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Depression-Related Hospital Stays on the Rise
> 11/15/2007 12:09:01 PM

Depression not only compromises the social, personal and professional lives of 30 million Americans every year, fostering financial insecurity, substance abuse and failing relationships; it also plays a prime role in landing a surprising number of people in the hospital. And as our collective awareness of depression grows, so does the depth of its influence: according to a report issued by the Agency for Healthcare Research and Quality, more patients than ever are being diagnosed with depression as either a primary or complicating factor in their hospital admissions. And the problem plays a crucial role in one of the most contentious issues in an America bracing for the upcoming election cycle: In 2005 alone, the healthcare bill for depression topped $20 billion - 1/8 of overall hospital costs in the United States.

At 10%, the share of hospital admissions related to depression closely parallels the disorder's presence in the general population. While the number of patients admitted primarily for depression remained relatively stable between 1995 and 2005 and has actually declined since 2003, the prevalence of the disorder among inpatient populations increased significantly during the same period; stays in which depression was noted as a secondary diagnosis nearly doubled. Depression was not the primary reason for treatment in a majority of those cases (85%), but a large share of the health problems responsible for hospital stays are also common comorbidities with depression; 1 in 10 affected patients entered the hospital for cardiovascular problems to which depression has been repeatedly linked. Depression also weakens the immune system, leaving patients more susceptible to the sorts of unrelated conditions that could land them in the hospital.

Among those admitted with depression as a secondary diagnosis, alcohol and drug problems are 3.5 times as likely to serve as the primary reason for admission. Poisoning or overdosing on psychotropic medication was also 9 times as common among depressed patients; these conditions most often stem from unsuccessful suicide attempts. Affected patients were also twice as likely to lack health insurance than those admitted for conditions where depression was either non-applicable or served as a secondary diagnosis. And while the per-day price of hospital stays primarily related to depression was lower than that of conditions requiring more advanced surgeries and other procedures, the average length of their stays was considerably longer: 6.6 days as opposed to 5 for cases in which depression was either not a factor or provided a secondary diagnosis.

Hospitalization is also considerably more common among young adults and women. It is, in fact, the second leading cause of hospitalization for young women; the discrepancy cannot be completely explained by the greater prevalence of depression in the female population as a whole. Because so many more patients now enter the system suffering from depression, a shortage of space and the elevated costs of specialty clinics have turned community hospitals into the primary sources of treatment. Due to the fact that so many of these locations lack a satisfactory staff of mental health specialists, patients do not always receive the sort of treatment that their conditions require.

The vast majority of depression cases do not, thankfully, require hospitalization. But when they do, they must be treated with as much care as any other serious health risk, and physicians need to realize that ignoring or downplaying the condition in patients referred for more pressing health issues will encourage unsatisfactory personal care and heighten the possibility that the same patient will return for additional treatment at a later date. Depression slows the recovery process, compromising a patient's emotional and behavioral stability when he or she most needs to remain strong. And if a patient's mental illness grows severe enough to call for a hospital stay, that patient needs to know that he or she will receive the best care available.

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