Meeting News

Studies highlight unmet needs in patients with MDD, suicide attempt/ideation

Ella Daly

SAN FRANCISCO — Data from three studies presented here showed that among patients with major depressive disorder and suicidal ideation or suicide attempt who were diagnosed during hospitalization or visit to the ED, 18.4% experienced readmission or a future ED visit within 6 months after discharge.

What’s more, researchers reported that treatment within the year prior to suicidal ideation was distinctly low among these patients.

“Major depressive disorder (MDD) is the leading worldwide cause of disability and approximately 17 million Americans have MDD based on estimates from 2017. Unfortunately, MDD is also the most common psychiatric diagnosis associated with suicide,” Ella Daly, MD, therapeutic area leader, Mood Disorders, at Janssen Scientific Affairs, LLC, told Healio Psychiatry. “We know that between 1999 and 2016 there’s been a sharp increase in suicide rates, so we feel it’s important to us, not only at Janssen, but also clinically and policy-wide, to have a better understanding of this patient population who are suffering.”

Prescriptions prior to diagnosis

In a retrospective cohort study, Daly, along with Cheryl Neslusan, PhD, director of market access, scientific and external strategy, Janssen Scientific Affairs, LLC, and colleagues examined data from an electronic health record database to identify patients aged 18 years or older who were diagnosed between January 1, 2014 and December 31, 2016 with major depressive disorder and suicidal ideation or suicide attempt (n = 63,855). All patients included in the study had been observed in the 12 months prior (baseline) and at least 3 months post suicidal ideation or suicide attempt. Mean age of participants was 39 years, and 59% were female.

“We were particularly interested in those patients who have MDD. And while there’s been a lot of literature on that population, there hasn’t been as much research on the overlap between MDD and suicide ideation or attempt because although the rates have been increasing, it’s still more of a rare occurrence, even though patients with MDD are among those at highest risk,” Naslusen told Healio Psychiatry. “That’s where these large observational databases can help because they have big samples, so we could hone in on the patient population who had MDD vs. other psychiatric conditions.”

Researchers looked at antidepressant, anxiolytic, anticonvulsant, antipsychotic, a group of miscellaneous psychotherapeutic and neurological agents and lithium prescriptions during baseline, and examined differences in usage of each according to age range, gender and insurance status.

According to the results, the percentage of patients prescribed at least one medication during the baseline period was: 42% for antidepressants; anxiolytics, 32%; anticonvulsants, 22%; antipsychotics, 14%; miscellaneous psychotherapeutic and neurological agents, 9%; and lithium, 0.4%. Nearly half of patients had no recorded prescription for any of these medications (47%).

Cheryl Neslusan

Fewer young patients (18 to 25 years) — compared with those aged 65 years and older — were prescribed antidepressants (33% vs. 54%; P <0.0001), anxiolytics (18% vs. 42%; P <0.0001), anticonvulsants (10% vs. 30%; P <0.0001), antipsychotics (9% vs. 16%; P <0.0001) and psychostimulants (4% vs. 8%; P <0.0001).

Prescriptions for antidepressants, anxiolytics and anticonvulsants were more common among women than men (P < .0001 for all), while prescriptions for miscellaneous psychotherapeutic and neurological agents were less common (P < .0001). Lastly, uninsured patients were less likely than insured patients to be prescribed antidepressants, anxiolytics, anticonvulsants and antipsychotics (P < .0001).

Length of stay

In a second study to determine whether length of hospitalization affects the risk for subsequent hospitalizations or ED visits, researchers identified 160,343 patients aged 18 years or older who were diagnosed during an inpatient admission with major depressive disorder and suicidal ideation or suicide attempt between January 1, 2014 and June 30, 2017 using the Premier Hospital database.

Researchers examined and compared all-cause, major depressive disorder-related and suicidal ideation/suicide attempt-related ED visit or readmission over 6 months of follow-up after first hospital discharge. They aimed to determine whether inpatient length of stay (short: 1 to 3 days; medium: 4 to 5 days; and long: 6 days or longer) was related to the risk for readmission or subsequent ED visit. Lengths of stay were as follows: short = 41.2%, medium = 26.7% and long = 32.1%.

During follow-up, 15.9% of patients in the short stay, 18.2% in the medium stay and 24.2% in the long stay groups experienced a readmission or subsequent ED visit. MDD-related readmissions/ED visits occurred among 13.7% in the short stay, 15.5% in the medium stay and 20.9% in the long stay groups. Suicidal ideation/suicide attempt-related events occurred in 7.4% of short stay, 9.1% of medium stay and 13.2% of long stay groups.

Compared with short lengths of stay, long lengths of stay were associated with higher risk for all-cause (HR = 1.40; 95% CI, 1.36-1.44), MDD-related (HR = 1.41; 95% CI, 1.37-1.45) and suicidal ideation/suicide attempt-related events (HR = 1.72; 95% CI, 1.65-1.78), according to Neslusan and Daly. The risk was also increased among patients with medium lengths of stay compared with short (P < .001 for all-cause, MDD-related and suicidal ideation/suicide attempt-related events).

Hospital admissions vs. ED visits

In the third and final study, researchers used the same data set (Premier Hospital database) to examine whether care received in the inpatient setting or ED visit only influenced the risk for readmission or later ED visit.

Of the 251,259 patients included in the study, inpatient admissions occurred among 63.8% and ED visits among 36.2%. Of those in the inpatient setting, during 6 months of follow-up, the percentage of patients who experienced readmission or subsequent ED visit were as follows: 19.2% for any cause; 16.5% MDD-related and 9.7% suicidal ideation/suicide attempt-related. Of those with an ED visit only: 16.9% were for any cause; 15.3% were for MDD-related and 7.9% were for suicidal ideation/suicide attempt-related.

Additionally, hospital admissions were associated with a higher risk for readmission/ED event due to all causes (HR = 1.09; 95% CI, 1.07-1.11), MDD-related (HR = 1.03; 95% CI, 1.01-1.05) and suicidal ideation/suicide attempt-related (HR = 1.22; 95% CI, 1.19-1.26).

“Our goal is to bring to the attention of policymakers and health care systems that these patients with MDD are suffering and, unfortunately, for many of them in that year prior to the time they present with ideation or attempt there are relatively low rates of actual treatment,” Daly said. “This highlights the importance of taking a better look at care for this population to see what’s working and what’s not working. ... We see this as a call to arms to increase awareness in an effort to help this vulnerable population.” – by Stacey L. Adams

References:

Neslusan C, et al. Abstract #59.

Neslusan C, et al. Abstract #60.

Neslusan C, et al. Abstract #61. Presented at: APA Annual Meeting; May 18-23, 2019; San Francisco.

Disclosures: Daly and Neslusan are employees of Janssen.

Ella Daly

SAN FRANCISCO — Data from three studies presented here showed that among patients with major depressive disorder and suicidal ideation or suicide attempt who were diagnosed during hospitalization or visit to the ED, 18.4% experienced readmission or a future ED visit within 6 months after discharge.

What’s more, researchers reported that treatment within the year prior to suicidal ideation was distinctly low among these patients.

“Major depressive disorder (MDD) is the leading worldwide cause of disability and approximately 17 million Americans have MDD based on estimates from 2017. Unfortunately, MDD is also the most common psychiatric diagnosis associated with suicide,” Ella Daly, MD, therapeutic area leader, Mood Disorders, at Janssen Scientific Affairs, LLC, told Healio Psychiatry. “We know that between 1999 and 2016 there’s been a sharp increase in suicide rates, so we feel it’s important to us, not only at Janssen, but also clinically and policy-wide, to have a better understanding of this patient population who are suffering.”

Prescriptions prior to diagnosis

In a retrospective cohort study, Daly, along with Cheryl Neslusan, PhD, director of market access, scientific and external strategy, Janssen Scientific Affairs, LLC, and colleagues examined data from an electronic health record database to identify patients aged 18 years or older who were diagnosed between January 1, 2014 and December 31, 2016 with major depressive disorder and suicidal ideation or suicide attempt (n = 63,855). All patients included in the study had been observed in the 12 months prior (baseline) and at least 3 months post suicidal ideation or suicide attempt. Mean age of participants was 39 years, and 59% were female.

“We were particularly interested in those patients who have MDD. And while there’s been a lot of literature on that population, there hasn’t been as much research on the overlap between MDD and suicide ideation or attempt because although the rates have been increasing, it’s still more of a rare occurrence, even though patients with MDD are among those at highest risk,” Naslusen told Healio Psychiatry. “That’s where these large observational databases can help because they have big samples, so we could hone in on the patient population who had MDD vs. other psychiatric conditions.”

Researchers looked at antidepressant, anxiolytic, anticonvulsant, antipsychotic, a group of miscellaneous psychotherapeutic and neurological agents and lithium prescriptions during baseline, and examined differences in usage of each according to age range, gender and insurance status.

According to the results, the percentage of patients prescribed at least one medication during the baseline period was: 42% for antidepressants; anxiolytics, 32%; anticonvulsants, 22%; antipsychotics, 14%; miscellaneous psychotherapeutic and neurological agents, 9%; and lithium, 0.4%. Nearly half of patients had no recorded prescription for any of these medications (47%).

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Cheryl Neslusan

Fewer young patients (18 to 25 years) — compared with those aged 65 years and older — were prescribed antidepressants (33% vs. 54%; P <0.0001), anxiolytics (18% vs. 42%; P <0.0001), anticonvulsants (10% vs. 30%; P <0.0001), antipsychotics (9% vs. 16%; P <0.0001) and psychostimulants (4% vs. 8%; P <0.0001).

Prescriptions for antidepressants, anxiolytics and anticonvulsants were more common among women than men (P < .0001 for all), while prescriptions for miscellaneous psychotherapeutic and neurological agents were less common (P < .0001). Lastly, uninsured patients were less likely than insured patients to be prescribed antidepressants, anxiolytics, anticonvulsants and antipsychotics (P < .0001).

Length of stay

In a second study to determine whether length of hospitalization affects the risk for subsequent hospitalizations or ED visits, researchers identified 160,343 patients aged 18 years or older who were diagnosed during an inpatient admission with major depressive disorder and suicidal ideation or suicide attempt between January 1, 2014 and June 30, 2017 using the Premier Hospital database.

Researchers examined and compared all-cause, major depressive disorder-related and suicidal ideation/suicide attempt-related ED visit or readmission over 6 months of follow-up after first hospital discharge. They aimed to determine whether inpatient length of stay (short: 1 to 3 days; medium: 4 to 5 days; and long: 6 days or longer) was related to the risk for readmission or subsequent ED visit. Lengths of stay were as follows: short = 41.2%, medium = 26.7% and long = 32.1%.

During follow-up, 15.9% of patients in the short stay, 18.2% in the medium stay and 24.2% in the long stay groups experienced a readmission or subsequent ED visit. MDD-related readmissions/ED visits occurred among 13.7% in the short stay, 15.5% in the medium stay and 20.9% in the long stay groups. Suicidal ideation/suicide attempt-related events occurred in 7.4% of short stay, 9.1% of medium stay and 13.2% of long stay groups.

Compared with short lengths of stay, long lengths of stay were associated with higher risk for all-cause (HR = 1.40; 95% CI, 1.36-1.44), MDD-related (HR = 1.41; 95% CI, 1.37-1.45) and suicidal ideation/suicide attempt-related events (HR = 1.72; 95% CI, 1.65-1.78), according to Neslusan and Daly. The risk was also increased among patients with medium lengths of stay compared with short (P < .001 for all-cause, MDD-related and suicidal ideation/suicide attempt-related events).

Hospital admissions vs. ED visits

In the third and final study, researchers used the same data set (Premier Hospital database) to examine whether care received in the inpatient setting or ED visit only influenced the risk for readmission or later ED visit.

Of the 251,259 patients included in the study, inpatient admissions occurred among 63.8% and ED visits among 36.2%. Of those in the inpatient setting, during 6 months of follow-up, the percentage of patients who experienced readmission or subsequent ED visit were as follows: 19.2% for any cause; 16.5% MDD-related and 9.7% suicidal ideation/suicide attempt-related. Of those with an ED visit only: 16.9% were for any cause; 15.3% were for MDD-related and 7.9% were for suicidal ideation/suicide attempt-related.

Additionally, hospital admissions were associated with a higher risk for readmission/ED event due to all causes (HR = 1.09; 95% CI, 1.07-1.11), MDD-related (HR = 1.03; 95% CI, 1.01-1.05) and suicidal ideation/suicide attempt-related (HR = 1.22; 95% CI, 1.19-1.26).

“Our goal is to bring to the attention of policymakers and health care systems that these patients with MDD are suffering and, unfortunately, for many of them in that year prior to the time they present with ideation or attempt there are relatively low rates of actual treatment,” Daly said. “This highlights the importance of taking a better look at care for this population to see what’s working and what’s not working. ... We see this as a call to arms to increase awareness in an effort to help this vulnerable population.” – by Stacey L. Adams

References:

Neslusan C, et al. Abstract #59.

Neslusan C, et al. Abstract #60.

Neslusan C, et al. Abstract #61. Presented at: APA Annual Meeting; May 18-23, 2019; San Francisco.

Disclosures: Daly and Neslusan are employees of Janssen.

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