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Variations in the Associations Between Psychiatric Comorbidity and Hospital Mortality According to the Method of Identifying Psychiatric Diagnoses

  • Hospital Medicine
  • Published:
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Summary

Objective

Little is known about associations between psychiatric comorbidity and hospital mortality for acute medical conditions. This study examined if associations varied according to the method of identifying psychiatric comorbidity and agreement between the different methods.

Patients/Participants

The sample included 31,218 consecutive admissions to 168 Veterans Affairs facilities in 2004 with a principle diagnosis of congestive heart failure (CHF) or pneumonia. Psychiatric comorbidity was identified by: (1) secondary diagnosis codes from index admission, (2) prior outpatient diagnosis codes, (3) and prior mental health clinic visits. Generalized estimating equations (GEE) adjusted in-hospital mortality for demographics, comorbidity, and severity of illness, as measured by laboratory data.

Measurements and Main Results

Rates of psychiatric comorbidities were 9.0% using inpatient diagnosis codes, 27.4% using outpatient diagnosis codes, and 31.0% using mental health visits for CHF and 14.5%, 33.1%, and 34.1%, respectively, for pneumonia. Agreement was highest for outpatient codes and mental health visits (κ = 0.51 for pneumonia and 0.50 for CHF). In GEE analyses, the adjusted odds of death for patients with psychiatric comorbidity were lower when such comorbidity was identified by mental health visits for both pneumonia (odds ratio [OR] = 0.85; P = .009) and CHF (OR = 0.70; P < .001) and by inpatient diagnosis for pneumonia (OR = 0.63; P ≤ .001) but not for CHF (OR = 0.75; P = .128). The odds of death were similar (P > .2) for psychiatric comorbidity as identified by outpatient codes for pneumonia (OR = 1.04) and CHF (OR = 0.93).

Conclusions

The method used to identify psychiatric comorbidities in acute medical populations has a strong influence on the rates of identification and the associations between psychiatric illnesses with hospital mortality.

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Acknowledgments

This research was conducted and completed by only those authors listed on the title page. No other authors contributed in a significant manner to this work.

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (HSR&D) Service through the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) (HFP 04-149). Dr. Abrams is a fellow associate supported by additional VA funding through the Office of Academic Affairs. This work was presented at the Annual Society of General Internal Medicine conference in Toronto, Canada on April 27, 2007.

Conflict of Interest

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The authors report no conflicts of interest in regards to this study.

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Authors and Affiliations

  1. The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Healthcare System, Iowa City, IA, USA

    Thad E. Abrams MD, MS, Mary Vaughan-Sarrazin PhD & Gary E. Rosenthal MD

  2. The Department of Internal Medicine, University of Iowa, Iowa City, IA, USA

    Thad E. Abrams MD, MS & Gary E. Rosenthal MD

Authors
  1. Thad E. Abrams MD, MS
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  2. Mary Vaughan-Sarrazin PhD
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  3. Gary E. Rosenthal MD
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Correspondence to Thad E. Abrams MD, MS.

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Abrams, T.E., Vaughan-Sarrazin, M. & Rosenthal, G.E. Variations in the Associations Between Psychiatric Comorbidity and Hospital Mortality According to the Method of Identifying Psychiatric Diagnoses. J GEN INTERN MED 23, 317–322 (2008). https://doi.org/10.1007/s11606-008-0518-z

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  • DOI: https://doi.org/10.1007/s11606-008-0518-z

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