Frequency of depressive and anxious symptoms in patients on Contact Precautions at hospital admission

Background: Although Contact Precautions have been shown to reduce transmission of multidrug-resistant organisms, adverse psychological effects have been reported including frustration, boredom, generally negative feelings towards isolation as well as depression and anxiety.

 Objective: The current study estimates the point prevalence of depression and anxiety using a validated self-assessment questionnaire, the Hospital Anxiety and Depression Scale (HADS). HADS was designed as a measure to screen for anxiety and depression in hospitalized adults.

Methods:  We conducted a prospective cohort study of general medical, surgical admissions to a Department of Veterans Affairs hospital from February to November, 2009. Veterans were approached within 48 hours of admission for enrollment in a larger study of risk factors for methicillin-resistant Staphylococcus aureus (MRSA). At time of enrollment, demographic, risk factor questions and HADS were collected. Univariate, bivariate and regression analyses were completed in SAS version 9.1.

 Results:   113 sequential patients completed HADS at time of admission (17 on Contact Precautions and 96 patients not on Contact Precautions). Veterans on Contact Precautions were slightly older than non-Contact Precautions veterans (mean=72.0, 95% confidence interval (CI): 65.4-78.7) vs. (mean=63.3, 95% CI: 60.7-65.8). Veterans on isolation had non-significantly lower educational levels.

 Unadjusted analyses showed no significant differences in depression (mean 6.5 Contact Precautions vs. mean 5.6 not, p = 0.30) or anxiety (mean 7.8 Contact Precautions vs. mean 7.9 not, p = 0.89) within 48 hours of admission.

 When adjusting for age, sex and education level, there was a trend towards higher depressive symptoms in the Contact Precautions group (ß=1.91, p = 0.08). According to the resulting model, a patient with average age, sex and education level would have a mean HAD depression score of 7.55 if on Contact Precautions compared to a mean of 5.65  if not on Contact Precautions.

 No significant differences were seen in levels of anxiety symptoms from Contact Precautions (ß=1.31, p = 0.30). Younger age, however, was a strong independent predictor of anxiety scores (p < 0.01) and younger age remained the only significant predictor of HADS anxiety scores when looking at isolation, age, sex and education level. Age was not an independent predictor of depressive scores (p = 0.95).

 Conclusions: Patients initially placed on Contact Precautions may have higher depressive symptoms than patients not on Contact Precautions. Younger age was a much better predictor of anxiety than Contact Precautions. However, with only 17 patients in Contact Precautions, power for this study was limited. Future studies should include longitudinal tracking of depression and anxiety symptoms to determine if these symptoms change over the length of the hospital stay.