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Community-Level Risk Factors for Depression Hospitalizations

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Abstract

This study measured geographic variation in depression hospitalizations and identified community-level risk factors. Depression hospitalizations were identified from the Statewide Inpatient Database. The dependent variable was specified as the indirectly standardized hospitalization rate. County-level data for 14 states were collected from federal agencies. The Bayesian spatial regression model included socio-demographic, economic, and health system characteristics as independent variables. There were 8.5 depression hospitalizations per 1,000 residents. 8.8% of counties had hospitalization rates 33% greater than the standardized rate. Significant risk factors included unemployment, poverty, physician supply, and hospital bed supply. Significant protective factors included rurality, economic dependence, and housing stress.

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Notes

  1. Admissions with primary or secondary diagnoses of ICDN-9 296.2x, 296.3x, 298.0, 300.4 309.1, 311 were extracted from the SID database. These are the diagnostic codes used for the NCQA HEDIS depression performance measure.

  2. The 10 age groups were 20–24, 25–29, 30–34, 35–44, 45–54, 55–59, 60–64, 65–74, 75–84, and 85+.

References

  • Andrews, R. M., Fox, S., Elixhauser, A., Coffey, R. M., Raskin, I. E., & Agency for Health Care Policy and Research. (1994). The National Bill for Diseases Treated in U.S. Hospitals: 1987 (AHCPR Publication No. 94–0002). Division of Provider Studies Research Note 19. Rockville, MD: Agency for Health Care Policy and Research.

  • Baker, D. W. (1995). Access to health care and preventable hospitalizations. Journal of the American Medical Association, 274(22), 1759–1760.

    Article  PubMed  CAS  Google Scholar 

  • Besag, J., York, J., & Mollie, A. (1991). Bayesian image restoration, with two applications in spatial statistics. Annals of the Institute of Statistical Mathematics, 43, 1–59.

    Article  Google Scholar 

  • Blakely, T. A., & Woodward, A. J. (2000). Ecological effects in multi-level studies. Journal of Epidemiology and Community Health, 54(5), 367–374.

    Article  PubMed  CAS  Google Scholar 

  • Booth, B. M., Ludke, R. L., Wakefield, D. S., Kern, D. C., Burmeister, L. F., & Fisher, E. M. et al. (1991a). Nonacute days of care within Department of Veterans Affairs Medical Centers. Medical Care, 29(8, Suppl), AS51–AS63.

    Google Scholar 

  • Booth, B. M., Ludke, R. L., Wakefield, D. S., Kern, D. C., & duMond, C. E. (1991b). Relationship between inappropriate admissions and days of care: Implications for utilization management. Hospital and Health Services Administration, 36(3), 421–437.

    CAS  Google Scholar 

  • Booth, B. M., Ludke, R. L., Wakefield, D. S., Kern, D. C., Fisher, E. M., & Ford, T. W. (1991c). Nonacute inpatient admissions to Department of Veterans Affairs Medical Centers. Medical Care, 29(8, Suppl), AS40–AS50.

    Google Scholar 

  • Braunstein, J. B., Anderson, G. F., Gerstenblith, G., Weller, W., Niefeld, M., Herbert, R. et al. (2003). Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. Journal of the American College of Cardiology, 42(7), 1226–1233.

    Article  PubMed  Google Scholar 

  • Catalano, R., & Dooley, C. D. (1977). Economic predictors of depressed mood and stressful life events in a metropolitan community. Journal of Health and Social Behavior, 18, 292–307.

    Article  PubMed  CAS  Google Scholar 

  • Catalano, R., Dooley, D., & Jackson, R. (1981). Economic predictors of admissions to mental health facilities in a nonmetropolitan community. Journal of Health and Social Behavior, 22, 284–297.

    Article  PubMed  CAS  Google Scholar 

  • Clayton, D., & Kaldor, J. (1987). Empirical Bayes estimates of age-standardized relative risks for use in disease mapping. Biometrics, 43(3), 671–681.

    Article  PubMed  CAS  Google Scholar 

  • Clayton, D. G., Bernardinelli, L., & Montomoli, C. (1993). Spatial correlation in ecological analysis. International Journal of Epidemiology, 22(6), 1193–1202.

    Article  PubMed  CAS  Google Scholar 

  • Dartmouth Medical School & Center for the Evaluative Clinical Sciences (1996). The Dartmouth Atlas of Health Care. Chicago: American Hospital Publishing, Inc.

    Google Scholar 

  • Dooley, D., & Cotalano, R. (1988). Recent research on the psychological effects of unemployment. Journal of Social Issues, 44(4), 1–12.

    Article  Google Scholar 

  • Egede, L. E., & Zheng, D. (2003). Independent factors associated with major depressive disorder in a national sample of individuals with diabetes. Diabetes Care, 26(1), 104–111.

    Article  PubMed  Google Scholar 

  • Eibner, C., Sturn, R., & Gresenz, C. R. (2004). Does relative deprivation predict the need for mental health services? Journal of Mental Health Policy and Economics, 7(4), 167–175.

    PubMed  Google Scholar 

  • Feltbower, R. G., Manda, S. O., Gilthorpe, M. S., Greaves, M. F., Parslow, R. C., Kinsey, S. E. et al. (2005). Detecting small-area similarities in the epidemiology of childhood acute lymphoblastic leukemia and diabetes mellitus, type 1: A Bayesian approach. American Journal of Epidemiology, 161(12), 1168–1180.

    Article  PubMed  Google Scholar 

  • Fergusson, D. M., Horwood, L. J., & Lynskey, M. T. (1997). The effects of unemployment on psychiatric illness during young adulthood. Psychological Medicine, 27(2), 371–381.

    Article  PubMed  CAS  Google Scholar 

  • Fortney, J. C., Owen, R., & Clothier, J. (1999). Impact of travel distance on the disposition of patients presenting for emergency psychiatric care. Journal of Behavioral Health Services & Research, 26(1), 104–108.

    Article  CAS  Google Scholar 

  • Fortney, J. C., Steffick, D. E., Burgess, J. F., Jr., Maciejewski, M. L., & Petersen, L. A. (2005). Are primary care services a substitute or complement for specialty and inpatient services? Health Services Research, 40(5 Pt 1), 1422–1442.

    Article  PubMed  Google Scholar 

  • Gotway, C., & Waller, L. (2004). Applied spatial statistics for public health data. Hoboken, NJ: John Wiley and Sons.

    Google Scholar 

  • Greenland, S. (2001). Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects. International Journal of Epidemiology, 30, 1343–1350.

    Article  PubMed  CAS  Google Scholar 

  • Griffith, D. A., & Haining, R. (2006). Beyond mule kicks: The Poisson distribution in geographical analysis. Geographical Analysis, 38, 123.

    Article  Google Scholar 

  • Harman, J. S., Edlund, M. J., & Fortney, J. C. (2004). Disparities in the adequacy of depression treatment in the United States. Psychiatric Services, 55(12), 1379–1385.

    Article  PubMed  Google Scholar 

  • Hart, L. G., Larson, E. H., & Lishner, D. M. (2005). Rural definitions for health policy and research. American Journal of Public Health, 95(7), 1149–1155.

    Article  PubMed  Google Scholar 

  • Hays, R. D., Wells, K. B., Sherbourne, C. D., Rogers, W., & Spritzer, K. (1995). Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Archives of General Psychiatry, 52, 11–19.

    PubMed  CAS  Google Scholar 

  • Hendryx, M. S., & Rohland, B. M. (1994). A small area analysis of psychiatric hospitalizations to general hospitals: Effects of community mental health centers. General Hospital Psychiatry, 16, 313–318.

    Article  PubMed  CAS  Google Scholar 

  • Himelhoch, S., Weller, W. E., Wu, A. W., Anderson, G. F., & Cooper, L. A. (2004). Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Medical Care, 42(6), 512–521.

    Article  PubMed  Google Scholar 

  • Katon, W., & Schulberg, H. (1992). Epidemiology of depression in primary care. General Hospital Psychiatry, 14, 237–247.

    Article  PubMed  CAS  Google Scholar 

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.

    Article  Google Scholar 

  • Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.

    Article  Google Scholar 

  • Kozak, L. J., Owings, M. F., & Hall, M. J. (2005). National Hospital Discharge Survey: 2002 annual summary with detailed diagnosis and procedure data National Center for Health Statistics.

  • Lopez-Abente, G., Pollan, M., Ardanaz, E., & Errezola, M. (2003). Geographical pattern of brain cancer incidence in the Navarre and Basque Country regions of Spain. Occupational and Environmental Medicine, 60, 504–508.

    Article  PubMed  CAS  Google Scholar 

  • Ludke, R. L., Booth, B. M., & Lewis-Beck, J. A. (1993). Relationship between early readmission and hospital quality of care indicators. Inquiry, 30, 95–103.

    PubMed  CAS  Google Scholar 

  • Merrill, C. T., & Elixhauser, A. (2005). Hosptialization in the United States, 2002 (Rep. No. H-CUP Fact Book No. 6. AHRQ Publication No. 05–056). Rockville, MD: Agency for Healthcare Research and Quality.

  • Mirowsky, J., & Ross, C. E. (2001). Age and the effect of economic hardship on depression. Journal of Health and Social Behavior, 42(2), 132–150.

    Article  PubMed  CAS  Google Scholar 

  • Montgomery, S. M., Cook, D. G., Bartley, M. J., & Wadsworth, M. E. (1999). Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men. International Journal of Epidemiology, 28(1), 95–100.

    Article  PubMed  CAS  Google Scholar 

  • Niefeld, M. R., Braunstein, J. B., Wu, A. W., Saudek, C. D., Weller, W. E., & Anderson, G. F. (2003). Preventable hospitalization among elderly Medicare beneficiaries with type 2 diabetes. Diabetes Care, 26(5), 1344–1349.

    Article  PubMed  Google Scholar 

  • Patrick, D. L., & Wickizer, T. M. (1995). Community and health. In B. C. Amick, S. Levine, A. R. Tarlov, & D. C. Walsh (Eds.), Society and health (pp. 46–92). New York, NY: Oxford University Press, Inc.

    Google Scholar 

  • Quality Resource Systems, I. (2006). Area Resource File website. Accessed 3/29/2006. [On-line]. Available: http://www.arfsys.com/

  • Riolo, S. A., Nguyen, T. A., Greden, J. F., & King, C. A. (2005). Prevalence of depression by race/ethnicity: Findings from the National Health and Nutrition Examination Survey III. American Journal of Public Health, 95(6), 998–1000

    Article  PubMed  Google Scholar 

  • Rost, K., Zhang, M., Fortney, J., Smith, J., & Smith, G. R., Jr. (1998a). Expenditures for the treatment of major depression. American Journal of Psychiatry, 155(7), 883–888.

    CAS  Google Scholar 

  • Rost, K., Zhang, M., Fortney, J., Smith, J., & Smith, G. R., Jr. (1998b). Rural-urban differences in depression treatment and suicidality. Medical Care, 36(7), 1098–1107

    Article  CAS  Google Scholar 

  • Saraceno, B., Levav, I., & Kohn, R. (2005). The public mental health significance of research on socio-economic factors in schizophrenia and major depression. World Psychiatry, 4(3), 181–185.

    PubMed  Google Scholar 

  • Simon, G., Ormel, J., VonKorff, M., & Barlow, W. (1995). Health care costs associated with depressive and anxiety disorders in primary care. American Journal of Psychiatry, 152(3), 352–357

    PubMed  CAS  Google Scholar 

  • Smith, C. B., Goldman, R. L., Martin, D. C., Williamson, J., Weir, C., Beauchamp, C. et al. (1996). Overutilization of acute-care beds in Veterans Affairs hospitals. Medical Care, 34(1), 85–96

    Article  PubMed  CAS  Google Scholar 

  • Spiegelhalter, D. J., Best, N. G., Carlin, B. P., & Van der Linde, A. (2002). Bayesian measures of model complexity and fit. Journal of the Royal Statistical Society: Series B, 6, 583–639.

    Google Scholar 

  • Stokols, D. (1992). Establishing and maintaining healthy environments. Toward a social ecology of health promotion. American Psychologist, 47, 6–22.

    Article  PubMed  CAS  Google Scholar 

  • Stokols, D. (1996). Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion, 10(4), 282–293.

    PubMed  CAS  Google Scholar 

  • Thomas, A., Best, N., Arnold, R., & Spiegelhalter, D. (2002). GeoBugs User Manual (Version 1.1 Beta). [On-line]. Available: http://www.mrc-bsu.cam.ac.uk/bugs

  • United States Department of Agriculture Economic Research Service County Typology Codes (website). Last accessed 3/29/06. [On-line]. Available: http://www.ers.usda.gov/Data/TypologyCodes/

  • Unutzer, J., Patrick, D. L., Simon, G., Grembowski, D., Walker, E., Rutter, C. et al. (1997). Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: A 4-year prospective study. Journal of the American Medical Association, 277(20), 1618–1623

    Article  PubMed  CAS  Google Scholar 

  • Vidal Rodeiro, C. & Lawson, A. (2005). An evaluation of the edge effects in disease map modeling. Computational Statistics and Data Analysis, 49, 45–62

    Article  Google Scholar 

  • Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005a). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 603–613.

    Article  Google Scholar 

  • Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005b). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629–640

    Article  Google Scholar 

  • Wells, K. B., Stewart, A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M. et al. (1989). The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. Journal of the American Medical Association, 262(7), 914–919.

    Article  PubMed  CAS  Google Scholar 

  • Whalen, D., Houchens, R., & Elixhauser, A. (2003). Final 2000 NIS Comparison Report (HCUP Methods Series Report #2003-1). U.S. Agency for Healthcare Research and Quality.

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Acknowledgments

This research was supported by the Health Resources and Services Administration WICHE Rural Mental Health Center (1U1CRH03713-01-00 to Dr. Rost).

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Authors and Affiliations

  1. Health Services Research and Development, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA

    John Fortney

  2. Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    John Fortney

  3. Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    John Fortney

  4. Department of Geography, University of Iowa, Iowa City, IA, USA

    Gerard Rushton & Lixun Zhang

  5. Department of Health Policy and Management, College of Public Health, University of Iowa, Iowa City, IA, USA

    Gerard Rushton

  6. Division of Educational Measurement and Statistics, University of Iowa, Iowa City, IA, USA

    Scott Wood

  7. Department of Biostatistics, University of Iowa, Iowa City, IA, USA

    Lixun Zhang

  8. Clinical Research Unit, Kaiser Permanente Colorado, Denver, CO, USA

    Stan Xu

  9. Western Interstate Commission for Higher Education, Boulder, CO, USA

    Fran Dong

  10. Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, Tallahassee, FL, USA

    Kathryn Rost

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  1. John Fortney
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  2. Gerard Rushton
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Correspondence to John Fortney.

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Fortney, J., Rushton, G., Wood, S. et al. Community-Level Risk Factors for Depression Hospitalizations. Adm Policy Ment Health 34, 343–352 (2007). https://doi.org/10.1007/s10488-007-0117-z

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