The Paradoxical Role of Depression in Mortality, Hospitalisation, and Economic Burden Among Bone Marrow Transplantation Patients - Using the National Inpatient Sample (NIS) - 2021

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Introduction Bone marrow transplantation (BMT) is a critical treatment for haematological malignancies, yet patients undergoing BMT often face significant psychological comorbidities, including depression. Depression is known to influence treatment outcomes in various medical conditions, but its role in patients undergoing BMT is not well understood. This study investigates the effects of depression on mortality, length of hospital stay (LOS), and total hospitalization charges in patients who have undergone BMT, using data from the National Inpatient Sample (NIS) 2021. Methods A retrospective cohort analysis was performed using the NIS database. Patients who underwent BMT and patients diagnosed with Depression were identified using appropriate ICD-10 codes. A survey-weighted analysis was employed to adjust for the complex design of the NIS. Multivariate survey-weighted logistic and linear regression models were used to examine the association of depression with mortality, LOS, and hospitalization costs, controlling for age, sex, race, ZIP code income quartile, Charlson Comorbidity Index, hospital teaching status, hospital bed size, and hospital region Results A total of 55,115 BMT inpatient hospitalisations were identified, with 14.1% diagnosed with depression. Surprisingly, patients with depression had a significantly lower mortality rate (2.83%) compared to those without depression (5.04%), with an odds ratio (OR) of 0.55 (95% CI: 0.40-0.76, p<0.001). Length of stay did not significantly differ between depressed (mean: 8.15 days) and non-depressed patients (mean: 8.08 days) (p=0.42). Similarly, hospitalization charges were not significantly different between the two groups after adjustment, with depressed patients incurring a mean charge of $139,866 compared to $149,116 in non-depressed patients (p=0.89). Age (OR: 1.01, p<0.001), higher Charlson comorbidity index (OR: 1.42, p<0.001), and larger hospital size (OR: 1.46, p=0.01) were significantly associated with higher mortality. Conclusions In this cohort of BMT patients, the presence of depression was associated with a paradoxically lower mortality rate but had no significant impact on length of stay or hospitalization charges. These findings suggest that depression in SCT/BMT patients may be under-recognized or that depressed patients may receive more comprehensive care, leading to improved survival outcomes. Further research is needed to elucidate the mechanisms behind these associations and to optimize care for patients with comorbid psychiatric conditions undergoing intensive cancer therapies.

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