title: Depression care following psychiatric hospitalization in the Veterans Health Administration.
abstract: OBJECTIVE
  To assess quality of depression care during the high-risk period following a psychiatric hospitalization.
  
  
  METHODS
  Retrospective administrative data analysis.
  
  
  METHODS
  Using Veterans Health Administration (VHA) administrative data, we assessed mental health follow-up within 7 and 30 days of psychiatric hospitalizations for major depression from 2004 to 2008. Adequate antidepressant medication coverage and number of psychotherapy visits were assessed within 90 days of discharge. Multivariable logistic regression was used to identify patient demographic and clinical characteristics associated with each quality indicator.
  
  
  RESULTS
  Of the 45,587 patients discharged from a psychiatric inpatient stay with a diagnosis of major depressive disorder, 39.4% and 75.8% received an outpatient visit within 7 and 30 days of discharge, respectively; 58.7% of patients received adequate antidepressant coverage (72 of 90 days) and 12.9% received adequate psychotherapy encounters (8 visits). Receipt of outpatient mental health visits and of adequate psychotherapy were less likely among patients who were male, aged >35 or <65 years, had >3 major general medical comorbidities, lived >30 miles from a VHA clinic, or whose hospital length of stay was <7 days. Patients with comorbid substance use disorders were less likely to receive adequate antidepressant treatment.
  
  
  CONCLUSIONS
  To optimize evidence-based depression care after a psychiatric hospitalization, health systems might increase receipt of psychotherapy by considering potential barriers related to age, medical condition, and distance. Patients with comorbid substance use disorders or their providers may need additional services to support antidepressant treatment.
authors: National Serious Mental Illness Treatment Resource and Evaluation Center and VA Center for Clinical Management Research, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA. ppfeiffe@umich.edu
authors: Paul N
authors: PN
authors: Pfeiffer
authors: Dara
authors: D
authors: Ganoczy
authors: Nicholas W
authors: NW
authors: Bowersox
authors: John F
authors: JF
authors: McCarthy
authors: Frederic C
authors: FC
authors: Blow
authors: Marcia
authors: M
authors: Valenstein
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000928:Antidepressive Agents