Hospitalizations for Depression on the Rise

ATLANTA -- Hospitalizations for depression have been on the rise, and may be more common in minority populations, researchers reported here.

In an analysis of National Inpatient Sample (NIS) data, admissions for the mood disorder jumped from about 50,000 per year in 2008 to about 60,000 annually in 2012, Ankur Patel, MD, of Penn State Hershey Medical Center, reported at the American Psychiatric Association annual meeting here.

Rates were highest among minority groups in the U.S., which "indirectly shows that they're coming to the hospital at a later stage with more serious depression," Patel told MedPage Today.

Many factors may contribute to racial and ethnic groups not seeking care for mental health conditions, including cost and stigma, Patel said.

Thus, such individuals may be more likely to be hospitalized when more severe symptoms of their depression manifest, such as violent behavior, suicide attempts, paranoia, and psychosis.

To examine trends in hospitalizations for depression, Patel and colleagues looked at data from the NIS database for all years from 2008 to 2012 on all hospitalizations with a primary diagnosis of major depressive disorder. During this 5-year period, there were 465,434 hospitalizations for major depression.

The highest number of depression-related hospitalizations were seen among whites, at 60,000 in 2012, followed by about 10,000 in blacks and the same number in Hispanics.

Lower income -- measured by being from a zip code in which the median household income is under $40,000 -- was associated with a greater number of hospitalizations.

The cost of a hospital stay was greatest among black patients, at more than $25,000 in 2012, followed by Hispanics at about $20,000 for the stay. That compared with an average of about $15,000 for whites and about $10,000 for Native Americans.

Patel said the rates of hospitalizations among minority groups might be reduced if primary care physicians start asking them about mental health. "People might feel more comfortable with their primary care doctor than with a new doctor" -- as would be the case with picking out a psychiatrist -- "and revealing themselves and their life story."

They may also be more comfortable "sharing their thoughts with their doctor, rather than with a family member who is asking them about suicide," he added.

Primary care physicians can deploy standard mental health questionnaires, including the Patient Health Questionnaire (PHQ)-9 or PHQ-1, he said. Or, they can just ask simple questions about mood, interest in activities, and changes in sleep and appetite.

"Doctors can then start a trial of SSRIs [selective serotonin reuptake inhibitors] or refer patients to a psychiatrist," he said. "It would be more on the primary prevention side than having them be admitted to the hospital at a very complicated stage of their illness."