Clinical outcomes of psychotic depression in Sweden: a nationwide register study

Data on clinical outcomes in psychotic depression remain limited. We examined hospitalization, suicide, and treatment patterns in Swedish patients with psychotic depression.

This nationwide register-based study included patients with an index diagnosis of psychotic unipolar depression during 2012-2020. Post-index psychiatric hospitalizations and suicide deaths were examined descriptively and using logistic regression adjusted for sex, age, prior admissions, psychiatric comorbidity, index care setting (inpatient or outpatient), and pharmacological treatment. For patients treated with electroconvulsive therapy (ECT) during 2012-2020, the outcomes of response and remission according to the Clinical Global Impressions Scale were assessed by logistic regression.

Of 8048 patients, 54.8% were women, median age was 47 years (interquartile range 30-63), and 51.8% were diagnosed in specialized outpatient care. A total of 25.1% were hospitalized and 0.8% died by suicide within 36 weeks. Index diagnosis in inpatient care, prior admissions, comorbid alcohol or substance use disorder, antipsychotic treatment, and younger age (≤25 years) were associated with increased odds of post-index hospitalization. Younger age was associated with decreased odds of suicide. Among ECT-treated patients, 89.8% achieved response and 48.4% achieved remission. Younger age and prior admissions were associated with decreased odds of remission. Age 51-75 years, compared with ≤25 years, was associated with increased odds of response.

Psychotic depression carries a high risk of psychiatric hospitalization and suicide shortly after index diagnosis. Increased odds of hospitalization associated with antipsychotic treatment likely reflect confounding by indication. Among ECT-treated patients, response and remission rates were high.