Health care utilisation in treatment-resistant depression: a Swedish population-based cohort study

Area of Science:

• Psychiatry and Mental Health
• Health Services Research
• Epidemiology

Background:

• Depression is a leading cause of disability worldwide.
• Treatment-resistant depression (TRD) affects a significant proportion of individuals with depression, posing challenges for effective management.
• Understanding the healthcare utilization (HCU) patterns in TRD is crucial for resource allocation and patient support.

Purpose of the Study:

• To compare the health care utilisation (HCU) of patients diagnosed with treatment-resistant depression (TRD) against those with depression not meeting TRD criteria.
• To quantify differences in inpatient and outpatient care frequency between TRD and non-TRD depression cohorts.

Main Methods:

• A nationwide Swedish register-based prospective cohort study was conducted.
• 16,329 patients aged 18-69 with incident depression and antidepressant treatment were identified and defined as TRD upon the third distinct consecutive treatment episode.
• Each TRD patient was matched with five comparators; HCU (inpatient days, outpatient visits) was assessed, with a focus on depression or suicide attempt as the main diagnosis.

Main Results:

• Patients with TRD exhibited substantially higher all-cause inpatient care risk (first year aRR 3.03) compared to controls.
• The disparity was more pronounced for depression as a main diagnosis (first year aRR 4.41) and after suicide attempts (first year aRR 4.43).
• TRD patients also had more frequent outpatient visits (first year aRR 2.05), with elevated HCU persisting throughout the follow-up period.

Conclusions:

• Patients with treatment-resistant depression demonstrate a two- to fourfold increase in healthcare utilisation across various measures.
• This elevated HCU for TRD patients is sustained over an extended period, suggesting increased healthcare costs and patient burden.
• The findings highlight the significant impact of TRD on healthcare systems and the need for targeted interventions and support.