Unmet need in major depressive disorder and acute suicidal ideation or behavior: findings from a longitudinal electronic health record data analysis

Aims Using a national electronic health records (EHR) database, the current study describes treatments, depression severity, and health care resource utilization (HRU) among patients with major depressive disorder (MDD) and acute suicidal ideation or behavior (MDSI) prior to, during, and following a suicide-related event in the United States. Materials and methods This retrospective matched cohort study used data collected from the Optum EHR de-identified database for patients with diagnosis codes for MDD and acute suicidal ideation or behavior and a propensity score-matched cohort of patients without MDD or a suicide-related event. The study period was 31 October 2015-30 September 2019. MDD-related treatments and 9-item Patient Health Questionnaire (PHQ-9) scores, when available, were assessed at the first health care encounter for a suicide-related event (index period), 12 months before (pre-period), and 6 months after (post-period). All-cause and MDD-related HRU were assessed during the post-period. Results The mean (standard deviation) age of patients with MDSI was 39 (16) years; 55.0% were female. Index events occurred as follows: inpatient stay, 38.9%; observation unit stay, 4.6%; emergency department (ED) visit, 46.5%; and outpatient visit, 10.1%. Antidepressants and psychotherapy were the most common pharmacologic and nonpharmacologic treatments, respectively, prescribed during the pre- (31.3%, 9.5%, respectively) and index (41.2%, 18.7%, respectively) periods. Post-period data (n = 40,261) revealed only 43.4% received an antidepressant and 20.5% had psychotherapy after the suicide-related event. Few patients had PHQ-9 scores recorded during the pre- (4.4%), index (1.3%), and post- (7.6%) periods. During the post-period, 11.8%, 5.0%, and 33.1% of patients had >= 1 all-cause inpatient stay, observation unit stay, and ED visit, respectively; 61.0% had >= 1 all-cause and 33.4% >= 1 MDD-related outpatient visit. Most patients with MDSI and an inpatient encounter or ED visit were discharged to home or self-care (65.4%). Odds of an all-cause hospital encounter during the post-period were higher for patients with versus without MDSI (by 30.1, 33.5, and 33.9 times for inpatient stay, ED visit, and observation unit stay, respectively). Conclusion This analysis highlights an opportunity to improve outcomes for this vulnerable population. More complete data on patient outcomes is needed to inform strategies designed to optimize screening and treatment.

Automated summary

Using a national electronic health records database, this study examines the treatments, depression severity, and health care resource utilization among patients with major depressive disorder and acute suicidal ideation or behavior in the United States. The findings suggest a need for improved outcomes and strategies to optimize screening and treatment for this vulnerable population.