Possible precipitants of psychiatric hospitalization in patients with major depression: Results from the Jerusalem Collaborative Depression Project

Bernard Lerer*, Baruch Shapira, Miki Bloch, Bella Hanin, Tristan Trudart, J. Rachel Alexander, Miriam Popper, Dalit Braun, Ronnen H. Segman, Michael Ritsner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

In spite of substantial advances in the treatment of major depression by pharmacotherapy and other means, a significant number of depressed patients require hospitalization. In the context of the Jerusalem Collaborative Depression Project, possible precipitants of psychiatric hospitalization were sought in a cohort of patients (n=107) who were admitted to hospitals in the Jerusalem area during a 14-month period because of a depressive episode. The patients fulfilled DSM III-R criteria for major depression, single or recurrent; bipolar 1 disorder, depressed or mixed; bipolar 2, depressed. The cohort encompassed more than two thirds of potential subjects admitted during this period with the ICD-9 equivalents of the specified diagnoses (as reported to the Israel Ministry of Health National Psychiatric Case Register) and were similar to the entire potential population in terms of their diagnostic breakdown. The patients underwent extensive socio-demographic and clinical evaluation that included detailed documentation of treatment received prior to hospitalization. Notwithstanding the absence of a comparison group of depressed patients who were not hospitalized, a number of potential precipitants were identified. These included older age (55.2% >60 years, 20.6% >70 years), immigration to Israel during the preceding 5 years (34. 7%), concomitant physical illness (60%) which was associated with moderate to severe disability in 41% and poor quality of antidepressant pharmacotherapy prior to hospitalisation (only 24.3% received an adequate trial of antidepressant medication). Further evaluation of these and other potential factors could facilitate targeting of patient groups at particular risk for hospitalization and reduce the need for it.

Original languageEnglish
Pages (from-to)156-162
Number of pages7
JournalDepression and Anxiety
Volume9
Issue number4
DOIs
StatePublished - 1999
Externally publishedYes

Keywords

  • Aging immigration
  • Major depression
  • Physical comorbidity
  • Psychiatric hospitalization

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