Patients with major depressive episode, suicidality face significant care barriers
U.S. adults with a major depressive episode and suicidal ideation or behavior with intent had higher mental health care resource utilization and more barriers to care than those with only a major depressive episode.
“We were interested in looking at the real-world patterns of health care delivery among individuals with depression and suicidal ideation,” co-author Samuel T. Wilkinson, MD, assistant professor in the department of psychiatry at Yale School of Medicine in Connecticut, told Healio Psychiatry. “This is a population that has historically been excluded from most antidepressant clinical trials.
“We were able to confirm (which many practicing psychiatrists already knew) that these individuals represent the most severely ill end of the spectrum of individuals with depression,” Wilkinson added. “As such, they use a very large amount of health care compared with individuals with depression without suicidal ideation.”
Wilkinson and colleagues aimed to assess the incremental mental health care resource utilization and barriers to receipt of mental health services among adults with a major depressive episode and suicidal ideation or behavior with intent. They used data from participants of the 2017 National Survey on Drug Use and Health to pinpoint three cohorts. These included individuals with a major depressive episode defined via DSM-5 criteria with suicidal ideation or behavior with intent (MDSI) (n = 572), those with a major depressive episode (n = 2,513) and those without a major depressive episode (36,903). The researchers used logistic regression models to compare mental health care resource utilization and barriers to receipt of mental health services among cohorts.
Results showed significantly increased risk for receipt of mental health-related inpatient care, outpatient care, prescription medications and any treatment for the MDSI cohort compared with the major depressive episode cohort and the non-major depressive episode cohort. The MDSI cohort vs. the major depressive episode cohort significantly more often reported barriers to receipt of mental health services, with the largest differences between cohorts associated with fear of negative impact. A total of 30.6% of the MDSI cohort and 47% of the major depressive episode cohort received no past-year mental health treatment.
“Despite the fact that individuals with depression and suicidal ideation have a high rate of use of health care resources, there are clearly some gaps where they should be receiving more care,” Wilkinson said. “For instance, among individuals with depression and suicidal ideation, only 69.4% reported any mental health care in the prior year.
“I would hope that this figure could be closer to 100%, because it’s not normal to be having suicidal thoughts,” Wilkinson added.
According to Wilkinson, a study limitation and a potential area for future study included that the researchers did not look closely at the relationship between substance abuse, depression and suicidal ideation, and how substance abuse might have also affected this higher rate of health care utilization.