Association of depression symptom severity with short-term risk of an initial hospital encounter in adults with major depressive disorder

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.

Predicting Poor Outcomes Among Individuals Seeking Care for Major Depressive Disorder

“…Further, a study by Voelker et al. (34) found that depression symptom severity is associated with increased risk of all‐cause and MDD‐related hospital encounters. A meta‐analysis by Zhou et al.…”

High depression symptomatology and mental pain characterize suicidal psychiatric patients

“…Additionally, the severity of depressive symptoms in major depressive disorder (MDD) was reported to be associated with an increased risk of an MDD-related hospital encounter in the short term (13). A recent study showed that patients with MDD and suicidal ideation (vs patients without suicidal ideation and the general population) had significantly worse quality of life, high healthcare resource use, and greater loss of productivity and impediment of activity (14).…”