Patient profiles, initial hospital encounter characteristics, and hospital re-encounters of patients with a hospital emergency department visit or inpatient admission for major depressive disorder

Abstract

Objectives

To gain a better understanding of the characteristics of patients with a hospital encounter for major depressive disorder (MDD) and evaluate associated hospital resource utilization, hospital charges and costs, and hospital re-encounters.

Methods

Adult patients with a hospital encounter (i.e. emergency department [ED] visit only or inpatient admission) with MDD as the primary discharge diagnosis (index event) during July 2018‒March 2019 were selected from the Premier Healthcare Database. Patient characteristics, hospital resource utilization, and hospital charges and costs were evaluated during index events. During a 12-month follow-up, hospital re-encounters (MDD-related and all-cause ED visit only or inpatient readmissions) were examined.

Results

The study population included 77,178 patients with an index hospital encounter (ED visit only: 49.9%; inpatient admission: 50.1%) for MDD. The most common secondary mental health-related diagnosis was suicidal ideation/behavior, which was recorded in 51.8% of patients. The mean age was 38.2 years, 53.0% were female, and 72.1% were Caucasian. Among patients with an ED visit only, the mean index hospital charges and costs were $3,608 and $639, respectively. Among those with inpatient admissions, the mean length of stay was 4.9 days, and the mean index hospital charges and costs were $17,107 and $6,095, respectively. During the 12-month follow-up, 13.3% of patients in the overall study population had an MDD-related hospital re-encounter (primary or secondary discharge diagnosis code indicating MDD); nearly one-third (31.3%) occurred within 30 days post-discharge. During the follow-up, 28.1% had an all-cause hospital re-encounter with 29.7% having occurred within 30 days post-discharge.

Limitations

Due to constraints of the Premier Healthcare Database, healthcare resource utilization and costs outside of the hospital could not be evaluated.

Conclusions

Patients with a hospital encounter for MDD are relatively young, commonly have suicidal ideation/behavior, utilize substantial hospital resources, and have a high risk for a hospital re-encounter in the 30 days post-discharge.

Keywords:

• Hospital charges
• hospital costs
• hospital encounter
• hospital re-encounter
• hospital resource utilization
• major depressive disorder

JEL Classification Codes:

• I00
• I
• I19
• I1

Transparency

Declaration of funding

Sponsorship for this study and preparation of this manuscript was provided by Janssen Global Services, LLC.

Declaration of financial/other relationships

QZ, MO’H, CM, SB, MM, KJ, and JA are employees of Janssen, LLC. MLS and JL are employees of Novosys Health, which received research funds from Janssen, LLC in connection with conducting this study and preparation of this manuscript.

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

QZ, MO’H, CM, SB, MM, KJ, JA, and JL contributed to the conception, study design.

MLS and JL contributed to the data analyses.

QZ, MO’H, CM, SB, MM, KJ, JA, MLS and JL contributed to the data interpretation, drafting and revising of the manuscript.

Acknowledgements

None reported.

Compliance with ethics guidelines

The data source used for this study is comprised of administrative healthcare records that are deidentified and certified to be fully compliant with the Health Insurance Portability and Accountability Act patient confidentiality requirements. Institutional review board approval to conduct this study was not required because the study used only deidentified patient records and did not involve the collection, use, or transmittal of individually identifiable data.

Data availability statement

All data generated or analyzed during this study are included in this published article or are available upon request from the corresponding author.