Clinical and economic burden of major depressive disorder with acute suicidal ideation or behavior in a US Veterans Health Affairs database

Abstract

Objective

Although a high incidence of major depressive disorder (MDD) and an increased risk of suicide are observed among the veteran population, there are yet limited real-world data characterizing patients with MDD with acute suicidal ideation/behavior (MDSI) in the Veterans Health Administration (VHA) system. We assessed the clinical and economic burden, including comorbidities, treatment patterns, health care resource utilization, and health care costs, among veterans and their family members with MDSI within the VHA system.

Methods

This retrospective, longitudinal analysis of VHA datasets (10/1/2015–3/31/2018) evaluated the clinical and economic burden associated with MDSI and compared this population with matched MDD alone (i.e. MDD diagnosis without acute suicidal ideation/behavior) and non-MDD (i.e. neither MDD nor acute suicidal ideation/behavior) cohorts.

Results

Among 11,203 patients with MDSI, the proportions of patients who filled a prescription for ≥1 antidepressant during the 12-month pre- and 6-month post-periods were significantly higher compared with patients with MDD alone (53.7% vs 28.8%, p < .05; and 72.3% vs 44.1%, p < .05; respectively). During the 12-month pre-period, the MDSI cohort had the highest proportion of patients with ≥1 mental health-related inpatient visit compared with the MDD alone and non-MDD cohorts (13.2% vs 2.3% vs 1.4%, respectively; p < .05), and the highest mental health-related costs per patient ($8853 vs $1913 vs $1079, respectively). For the 6-month post-period, the MDSI cohort had the highest proportion of patients with ≥1 mental health-related inpatient visit compared with the MDD alone and non-MDD cohorts (60.4% vs 7.9% vs 0.8%, respectively; p < .05), and had the highest mental health-related costs per patient ($20,334 vs $4803 vs $545, respectively).

Conclusions

Findings demonstrate significant clinical and economic burden for those in the VHA system diagnosed with MDSI and highlight unmet needs and opportunities for improving the care of this vulnerable group.

PLAIN LANGUAGE SUMMARY

There are limited real-world data regarding patients diagnosed with major depressive disorder and having suicidal thoughts/behavior (MDSI) in the Veterans Health Administration (VHA) system. We examined data on 11,203 patients with MDSI from the VHA between October 1, 2015 and March 31, 2018. We compared patients with MDSI with patients with major depressive disorder alone (MDD) and patients with no depression (non-MDD). Our results showed that patients with MDSI were treated with more antidepressant therapy, had more hospital stays (inpatient visits), and incurred greater costs than the MDD and non-MDD patients. These results highlight the unmet need and potential opportunity to improve patient care among veterans and their families with MDSI.

Keywords:

• Veterans
• veterans health
• veterans health services
• depressive disorder
• major
• suicidal ideation
• suicide
• attempted

Transparency

Declaration of funding

This work was supported by Janssen Scientific Affairs, LLC.

Declaration of financial/other relationships

CN, JV, and KJ are employees of Janssen Scientific Affairs, LLC, and may be stockholders in Johnson & Johnson. IC is an employee of STATinMED Research and is contracted to provide services for Janssen Scientific Affairs, LLC. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

CN was involved in conception/design, interpretation, draft/revisions, and final approval. KJ was involved in data interpretation, draft/revisions of the manuscript, and final approval. IC was involved in conception/design, interpretation, and final approval. JV was involved in data analysis and interpretation, draft/revisions of the manuscript, and final approval. All authors agree to be accountable for all aspects of the work.

Acknowledgements

Medical writing support was provided by Thomas J. Parkman, PhD, MBA, and Courtney St. Amour, PhD, of Cello Health Communications/MedErgy, and was funded by Janssen Scientific Affairs, LLC. Data analysis support was provided by Ghurucharan Ramachandran, MS.

Data availability statement

The VHA Medical SAS Datasets were extracted from the National Patient Care Database maintained by the VHA Office of Information.