In this study, Hospital Anxiety and Depression Scale (HADS) scores tended to be higher in patients on Contact Precautions than patients who were not on Contact Precautions, but the difference was not statistically significant. We observed a difference in combined HADS score of 1.27 in the unadjusted analysis and 2.22 in the adjusted analysis although the study was underpowered to identify a smaller difference between groups. The increase in HADs scores appears greater in those with recent initiation of Contact Precautions, although the numbers are small.
Nearly 40% of the total sample was uncomfortable with Contact Precautions, this did not differ by whether a patient was currently on Contact Precautions.
Although we only had 22 Contact Precautions patients in our study, previous studies of depression and anxiety presented data on 8-27 patients in Contact Precautions 2
. Other studies reported higher levels of depression in patients on Contact Precautions, but none exclusively studied patients at time of hospital admission.2
To our knowledge, this is the first study designed to evaluate differences in levels of depressive symptoms and anxiety between patients on Contact Precautions and patients not on Contact Precautions at hospital admission. This is also the only study in a VA hospital. Previous studies, which are currently cited in the argument against Contact Precautions, measured symptom levels at varying points of hospitalization or nursing home care 2
or used subjective measures of depression.7
This study has several limitations. First, with only 20 people in Contact Precautions out of 103, we would only be able to detect a difference between the groups of 4.8 or greater based on a power calculation using alpha 0.05 and 80% power. Second, we have no record of pre-existing depression. Based on this study, we cannot determine if depression is the result of Contact Precautions or if Contact Precautions is simply a marker of patients with higher frequency of depression.
Although not statistically significant, our data suggests Veterans on Contact Precautions have more symptoms of depression and anxiety at admission. Larger longitudinal studies are needed to understand the association between depression and anxiety with Contact Precautions.