Rehospitalization rates in older depressed adults after antidepressant and electroconvulsive therapy treatment.
OBJECTIVE
To determine (1) if a "high risk" period for rehospitalization can be identified in a population of depressed older adults and (2) if age of onset and previous history of depression is associated with an increased risk of rehospitalization.


METHODS
Naturalistic, longitudinal treatment outcome study.


METHODS
Medical-psychiatry unit and outpatient clinic at a university hospital.


METHODS
Ninety-four older adults diagnosed with major depression based on SCID and DSM-III-R criteria who were hospitalized for treatment.


METHODS
All patients were initially hospitalized on a medical-psychiatry unit and treated with either antidepressants or electroconvulsive therapy.


METHODS
Patients were initially evaluated with the Structured Clinical Interview for DSM-III-R (SCID), the Hamilton Depression Rating Scale, and a battery of neuro-psychological and behavioral tests. Patients were followed over time with an average follow-up interval of 3.09 + 1.45 years, and the date of the first psychiatric rehospitalization (if any) was recorded.


RESULTS
Approximately 43.6 percent of the total sample required at least one psychiatric rehospitalization. The greatest risk of rehospitalization occurred in the first 18 months. No significant differences were noted between patient groups treated with ECT and those treated with antidepressants or between patients with a younger and those with an older age of onset of depressive disorder. A statistical trend was observed in which patients without previous episodes of depression had a lower overall rate of rehospitalization compared with patients with one or more previous episodes of depression.


CONCLUSIONS
There appears to be a relatively high risk of psychiatric rehospitalization in depressed older adults, particularly in the first 18 months. This rate of rehospitalization underscores the importance of providing maintenance therapy and intensive psychiatric supervision for a minimum of 18 months to 2 years during the course of a depressive episode requiring inpatient hospitalization.
Stoudemire
A
A
Medical Psychiatric Unit, Emory University Hospital, Atlanta, GA.
Hill
C D
CD
Dalton
S T
ST
Marquardt
M G
MG
D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D017050:Episode of Care; D005500:Follow-Up Studies; D005845:Georgia; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007406:Interview, Psychological; D008875:Middle Aged; D009483:Neuropsychological Tests; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents