Clinical and economic burden of major depressive disorder with acute suicidal ideation or behavior in a US Veterans Health Affairs database

Are patients with mental disorders more vulnerable to loneliness and social isolation during the COVID-19 pandemic? - Findings from the Japan COVID-19 and Society Internet Survey

BACKGROUND

Loneliness and social isolation are well-known factors that worsen the symptoms among patients with mental disorders. Few previous studies have explored loneliness and social isolation among populations with mental disorders during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, our study examined the mental health impact of the pandemic on these population groups in terms of loneliness and social isolation.

METHODS

We used data from the Japan COVID-19 and Society Internet Surveys, a large-scale online survey. Using multivariable logistic regression analysis, we calculated the odds ratios and 95 % confidence intervals (CIs) of moderate-to-severe loneliness and high social isolation for major chronic diseases, including mental disorders, after adjusting for potential confounders. Calculations were performed for each type of mental disorder. Finally, calculations were performed to explore the association between moderate-to-severe loneliness or high social isolation and psychiatric symptoms among patients with mental disorders.

RESULTS

Of the 28,175 participants, 2021 (7.2 %) had a mental disorder. Mental disorders, especially depression and anxiety disorders, were found to be associated with a higher risk of moderate-to-severe loneliness and high social isolation. Patients with mental disorders who experienced moderate-to-severe loneliness and high social isolation were found to have exacerbated psychiatric symptoms.

LIMITATION

Our findings were obtained from a cross-sectional study design.

CONCLUSIONS

Patients with mental disorders were more vulnerable to moderate-to-severe loneliness and high social isolation during the pandemic, which contributed to the exacerbation of their symptoms. Depression and anxiety, in particular, were most likely to occur and required special attention.

Unmet need in major depressive disorder and acute suicidal ideation or behavior: findings from a longitudinal electronic health record data analysis

AIMS

Using a national electronic health records (EHR) database, the current study describes treatments, depression severity, and health care resource utilization (HRU) among patients with major depressive disorder (MDD) and acute suicidal ideation or behavior (MDSI) prior to, during, and following a suicide-related event in the United States.

MATERIALS AND METHODS

This retrospective matched cohort study used data collected from the Optum EHR de-identified database for patients with diagnosis codes for MDD and acute suicidal ideation or behavior and a propensity score-matched cohort of patients without MDD or a suicide-related event. The study period was 31 October 2015-30 September 2019. MDD-related treatments and 9-item Patient Health Questionnaire (PHQ-9) scores, when available, were assessed at the first health care encounter for a suicide-related event (index period), 12 months before (pre-period), and 6 months after (post-period). All-cause and MDD-related HRU were assessed during the post-period.

RESULTS

The mean (standard deviation) age of patients with MDSI was 39 (16) years; 55.0% were female. Index events occurred as follows: inpatient stay, 38.9%; observation unit stay, 4.6%; emergency department (ED) visit, 46.5%; and outpatient visit, 10.1%. Antidepressants and psychotherapy were the most common pharmacologic and nonpharmacologic treatments, respectively, prescribed during the pre- (31.3%, 9.5%, respectively) and index (41.2%, 18.7%, respectively) periods. Post-period data (n = 40,261) revealed only 43.4% received an antidepressant and 20.5% had psychotherapy after the suicide-related event. Few patients had PHQ-9 scores recorded during the pre- (4.4%), index (1.3%), and post- (7.6%) periods. During the post-period, 11.8%, 5.0%, and 33.1% of patients had ≥1 all-cause inpatient stay, observation unit stay, and ED visit, respectively; 61.0% had ≥1 all-cause and 33.4% ≥1 MDD-related outpatient visit. Most patients with MDSI and an inpatient encounter or ED visit were discharged to home or self-care (65.4%). Odds of an all-cause hospital encounter during the post-period were higher for patients with versus without MDSI (by 30.1, 33.5, and 33.9 times for inpatient stay, ED visit, and observation unit stay, respectively).

CONCLUSION

This analysis highlights an opportunity to improve outcomes for this vulnerable population. More complete data on patient outcomes is needed to inform strategies designed to optimize screening and treatment.