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Do-not-resuscitate (DNR) status and major depressive disorder (MDD): Clinical association and hospitalization outcomes

Published online by Cambridge University Press:  27 April 2022

David Hyung Won Oh Open the ORCID record for David Hyung Won Oh [Opens in a new window] ,
Matthew J. Salzler ,
Rachel L. Bernstein  and
Christopher W. Racine
David Hyung Won Oh*
Affiliation:
Department of Medicine, Tufts University School of Medicine, Boston, MA
Matthew J. Salzler
Affiliation:
Department of Orthopaedics, Tufts Medical Center, Boston, MA
Rachel L. Bernstein
Affiliation:
Department of Medicine, Palliative Care, Tufts Medical Center, Boston, MA
Christopher W. Racine
Affiliation:
Department of Psychiatry, Maine Medical Center, Portland, ME
*
Author for correspondence: David Hyung Won Oh, 2302 Valdez St. #423, Oakland, CA 94612, USA. E-mail: [email protected]
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Abstract

Objectives

To understand (1) the association of Major Depressive Disorder (MDD) and do-not-resuscitate (DNR) status among hospitalized patients and (2) the association of MDD and hospitalization outcomes among DNR patients.

Methods

This was a cross-sectional analysis of United States Healthcare Cost and Utilization Project, Nationwide Inpatient Sample data from 2009 to 2013 for patients >18 years. To address the first objective, we used multivariable logistic regression among all hospitalized patients to compute the adjusted odds ratio (aOR) of having DNR status if patients have active MDD of varying severities after controlling for age, sex, race, suicidal ideation, and Elixhauser Comorbidity Index. To address the second objective, we used multivariable regression among patients with DNR status to compute aOR of having hospitalization outcomes such as increased length of stay, higher total charges, leaving against medical advice, and mortality if patients have MDD.

Results

Among all hospitalizations, 2.3% had DNR status. There was an inverse association between severity of MDD and having DNR status. Relative to those without MDD, patients with moderate recurrent MDD episode (aOR 0.74 (95% confidence interval (CI): 0.65–0.85) and severe recurrent MDD episode (aOR of 0.42 (95% CI: 0.37–0.48)) were significantly less likely to have DNR status. Among DNR patients, those with all severities of MDD except mild single episode MDD were >40% less likely to die during hospitalization. Among DNR patients, patients with MDD had 0.7 day longer length of stay, and >$4,500 higher total charges.

Significance of results

Patients are less likely to have DNR status if they have active MDD. Among patients with DNR status, those with MDD are less likely to die during hospitalization than those without MDD. With current practice, depression is not associated with increased likelihood of death due to foregoing resuscitation prematurely, though the exact mechanisms of these findings need further investigation.

Keywords

Code statusDepressionEpidemiologyPalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 4 , August 2022 , pp. 542 - 548
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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