Clinical Investigation| Volume 355, ISSUE 1, P21-26, January 2018

The Association Between Major Depressive Disorder and Outcomes in Older Veterans Hospitalized With Pneumonia

Published:September 08, 2017DOI:



      Major depressive disorder (“depression”) has been identified as an independent risk factor for mortality for many comorbid conditions, including heart failure, cancer and stroke. Major depressive disorder has also been linked to immune suppression by generating a chronic inflammatory state. However, the association between major depression and pneumonia has not been examined. The aim of this study was to examine the association between depression and outcomes, including mortality and intensive care unit admission, in Veterans hospitalized with pneumonia.

      Materials and Methods

      We conducted a retrospective national study using administrative data of patients hospitalized at any Veterans Administration acute care hospital. We included patients ≥65 years old hospitalized with pneumonia from 2002-2012. Depressed patients were further analyzed based on whether they were receiving medications to treat depression. We used generalized linear mixed effect models to examine the association of depression with the outcomes of interest after controlling for potential confounders.


      Patients with depression had a significantly higher 90-day mortality (odds ratio 1.12, 95% confidence interval 1.07-1.17) compared to patients without depression. Patients with untreated depression had a significantly higher 30-day (1.11, 1.04-1.20) and 90-day (1.20, 1.13-1.28) mortality, as well as significantly higher intensive care unit admission rates (1.12, 1.03-1.21), compared to patients with treated depression.


      For older veterans hospitalized with pneumonia, a concurrent diagnosis of major depressive disorder, and especially untreated depression, was associated with higher mortality. This highlights that untreated major depressive disorder is an independent risk factor for mortality for patients with pneumonia.

      Key Indexing Terms

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        • Kessler R.C.
        • Berglund P.
        • Demler O.
        • et al.
        The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).
        J Am Med Assoc. 2003; 289: 3095-3105
      1. Ambulatory Care Use and Physician office visits. 2016. Accessed November 1, 2016.
        • Barth J.
        • Schumacher M.
        • Herrmann-Lingen C.
        Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis.
        Psychosom Med. 2004; 66: 802-813
        • Jiang W.
        • Alexander J.
        • Christopher E.
        • et al.
        Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure.
        Arch Intern Med. 2001; 161: 1849-1856
        • Satin J.R.
        • Linden W.
        • Phillips M.J.
        Depression as a predictor of disease progression and mortality in cancer patients.
        Cancer. 2009; 115: 5349-5361
        • Blume J.
        • Douglas S.D.
        • Evans D.L.
        Immune suppression and immune activation in depression.
        Brain Behav Immun. 2011; 25: 221-229
        • Kung H.
        • Hoyert D.
        • Xu J.
        • et al.
        Deaths: final data for 2005.
        Natl Health Stat Report. 2008; 56: 1-120
        • DeFrances C.J.
        • Lucas C.A.
        • Buie V.C.
        • et al.
        2006 National hospital discharge survey.
        Natl Health Stat Report. 2008; 5: 1-20
        • Davydow D.S.
        • Hough C.L.
        • Zivin K.
        • et al.
        Depression and risk of hospitalization for pneumonia in a cohort study of older Americans.
        J Psychosom Res. 2014; 77: 528-534
        • Mortensen E.M.
        • Halm E.A.
        • Pugh M.J.
        • et al.
        Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia.
        J Am Med Assoc. 2014; 311: 2199-2208
        • Sohn M.-W.
        • Arnold N.
        • Maynard C.
        • et al.
        Accuracy and completeness of mortality data in the Department of Veterans Affairs.
        Popul Health Metr. 2006; 4: 1
        • Selim Alfredo J.
        • Fincke B. Graeme
        • Ren Xinhua S.
        • et al.
        Comorbidity assessments based on patient report: results from the Veterans Health Study.
        J Ambul Care Manage. 2004; 27: 281-295
        • Selim Alfredo J.
        • Berlowitz Dan R.
        • Fincke Graeme
        • et al.
        The health status of elderly veteran enrollees in the Veterans Health Administration.
        J Am Geriatr Soc. 2004; 52: 1271-1276
        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Kazis L.E.
        • Miller D.R.
        • Clark J.
        • et al.
        Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study.
        Arch Intern Med. 1998; 158: 626-632
        • Mortensen E.M.
        • Coley C.M.
        • Singer D.E.
        • et al.
        Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study.
        Arch Intern Med. 2002; 162: 1059-1064
        • Grant B.F.
        • Harford T.C.
        Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey.
        Drug Alcohol Depend. 1995; 39: 197-206
        • Hasin D.S.
        • Goodwin R.D.
        • Stinson F.S.
        • et al.
        Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions.
        Arch Gen Psychiatry. 2005; 62: 1097-1106
        • Breslau N.
        • Davis G.C.
        • Peterson E.L.
        • et al.
        A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection.
        Biol Psychiatry. 2000; 48: 902-909
        • Marshall R.D.
        • Olfson M.
        • Hellman F.
        • et al.
        Comorbidity, impairment, and suicidality in subthreshold PTSD.
        Am J Psychiatry. 2001; 158: 1467-1473
        • Siu A.L.
        • Bibbins-Domingo K.
        • Grossman D.C.
        • et al.
        Screening for depression in adults: US Preventive Services Task Force recommendation statement.
        J Am Med Assoc. 2016; 315: 380-387
        • Karamchandani R.R.
        • Vahidy F.
        • Bajgur S.
        • et al.
        Early depression screening is feasible in hospitalized stroke patients.
        PLoS One. 2015; 10: e0128246
        • Anderson D.
        • Aveyard B.
        • Baldwin B.
        • et al.
        Who Cares Wins: Improving the Outcome for Older People Admitted to the General Hospital: Guidelines for the Development of Liaison Mental Health Services for Older People.
        Royal College of Psychiatrists, London2005
        • Dennis M.
        • Kadri A.
        • Coffey J.
        Depression in older people in the general hospital: a systematic review of screening instruments.
        Age Ageing. 2012; 41: 148-154