title: Gender differences in hospitalization after emergency room visits for depressive symptoms.
abstract: BACKGROUND
  Depressed women have greater than three times the odds of hospitalization as clinically comparable men. The objective of this study is to understand if these gender differences emerge in admissions decisions after depressed individuals' arrival at the emergency room (ER).
  
  
  METHODS
  We used multivariate logistic regression to examine gender differences in hospitalization after 6266 ER visits for depressive symptoms in the nationally representative 1998-2007 National Hospital Ambulatory Care Medical Survey.
  
  
  RESULTS
  ER visits by depressed women have only 0.82 the odds of hospitalization (95% confidence interval [CI] 0.70-0.96, p=0.02) in models adjusted for sociodemographic, clinical, and system covariates. Sensitivity analyses demonstrate gender differences in visits by patients with no injury but not in visits by patients with self-inflicted injury.
  
  
  CONCLUSIONS
  These findings suggest that admission decisions after ER visits are not responsible for the increased risk of hospitalization previously reported in depressed women, as ER visits by women with depressive symptoms actually have lower odds of hospitalization than visits by men. We encourage further research to explore the causes and consequences of this practice pattern to move toward rational delivery systems committed to providing comparable treatment to clinically comparable individuals regardless of gender.
authors.affiliation: Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA. rostk@comcast.net
authors.forename: Kathryn
authors.initials: K
authors.lastname: Rost
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Hsieh
authors.forename: Stan
authors.initials: S
authors.lastname: Xu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Harman
mesh_terms: D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S.; D003657:Decision Making; D003866:Depressive Disorder / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012306:Risk; D017678:Sex Distribution; D014481:United States