Predictors of depressive symptoms at hospital discharge in patients with major depressive disorder

Abstract

Objective. Often patients with major depressive disorder (MDD) leave the hospital with continued significant symptomatology. This study sought to evaluate demographic, clinical, and psychosocial predictors of the presence of clinically significant depressive symptoms, defined as a Modified Hamilton Rating Scale for Depression score of ≥ 14, immediately following hospitalization for MDD. Methods. The study enrolled 135 patients with MDD as part of a larger clinical trial investigating the efficacy of post-hospitalization pharmacologic and psychosocial treatments for depressed inpatients. Structured clinical interview and self-report data were available from 126 patients at hospital admission and discharge. Results. Despite the significant decreases in depressive symptoms over the course of hospitalization, 91 (72%) displayed clinically significant depressive symptoms at discharge. Multivariate logistic regression analysis revealed that female sex, earlier age of onset, and poorer social adjustment were unique predictors of symptom outcome. Conclusions. Results suggest that a large proportion of patients leave the hospital with continued significant symptomatology, and the presence of such symptoms following hospitalization for MDD is likely to be explained by a combination of factors.

Key words::

• Major depressive disorder
• depression
• hospitalization

Acknowledgments

The authors wish to thank the inpatient medical staff of Butler Hospital for providing access to the units for participant recruitment and assessment.

Statement of interest

None of the authors reports conflicts of interest.

This research was supported by National Institute of Mental Health grant R01 MH058866, awarded to Dr. Miller. Study findings were presented in part at the annual meeting of the Association for Behavioral and Cognitive Therapies, Toronto, ON, November, 2011.

Notes

¹We chose to evaluate this categorical outcome, as opposed to continuous change in depressive symptoms, given that patients who nevertheless experience changes in MHRSD score from admission to discharge may still leave the hospital with clinically significant levels of depression. In contrast, using a post-discharge MHRSD ≥ 14 to differentiate mild versus moderate-to-severe depression allows for the evaluation of who has higher versus lower levels of symptomatology following psychiatric hospitalization, which was the primary aim of this study. As this cutoff is often used as an inclusion criterion for clinical trials of MDD (e.g., Miller et al. 2005), study results, therefore, carry both clinical and research implications.