Do Contact Precautions Cause Depression?

STOP Contact Precautions?

Mike has written several time about his concerns for the side-effects of contact precautions. (see his kill contact precautions, personal view and adverse effects posts). His post "adverse effects" discusses Dan Morgan's systematic review that looked at the state of the literature measuring what has become dogma for many hospital epidemiologists and clinicians: contact precautions harm people. After completing this review, we weren't entirely comfortable with the literature, so we set out to complete our own series of studies seeking to assess the association between contact precautions and adverse outcomes. 

The first such study by Hannah Day, a PhD student working with Dan Morgan and me, has just been published in the March 2011 AJIC.  It was a pilot study that allowed us to gather baseline estimates to complete power calculations for the larger studies that will follow. She measured the baseline levels of depression and anxiety in patients admitted to non-ICU wards of an acute-care VA hospital. Of note: this study was a sub-study within an MRSA prediction-rule study that we'd published earlier and Dan Morgan posted on a few months ago. (see Veteran's Day MRSA post)

In 2009, 103 patients (20 on contact precautions and 83 unisolated) were approached within 48 hours of admission and received a questionnaire that included a body of questions called the HADS - Hospital Anxiety and Depression Scale. What did she find?  The HADS score was 2.2 points higher in patients on contact precautions (p=0.21).  The odds ratio for having either depression or anxiety was nearly twice as high on contact precautions (OR=1.87, 95% CI 0.61-5.69).  Yes, the study was under powered.  Intriguingly, the increased HADS scores associated with contact precautions exposure was higher in those patients newly isolated (<1 year since first isolated).

Before everyone gets too excited, what does a HADS score difference of 2.2 mean? Well, this study was too small to determine whether this increase was due to depression or anxiety.  Additionally, with the combined scale, a minimum difference of 3.0 is considered clinically significant.  Thus, even if there is an association, it may have little clinical meaning.  Finally, the HADS was measured on admission, so we were unable to determine if isolation "caused" the depression. To do that, we would need to do repeated measurements on admission and throughout the stay to see if there was a change in HADS later in the admission.  More exciting data to come...

Day HR et al. Am J Infect Control March 2011