Comorbid depression is associated with increased hospital utilization and higher mortality in children, according to a study published in Journal of Affective Disorders.
This retrospective study involved 937,971 children between ages 6 to 20. US hospital records were obtained using the Kids’ Inpatient Database for 2012. Only patients with one of the 10 most common Clinical Classification Software discharge diagnoses (excluding affective disorders) were studied. The association between depression and hospitalization cost, length of hospital stay, number of procedures, and mortality were assessed using linear or logistic regression. Background characteristics (including gender, race, and income) were balanced between groups prior to analysis using propensity score matching.
The researchers found significantly higher average hospital costs in patients with depression ($10,643 vs $7,682 US dollars; 95% CI, $2401-$3512; P <.001). Children with comorbid depression also had longer hospitalizations (4.63 vs 3.74 days; 95% CI, 0.74-1.05), fewer procedures performed (1.42 vs 1.73; 95% CI, -0.34 to -0.26), and a higher likelihood of death (odds ratio 1.77; P <.013).
A subanalysis of these results revealed that children with depression under 13 years old had almost twice the average hospital cost as patients without depression in that age group ($20,768 vs $9365 US dollars; 95% CI, $7279-$15,527; P < .001), with length of hospitalization more than double patients who were not depressed (7.28 vs 3.85 days; 95% CI, 2.51-4.34; P < .001).
This study was limited by its retrospective nature, as well as a disproportionately high number of adolescents, which likely affected overall data. Additionally, variation in documenting procedures between hospitals may have been a source of error in terms of diagnosing depression. Further evaluation of re-admission rates would be helpful in assessment of hospital utilization in these patients.
In conclusion, comorbid depression is associated with a significantly higher rate of hospital utilization and mortality in children. Hospital utilization was found to be particularly high in young children with depression, which may merit additional research. The researchers suggest that identification and treatment of depression prior to or during hospitalization may result in better patient outcomes and utilization of hospital resources in this population.
Olusunmade M, Qadir T, Akyar S, Farid A, Aggarwal R. Incremental hospital utilization and mortality associated with co-morbid depression in pediatric hospitalizations. J Affect Disord. 2019; 251:270-273.