Data presented at the American Psychiatric Association 2019 Meeting suggest a low rate of psychiatric care received by adult patients with MDD before suicide ideation or attempt diagnosis
Originally Published by Johnson & Johnson.
Additional Data Show Patients Have a High Risk of Hospital Readmission or Subsequent Emergency Department Visit after Suicide Ideation or Attempt
The Janssen Pharmaceutical Companies of Johnson & Johnson presented new real-world data at the American Psychiatric Association (APA) 2019 Meeting which suggest that, among adult patients with major depressive disorder (MDD), psychiatric treatment in the year prior to a diagnosis of suicide ideation or attempt is markedly low. Additionally, 18.4 percent of adult patients diagnosed with MDD and suicide ideation or attempt during a hospitalization or emergency department (ED) visit had a readmission or subsequent ED visit to the same institution during the six months after discharge. Among those initially hospitalized, nearly half of readmissions or subsequent ED visits occurred within the first 30 days. Taken together, these findings suggest that better interventions are needed to improve outcomes for these individuals who are at high risk for readmission and additional ED visits.
“Sadly, approximately 47,000 people in the U.S. died by suicide in 2017, with rates rising sharply over the last 20 years, according to the National Institute of Mental Health,”1 said Ella Daly, M.D., Therapeutic Area Leader, Mood Disorders at Janssen Scientific Affairs, LLC. “We also know that the psychiatric diagnosis most commonly associated with suicide is depression.2These findings heighten the critical unmet need to improve care for these patients to improve outcomes.”
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The first study characterizing psychiatric treatment received by adult patients utilized The Optum® electronic health records database, which contains information from Integrated Delivery Networks (IDNs) and large multi-specialty practices. Recorded diagnosis codes were examined and 63,855 adult patients with MDD and suicide ideation or attempt were identified. Psychiatric and medical comorbidities were common, and most adult patients had insurance coverage. Psychiatric treatment was observed to have increased in the weeks immediately preceding the diagnosis of suicide ideation or attempt, suggesting a potential window of opportunity for intervention. Nevertheless, less than half were observed to have received an antidepressant in the year prior to their diagnosis of suicide ideation or attempt.
Two additional studies analyzed adult patients identified in the Premier Hospital Database who were diagnosed with MDD and suicide ideation or attempt during an inpatient hospital stay or ED visit. These patients were evaluated during the six-month period following the first qualifying inpatient hospital stay or ED visit.
In the first study from the Premier Hospital Database, of the 251,259 adult patients identified, 63.8 percent were admitted to the hospital while 36.2 percent had an ED visit only at the facility where suicide ideation and/or attempt was diagnosed. Approximately 18 percent of patients were either readmitted or returned to the ED at the same hospital within six months. After controlling for differences in patient socio-demographics and hospital characteristics, those who were initially admitted had a 22 percent higher risk of a rehospitalization or subsequent ED visit compared to those who only received care in the ED.
A separate study evaluating the 160,343 adult patients from the Premier Hospital Database who were hospitalized showed that 19.2 percent had a readmission or subsequent ED visit within six months, and nearly half of these events occurred within 30 days. Patients whose stays were longer were at elevated risk of a readmission or subsequent ED visit to that same institution within six months. For example, patients who were hospitalized for six or more days were estimated to have an approximately 40 percent higher risk compared to those whose initial hospital stay was only one to three days after controlling for variation in patient socio-demographics and hospital characteristics.
“These data yield valuable insights to help us better identify patients at the highest risk,” said Cheryl Neslusan, Ph.D., Director of Market Access, Scientific and External Strategy, Janssen Scientific Affairs, LLC. “Having major depressive disorder and active suicidal thoughts or behavior further contributes burden and risk to what is already a devastating illness. At Janssen we understand the urgent need and are committed to identifying potential ways to improve the care for the millions who are continuing to fight this battle.”