Insurance and inpatient admission of emergency department patients with depression in the United States.

OBJECTIVE: To estimate the contribution of insurance on rates of inpatient admission for emergency department visits with depression diagnoses.
METHODS: We identified 3,681,581 visits for depression in the National Emergency Department Sample (2007-2018). We classified them by concurrent injury, suicidal ideation, or neither. Payer categories were defined, non-exclusively, as Medicare, Medicaid, private insurance, and no insurance. Logistic regression models, adjusted for age, year, and comorbidities, were used to describe differences in rates of inpatient admission by payer type, stratified by visit features.
RESULTS: Rates of inpatient admission for visits with neither injury nor suicidal ideation (31.9%; 95%CI, 30.8-33.0) were lower than for visits with injury (37.9%; 95%CI, 36.7-39.1) or with suicidal ideation (39.7%; 95%CI, 37.3-42.1). Rates of admission were significantly lower for those without insurance (26.6%; 95%CI, 25.5-27.8) than for those with insurance (37.1%; 95%CI, 36.1-38.1). In adjusted models, insurance was associated with increased likelihood (OR = 1.81, 95%CI, 1.69-1.94) of admission. Insurance continued to be a significant predictor of admission among ED visits for depression with concurrent injury (OR = 1.39; 95%CI, 1.29-1.51).
CONCLUSION: After controlling for demographic characteristics and medical comorbidities, patients with depression who have insurance are significantly more likely to be admitted to the hospital compared to those without insurance.