Category: Health Care System / Public Policy

Symposium

"U-Turns" in Psychiatric Admissions for Major Depressive Disorder: Identifying Risk Factors for Early Rehospitalization

Saturday, November 18
8:30 AM - 10:00 AM
Location: Indigo Ballroom B, Level 2, Indigo Level

Keywords: Depression | Health Care System | Treatment Integrity / Adherence / Compliance
Presentation Type: Symposium

Background. The transition from psychiatric hospitalization to home is marked by high clinical vulnerability, characterized by risk of symptom rebound, exposure to preexisting stressors, and challenges with outpatient treatment linkage. Unsurprisingly, rates of rehospitalization during this post-discharge period, particularly for those with severe mood disorders, are reportedly high. This study evaluated demographic and clinical predictors of early (i.e., 30 day) rehospitalization in a sample of psychiatrically hospitalized adults with major depressive disorder (MDD).


Methods. Retrospective chart review was conducted for all patients with MDD (N=1315) admitted to an academically-affiliated psychiatric hospital within one calendar year. Using a computer algorithm, a hospital administrator extracted relevant demographic, clinical, and treatment information from the electronic medical record for analysis. 


Results. Overall, 121 (9%) were rehospitalized within 30 days of index hospital discharge.  Average time to rehospitalization in this group was only 10.7 (SD=9.4; range=0-30) days. Univariate logistic regression analyses elucidated four putative predictors of 30-day rehospitalization for evaluation in a subsequent multivariate model: older age (χ2(1)=3.98, OR=1.01, p=0.05), lower global assessment of functioning (χ2(1)=67.38, OR=0.90, pχ2(1)=14.95, OR=2.10, p2(1)=5.16, OR=1.67, p=0.023). When evaluated in a multivariate logistic regression model, only GAF (χ2(1)=58.50, OR=0.90, pχ2(1)=7.29, OR= 1.172, p=0.007) emerged as significant predictors of 30-day rehospitalization. 


Discussion.  Data highlight the relative importance of patient functioning as a predictor of early rehospitalization in adults with MDD. Independent of clinical severity, data further suggest that more complex polypharmacy regimens may also predict early rehospitalization. Discussion will focus on ways to best meet the needs of patients with MDD during the vulnerable transition from hospitalization to outpatient treatment.

Lauren M. Weinstock

Associate Professor (Research)
Brown University & Butler Hospital

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