Impact of Social Drivers of Health on Hospitalizations in Patients With Major Depressive Disorder

OBJECTIVES: Major depressive disorder (MDD) is a debilitating, episodic, and recurrent illness and second leading cause of disability in the US. The economic burden is high, driven primarily by higher inpatient visits. MDD patients with social drivers of health (SDOH) have even higher risk of worse health outcomes but the relationship of SDOH with hospitalizations has not been assessed using real-world data.

METHODS: Retrospective observational study of patients 18 years and older newly diagnosed with MDD between 2016 and 2018. SDOH were linked at the “near-neighborhood” level. A multivariable model assessed the association of SDOH with hospitalizations (incidence rate ratios [95% CI]).

RESULTS: Of 1,958,532 patients with MDD, 49.6% covered by Commercial and 50.4% Medicaid insurance; mean ages were similar (43.9; 43.4) with more females (67.6%; 70.5%). Nearly one-third of Medicaid patients had at least 1 hospitalization (29.6%) with mean length of stay 6.8 days compared to 14.7% of Commercially insured patients with length of stay 5.9 days. Females were less likely (Commercial 0.87; Medicaid 0.80; P<0.05) and patients with more comorbidities more likely to be hospitalized (Commercial 1.33; Medicaid 1.27; P<0.05). All treatment classes relative to antidepressants only increased likelihood of hospitalization. Household income was inversely associated with hospitalizations for both populations while limited English proficiency (LEP) reduced likelihood inpatient admission by >70% among Medicaid patients (0.27, P<0.05). Living in areas with no shortage of mental health practitioners was associated with higher hospitalizations.

CONCLUSIONS: Female sex, higher comorbidities, and living in areas with no shortage of mental health practitioners were associated with more hospitalizations among patients with MDD. Income was inversely associated with hospitalizations, with lower rates at higher income levels. Findings suggest disparities in access to care related to income, language proficiency, and availability of mental health practitioners that should be addressed to assure equitable care for all patients with MDD.