Depression linked to C. difficile infection risk
Adults with major depression had higher CDI rates, and specific antidepressants plus living alone/widowhood also associated with infection risk.
Source
Depression, antidepressant medications, and risk of Clostridium difficile infection
Study at a glance
- Design
- Cohort — Linked HRS–Medicare analyses plus complementary clinical cohorts
- N
- N=16781 · HRS–CMS linked Study 1 sample size; complementary clinical cohorts also reported
- Population
- Older US adults in the Health and Retirement Study linked to Medicare claims
- Outcome
- Clostridium difficile infection rates/odds by depression and antidepressant exposure
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Depression linked to C. difficile infection risk
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CDI rate 282.9 vs 197.1 per 100,000 person-years with vs without depression.
The rate of CDI was 282.9 per 100,000 person-years in those with depression, and 197.1 per 100,000 person-years in those without depression.
Among CDI cases, how common was prior major depression?
Of these 404 people diagnosed with CDI, 142 (35%) had received a diagnosis of major depression and 150 (37%) had received a diagnosis of a depressive disorder prior to CDI.
What they did
Complementary analyses used linked Health and Retirement Study–Medicare data and clinical cohorts to relate depression diagnoses, antidepressants, and social factors to CDI.
What they found
CDI rates were 282.9 vs 197.1 per 100,000 person-years with vs without depression; adjusted odds of CDI were 36% higher with major depression; widowhood and living alone also associated.
The limits
What it doesn't show
Whether treating depression lowers CDI, or that all antidepressants equally raise risk; residual confounding by healthcare exposure remains possible.
Key terms
- Clostridium difficile infection (CDI)
- Antibiotic-associated diarrheal infection now a major nosocomial threat.
- Major depression
- Physician-diagnosed depressive disorder coded before CDI onset.
- Person-years
- Sum of observation time used to compute incidence rates.
- Antidepressants
- Medications for depression; some agents were linked to CDI risk.
- Widowhood
- Loss of spouse; social factor associated with CDI here.
- Odds ratio
- Measure of association comparing odds of CDI across exposures.
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CDI rate with depression was about:
Common questions
How much higher were CDI rates with depression?
282.9 vs 197.1 per 100,000 person-years.
What was the adjusted association?
36% higher odds of CDI with major depression after covariates.
What social factors mattered?
Widowhood and living alone associated with CDI.
Clinical takeaway emphasized?
Antibiotic prescribers should be aware of possible higher CDI risk in depressed patients.
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