5-9, in New York City, New York.
The investigators used the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project from 2010 to 2014 to analyze differences in hospitalization outcomes, comorbidities, and use of procedures in patients with PD vs patients with PD and MDD. They identified PD as a primary diagnosis and MDD as a secondary diagnosis using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD-9-CM) codes.
A total of 63,912 patients with PD and 1445 patients with PD and MDD were included in the analysis. The results showed that patients with PD and MDD had a 3-fold greater chance for disposition to an acute care hospital (3.1% vs. 1.1%; P <.001). Median length of hospital stay was higher in patients with PD and MDD vs patients with PD alone (5.85 vs. 4.08 days; P <.001), but the median cost of hospitalization was low ($31,039 vs. $39,464; P <.001).
Results also showed that use of therapeutic nervous system procedures was lower in patients with PD and MDD vs patients with PD alone (29.9% vs. 59.5%; P <.001). In addition, diagnostic procedures such as computed tomography scans, magnetic resonance imaging, and diagnostic spinal tap were performed more in patients with PD and MDD (5.5%, 6.6%, and 3.4%, respectively) compared with patients with PD alone (4.2%, 2.8% and 2.5% respectively; P <.001).
Use of deep brain stimulation was also lower in patients with PD and MDD (9.4% vs. 25.6%; P <.001). Patients with PD and MDD had a 2-fold greater risk for major or extreme loss of function compared with patients with PD alone. The researchers also found that in-hospital mortality was significantly higher in patients with PD and MDD (1.4% vs. 1.1%; P <.001). Comorbidities observed in patients with PD and MDD included alcohol abuse (3.7%), psychosis (100%), and drug abuse (5%) compared with 1.4%, 0 %, and 0.8%, respectively, in patients with PD alone (P <.001).
“Further research to guide development of clinical care models for targeting identification and treatment of depression in PD are warranted to both reduce mortality and morbidity and improve quality of care in PD with MDD,” the investigators concluded.
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Patel R, Chopra A, Makani RD, Mansuri Z, Patel U, Desai R. Impact of depression on hospitalization and related outcomes for Parkinson's disease: a nationwide inpatient sample-based retrospective study. Presented at: 2018 American Psychiatric Association (APA) Annual Meeting; New York, NY; May 5-9. Poster 169.