Who receives outpatient monitoring during high-risk depression treatment periods?

Kales HC, Kim HM, Austin KL, Valenstein M. Who receives outpatient monitoring during high-risk depression treatment periods? Journal of the American Geriatrics Society. 2010 May 1; 58(5):908-13.

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Abstract:

OBJECTIVES: To examine the intensity of monitoring received by important patient subgroups during high-risk periods (the 12 weeks after psychiatric hospitalization and after new antidepressant starts). DESIGN: Retrospective secondary analysis of data from the Veterans Affairs (VA) National Registry for Depression using patients aged 65 and older receiving depression treatment from 1999 to 2004. SETTING: VA healthcare system. PARTICIPANTS: VA patients in depression treatment between April 1, 1999, and September 30, 2004, who had psychiatric inpatient stays (n = 73,137) or new antidepressant starts (n = 421,536). MEASUREMENTS: The relationship between the number of outpatient visits for each group and patient characteristics in the 12-week period after psychiatric hospitalizations and antidepressant starts. RESULTS: The characteristic associated with significantly lower rates of monitoring for both high-risk treatment periods was aged 65 and older. White race and living in the south or northeast were also associated with significantly lower rates of monitoring after new antidepressant starts and inpatient stays, respectively. Substance abuse disorders were associated with greater monitoring after both types of depression events but did not seem to interact with other patient characteristics in determining levels of monitoring. CONCLUSION: VA patients who are older, white, and living in the south or northeast receive less-intensive monitoring during high-risk treatment periods for suicide. This is of concern, given that older patients appear to be at higher risk for suicide, particularly after inpatient stays, and may need particular attention during this time frame. Adapted interventions and proactive outreach may be needed that target this patient group.