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Table 1 Resident Level Covariates & Justification

From: Depressive symptoms in long term care facilities in Western Canada: a cross sectional study

Outcome RAI-MDS 2.0 variable(s)  
Resident Demographics
 Age Calculated as difference between assessment reference date (A3) and birth date (AA3a)  
 Sex AA2  
 Marital status A5  
Comorbidities Justification for Covariates
 Cardiovascular diseases Either of arteriosclerotic heart disease (I1d), cardiac dysrhythmia (I1e), congestive heart failure (I1f), deep vein thrombosis (I1g), peripheral vascular disease (I1j), other cardiovascular disease (I1k) Major depression effects 19% of patients post myocardial infarction1. 14 to 60% of patients with heart failure experience depressive symptoms2. In peripheral vascular disease between 12 and 24% have depression, however this increases with amputation3. A UK study found 18.1% of patients had depressive symptoms4. Deep vein thrombosis and post thrombotic syndrome are known to negatively effect health related quality of life5, 6.Where DVT was associated with higher anxiety and depression compared to control on the EQ-5D6.
 Renal failure I1uu Across the 5 stages of chronic kidney disease the prevalence of depression 21.4%7
 Diabetes mellitus I1a The relative risk of depression in diabetes is RR 1.278.
 Stroke or transient ischemic attack I1u or I1dd The prevalence of any depressive disorder in stroke is 33.5%9.
 Seizure disorder I1cc Epilepsy has 22.9% prevalence of depressive disorders10
 Neurodegenerative disease Either of amyotrophic lateral sclerosis (I1q), Huntington’s chorea (I1x), multiple sclerosis (I1y), or Parkinson’s disease (I1aa) In Parkinson’s disease, 35% experience clinically relevant depressive symptoms11. For Multiple Sclerosis 30.5% have depression12. Those with Amyotrophic Lateral Sclerosis have a OR of depression of 1.713. Approximately 31.7% of those with Huntington’s disease experience major depression14.
 Traumatic brain injury I1ee Traumatic brain injury has a 43% prevalence of depressive disorders15
 Anxiety disorder I1ff Anxiety is common in LTC, with 29.7% of patients reporting anxiety symptoms16.
 Bipolar disorder I1hh Bipolar disorder17 includes depressive symptoms as part of the diagnosis
 Schizophrenia I1ii Depressive symptoms are common (~ 7–75%) patients with schizophrenia18, 19, with depression also being part of the diagnostic criteria for schizoaffective disorders17.
 Cancer I1rr 8–24% of Cancer patients experience depression20.
 Respiratory disease Asthma (I1jj) or emphysema/chronic obstructive pulmonary disease (I1kk) Pulmonary diseases have been associated with depression21, 22 and depression in LTC23.
 Gastrointestinal disease I1ss 21.6% of Inflammatory bowel disease patients experience symptoms of depression24.
 Liver disease I1tt Liver diseases, for e.g. non-alcoholic cirrhosis, has an incidence risk ratio for depression of 1.76.25
Other impairments
 Physical dependency Activities of Daily Living – Hierarchical26 score > 3 Depression is associated with a decline in function (e.g. poor self sufficiency)27
 Visual impairment Either of cataracts (I1ll), diabetic retinopathy (I1mm), glaucoma (I1nn), or macular degeneration (I1oo) Poor vision in seniors is associated with an 1.94 odds of depression (95% CI1.68, 2.25)28
 Hearing impairment C1 = 2 (hears in special situations only) or C1 = 3 (hearing highly impaired) Loss of hearing is associated with depression, OR 1.71 (95%CI 1.28,2.27)28.
 Pain Either J2a = 2 (daily pain) or J2b = 3 (phases of excruciating pain regardless of frequency) Pain and depression are highly correlated across multiple settings29.
Outcome TREC survey variable Justification for covariates
Unit type Care units are either general long term care, non secure dementia, secure dementia, secure mental health/ psychiatric, or other Our research has demonstrated that quality issues within LTC facilities vary substantially among care units and that unit-level measurement in addition to facility0level measurement is crucial to account for this variance.30
Unit staffing For each care unit TREC collects information on care staffing by care provider group that allows to calculate the care hours per resident day for care aides, licensed practical nurses and registered nurses.31 Systematic reviews suggested a link between higher staffing levels and better quality of care (including detection and management of depressive symptoms).32–34
Facility location Facility is located in either the Edmonton or Calgary Health Zone, in the Fraser or Interior Health Authority, or in the Winnipeg Regional Health Authority The Canadian Health Act requires public payment only for medical services provided in hospitals or by physicians.35 Provinces/territories determine individually which services are paid publicly (and how much is paid) and which services clients must cover themselves. Policies regulating LTC differ substantially among Canadian provinces, and so do quality of care issues.36 Therefore, and because this is one of the stratification variables to sample TREC facilities, we adjusted our models for facility location.
Facility size Facility is small (<  80 beds), medium (80–120 beds) or large (>  120 beds) Evidence suggests that an LTC facility’s size affects quality of care.37 Therefore, we adjusted our models for facility location. Therefore, and because this is one of the stratification variables to sample TREC facilities, we adjusted our models for facility location.
Facility owner-operator model Facility owner operator model is either public not-for-profit, voluntary not-for-profit (e.g., faith based) or private for-profit Evidence suggests that an LTC facility’s ownership model affects quality of care.37 Therefore, we adjusted our models for facility location. Therefore, and because this is one of the stratification variables to sample TREC facilities, we adjusted our models for facility location.
Mental health/geriatric services provided in facility TREC collects data on whether or not mental health and geriatric services are available in each TREC facility. Services include geriatric mental health consulting, geriatrician, psychiatrist or geriatric psychiatrist, each coded as 1 (available) or 0 (not available) Availability of mental health services is key to detection and appropriate management of depressive symptoms in older adults38.
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