BACKGROUND AND OBJECTIVE: Suicidal ideation or behavior are core symptoms of major depressive disorder (MDD). This study aimed to understand heterogeneity among patients with MDD and acute suicidal ideation or behavior. METHODS: Adults with a diagnosis of MDD on the same day or 6 months before a claim for suicidal ideation or behavior (index date) were identified in the MarketScan® Databases (10/01/2014-04/30/2019). A mathematical algorithm was used to cluster patients on characteristics of care measured pre-index. Patient care pathways were described by cluster during the 12-month pre-index period and up to 12 months post-index. RESULTS: Among 38,876 patients with MDD and acute suicidal ideation or behavior, three clusters were identified. Across clusters, pre-index exposure to mental healthcare was revealed as a key differentiator: Cluster 1 (N = 16,025) was least exposed, Cluster 2 (N = 5640) moderately exposed, and Cluster 3 (N = 17,211) most exposed. Patients whose MDD diagnosis was first observed during their index event comprised 86.0% and 72.8% of Clusters 1 and 2, respectively; in Cluster 3, all patients had an MDD diagnosis pre-index. Within 30 days post-index, in Clusters 1, 2, and 3, respectively, 79.3%, 85.2%, and 88.2% used mental health services, including outpatient visits for MDD. Within 12 months post-index, 61.5%, 91.5%, and 84.6% had one or more antidepressant claim, respectively. Per-patient index event costs averaged $5614, $6645, and $5853, respectively. CONCLUSIONS: Patients with MDD and acute suicidal ideation or behavior least exposed to the healthcare system pre-index similarly received the least care post-index. An opportunity exists to optimize treatment and follow-up with mental health services.
BACKGROUND AND OBJECTIVE: Suicidal ideation or behavior are core symptoms of major depressive disorder (MDD). This study aimed to understand heterogeneity among patients with MDD and acute suicidal ideation or behavior. METHODS: Adults with a diagnosis of MDD on the same day or 6 months before a claim for suicidal ideation or behavior (index date) were identified in the MarketScan® Databases (10/01/2014-04/30/2019). A mathematical algorithm was used to cluster patients on characteristics of care measured pre-index. Patient care pathways were described by cluster during the 12-month pre-index period and up to 12 months post-index. RESULTS: Among 38,876 patients with MDD and acute suicidal ideation or behavior, three clusters were identified. Across clusters, pre-index exposure to mental healthcare was revealed as a key differentiator: Cluster 1 (N = 16,025) was least exposed, Cluster 2 (N = 5640) moderately exposed, and Cluster 3 (N = 17,211) most exposed. Patients whose MDD diagnosis was first observed during their index event comprised 86.0% and 72.8% of Clusters 1 and 2, respectively; in Cluster 3, all patients had an MDD diagnosis pre-index. Within 30 days post-index, in Clusters 1, 2, and 3, respectively, 79.3%, 85.2%, and 88.2% used mental health services, including outpatient visits for MDD. Within 12 months post-index, 61.5%, 91.5%, and 84.6% had one or more antidepressant claim, respectively. Per-patient index event costs averaged $5614, $6645, and $5853, respectively. CONCLUSIONS:Patients with MDD and acute suicidal ideation or behavior least exposed to the healthcare system pre-index similarly received the least care post-index. An opportunity exists to optimize treatment and follow-up with mental health services.
Authors: R Mojtabai; M Olfson; N A Sampson; R Jin; B Druss; P S Wang; K B Wells; H A Pincus; R C Kessler Journal: Psychol Med Date: 2010-12-07 Impact factor: 7.723
Authors: Philip B Mitchell; Andrew Frankland; Dusan Hadzi-Pavlovic; Gloria Roberts; Justine Corry; Adam Wright; Colleen K Loo; Michael Breakspear Journal: Br J Psychiatry Date: 2011-04-20 Impact factor: 9.319
Authors: Florian Walter; Matthew J Carr; Pearl L H Mok; Sussie Antonsen; Carsten B Pedersen; Louis Appleby; Seena Fazel; Jenny Shaw; Roger T Webb Journal: Lancet Psychiatry Date: 2019-06-03 Impact factor: 77.056
Authors: Adam M Chekroud; David Foster; Amanda B Zheutlin; Danielle M Gerhard; Brita Roy; Nikolaos Koutsouleris; Abhishek Chandra; Michelle Degli Esposti; Girish Subramanyan; Ralitza Gueorguieva; Martin Paulus; John H Krystal Journal: Psychiatr Serv Date: 2018-07-02 Impact factor: 3.084
Authors: Daniel Chung; Dusan Hadzi-Pavlovic; Maggie Wang; Sascha Swaraj; Mark Olfson; Matthew Large Journal: BMJ Open Date: 2019-03-23 Impact factor: 2.692