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51 The Impact of Contact Precautions on Depression and Anxiety During the Course of a Hospital Admission

Saturday, April 2, 2011: 10:45 AM
Cortez Ballroom (Hilton Anatole)
Hannah R. Day, MS , University of Maryland, Baltimore, MD
Eli Perencevich, MD , Iowa City VA Medical Center, Iowa City, IA
Anthony D. Harris , University of Maryland, Baltimore, MD
Seth Himmelhoch, MD, MPH , University of Maryland School of Medicine, Baltimore, MD
Clayton Brown, PhD , University of Maryland, Baltimore, MD
Ann Gruber-Baldini , University of Maryland School of Medicine, Baltimore, MD
Atlisa Young, MSW , University of Maryland, Baltimore, MD
Lisa Pineles, MS , University of Maryland, Baltimore, MD
Daniel J. Morgan, MD , University of Maryland, Baltimore, MD
Background: Contact Precautions may be associated with incident depressive or anxious symptoms. Previous studies could not assess if Contact Precautions leads to more depression or anxiety.

Objective: To assess the effect of Contact Precautions on depression and anxiety in the hospital after adjusting for baseline depression and anxiety.

Methods: We conducted a prospective cohort study of general medical, surgical admissions to a teaching hospital from January 2010 to October, 2010. Patients were approached within 24 hours of admission and then again on hospital day 3. Non-Contact Precautions patients were frequency matched to Contact Precautions patients by ward. At time of enrollment, demographic, risk factor questions and Hospital Anxiety and Depression Scale (HADS) were collected. Patients provided follow up HADS scores on day 3. These scores were used to determine the primary outcome of possible or probable anxiety or depression. Multivariate logistic regression analyses were completed in SAS version 9.1.

Results:

419 patients completed HADS at time of admission and 243 stayed until Day 3 (126 on Contact Precautions and 117 patients not on Contact Precautions). No significant differences were seen in age, gender or Charlson Comorbidity Index score by Contact Precaution status.

On Day 1, patients on Contact Precautions were more likely to have possible/probable depression (odds ratio (OR) 1.7, 95% Confidence Interval (CI) 1.1-2.6) and no more likely to have possible or probable anxiety (OR 1.1, 95% CI 0.7-1.6) after adjusting for age, gender and Charlson Comorbidity Index score.

On Day 3, patients on Contact Precautions were no more likely to have possible/probable depression than patients not on Contact Precautions (OR 0.9, 95% CI 0.5-1.7) after adjusting for age, gender, Charlson Comorbidity Index and presence of possible/probable depression at admission. Patients on Contact Precautions were more likely to have possible/probable anxiety than non-Contact Precautions, even after adjusting for age, gender, Charlson Comorbidity Index and presence of possible/probable anxiety score at admission (OR 2.0, 95% CI 1.0-3.9).

Conclusions: Patients on Contact Precautions have more baseline depression but not anxiety at time of hospital admission. Contact Precautions appears associated with increased anxiety but not depression after 3 days of hospital admission.