No abstract

Background: Despite the availability of pharmacologic and nonpharmacologic treatment options, depression continues to be one of the leading causes of disability worldwide. This study evaluated whether depression symptom severity, as measured by PHQ-9 score, of patients diagnosed with MDD is associated with short-term risk of a hospital encounter (ER visit or inpatient stay). Methods: Adults with ≥1 PHQ-9 assessment in an outpatient setting (index date) and ≥1 MDD diagnosis within 6 months prior were included from the de-identified Optum Electronic Health Record database (April 2016-June 2019). Patients were categorized by depression symptom severity based on PHQ-9 scores obtained by natural language processing. Crude rates, adjusted absolute risks, and adjusted relative risks of all-cause and MDD-related hospital encounters within 30 days following assessment of depression severity were determined.Results: The study population consisted of 280 145 patients with MDD and ≥1 PHQ-9 assessment in an outpatient setting. Based on PHQ-9 scores, 26.9% of patients were categorized as having none/minimal depression symptom severity, 16.4% as mild, 24.7% as moderate, 19.6% as moderately severe, and 12.5% as severe. Among patients with none/minimal, mild, moderate, moderately severe, and severe depression, the adjusted absolute short-term risks of an initial all-cause hospital encounter were 4.1%, 4.4%, 4.8%, 5.6%, and 6.5%, respectively; MDD-related hospital encounter adjusted absolute risks were 0.8%, 1.0%, 1.3%, 1.6%, and 2.1%, respectively. Compared to patients with none/minimal depression symptom severity, the adjusted relative risks of an all-cause hospital encounter were 1.60 (95% CI 1.50-1.70) for those with severe, 1.36 (1.29-1.44) for those with moderately severe, 1.18 (1.12-1.25) for those with moderate, and 1.07 (1.00-1.13) for those with mild depression symptom severity. Conclusions: These study findings indicate that depression symptom severity is a key driver of short-term risk of hospital encounters, emphasizing the need for timely interventions that can ameliorate depression symptom severity.

BackgroundDespite the availability of pharmacologic and nonpharmacologic treatment options, depression continues to be one of the leading causes of disability worldwide. The impact of depression symptom severity on short-term risk of hospitalization is not well established in the literature. This study evaluates the degree to which depression symptom severity in patients diagnosed with MDD is associated with risk of an initial hospital encounter (ER visit or hospitalization) in the short-term following an outpatient PHQ-9 assessment. MethodsAdult patients (≥18 years of age) with ≥1 PHQ-9 assessment in an outpatient setting (index date) and ≥1 MDD diagnosis within 6 months prior were included from the de-identified Optum Electronic Health Record database (April 2016-June 2019). Patients were categorized based on PHQ-9 scores obtained by natural language processing. Crude rates and adjusted absolute risks of all-cause, MDD-related, and suicidal ideation (SI)/suicide attempt (SA)-related hospital encounters within 30 days of patients’ PHQ-9 assessments were evaluated.ResultsThe study population consisted of 280 145 patients with MDD and ≥1 PHQ-9 assessment in an outpatient setting. Based on PHQ-9 scores, 26.9% of patients were categorized as having none/minimal depression symptom severity, 16.4% as mild, 24.7% as moderate, 19.6% as moderately severe, and 12.5% as severe. Among patients with none/minimal, mild, moderate, moderately severe, and severe depression, the adjusted absolute short-term risks of an initial all-cause hospital encounter were 3.9%, 4.3%, 4.9%, 5.7%, and 6.7%, respectively; of a MDD-related hospital encounter they were 0.8%, 1.0%, 1.3%, 1.6%, and 2.2%, respectively; of a SI/SA-related hospital encounter they were 0.1%, 0.1%, 0.1%, 0.3%, and 0.8%, respectively ConclusionsThese study findings indicate that depression symptom severity is a key driver of short-term risk of hospital encounters, emphasizing the need of timely interventions that can ameliorate depression symptom severity.