2011 HSR&D National Meeting Abstract
3072 — Treatment Resistant Depression and Risk for Psychiatric Hospitalization and Suicide
Pfeiffer PN (Ann Arbor HSR&D COE/SMITREC), Ganoczy D
(Ann Arbor HSR&D COE/SMITREC), Zivin K
(Ann Arbor HSR&D COE/SMITREC), Valenstein M
(Ann Arbor HSR&D COE/SMITREC)
Treatment-resistant depression (TRD) has been variously defined, with most definitions including documented completion of antidepressant treatment trials without adequate treatment response. We used the Massachusetts General Hospital Staging (MGH-S) method, which measures TRD on a continuous scale, to examine the relationships between stages of TRD and subsequent psychiatric hospitalization or suicide among Veterans Health Administration (VHA) patients.
The MGH-S method stages TRD by assigning 1 point for every antidepressant trial lasting 6 to 10 weeks and then additional 0.5 points for each optimization to dose or duration, or use of an augmenting agent. TRD stage 0 corresponds to not receiving any antidepressant for a minimum duration of six weeks. We applied the MGH-S method to VHA administrative data of pharmacy and inpatient service use among 77,882 patients diagnosed with major depressive disorder between October 1, 2001 and September 30, 2004, and used National Death Index data to determine suicide deaths. We calculated TRD stage for the year following patients’ initial depression diagnosis and used logistic regression to determine whether TRD stage predicted psychiatric hospitalization or suicide in the subsequent year, controlling for demographic and clinical covariates.
Compared to patients with no adequate trial (TRD stage 0), patients with a single adequate antidepressant trial (TRD stage 1.5) had a lower risk of psychiatric hospitalization (OR 0.86; 95% CI: 0.78, 0.94) whereas patients requiring additional optimizations or antidepressant agents (TRD stages > 1.5) had greater risks of psychiatric hospitalization (OR 1.24; 95% CI: 1.12, 1.38 for TRD 2-2.5). Increased suicide risk was associated with both a limited antidepressant trial (TRD stage 1) (OR 3.19; 95% CI: 1.36, 7.49) and with treatment with more than two antidepressant agents (TRD > 5) (OR 6.88; 95% CI: 2.35, 20.12), but not the intervening stages, compared to patients with no adequate antidepressant trial.
Advanced stages of treatment-resistant depression as well as low TRD stages, reflecting inadequate treatment, are associated with increased risks of future psychiatric hospitalization and suicide.
TRD staging could be used to help identify depressed patients at increased risk for psychiatric hospitalization or suicide.