Study Examines Quality of VA Mental Health Care Following Psychiatric Hospitalization for Veterans with Depression
During the period immediately following discharge from a psychiatric hospitalization, patients are at high risk for functional impairment, re-hospitalization, and suicide. Suicide risk is nearly five times higher during the 12 weeks after a psychiatric hospitalization. This retrospective study sought to assess the quality of depression care (e.g., antidepressant treatment, psychotherapy) during the high-risk period following a psychiatric hospitalization. Using VA data, investigators examined VA mental health follow-up within 7 to 30 days for 45,587 Veterans with major depression who had a VA inpatient psychiatric hospitalization between 2004 and 2008. Adequacy of antidepressant treatment was determined by whether Veterans received at least a 72-day supply of an antidepressant medication during the initial 90 days following hospital discharge, and refilled the medication at least once. Adequate psychotherapy was defined as the receipt of eight individual or group psychotherapy visits during the initial 90 days following hospital discharge. Investigators also examined demographics, length of hospital stay, and comorbid mental health conditions. Comorbidities were common: 47% had comorbid substance use disorder, 34% had comorbid PTSD, and 12% had comorbid anxiety disorder.
Findings show that less than half of Veterans hospitalized for major depression had outpatient mental health follow-up within 7 days of discharge (39%), which is similar to rates found in the general U.S. population among Medicare (38%) and Medicaid (43%) beneficiaries in 2008. Mental health follow-up within 30 days for Veterans in this study was substantially more common (76%). Many Veterans also received adequate psychopharmacologic treatment following a hospitalization for depression (59%), but relatively few received adequate psychotherapy post-discharge (13%). Veterans were less likely to receive outpatient mental health visits and/or adequate psychotherapy if they were male, younger than 35 or 65 years and older, had three or more serious medical comorbidities, resided at least 30 miles from a VHA clinic, or had a hospital stay of less than seven days. Veterans were less likely to receive adequate antidepressant treatment if they were male, African American, Hispanic, had a comorbid substance use disorder or personality disorder, or had three or more comorbidities.
Pfeiffer P, Ganoczy D, Bowersox N, et al. Depression care following psychiatric hospitalization in the Veterans Health Administration. American Journal of Managed Care Sep 1, 2011;17(9):e358-64.
Dr. Pfeiffer was supported by an HSR&D Career Development Award. Drs. Pfeiffer, Ganoczy, and Bowersox are part of HSR&D’s Center for Clinical Management Research in Ann Arbor, MI.