Cross-national Differences in Inpatient Depression Treatment

Lars P Hölzel, Levente Kriston, Ann-Kristin Weiser, Martin Härter
European Psychiatric Review, 2011;4(1):32-34
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Abstract

Inpatient treatment is a central, evidence-based, yet cost-intensive component of depression management. To date, systematic investigations of cross-national differences in the inpatient treatment of depression are lacking. The objective of this study was to investigate cross-national differences in the number of cases and the average length of inpatient depression treatment in Western countries categorised as ‘advanced economies’ according to the International Monetary Fund. Data were collected from international databases of the World Health Organization (WHO), the European Union (EU), and national ministries. A high variation between the countries was found regarding the numbers of inpatient treatments (mean 115.6, median 62.3, range 0.8 to 392.9 per 100,000 inhabitants) and the average length of stay (mean 24.5, median 21.9, range 4.1 to 44.6 days). Substantial differences in inpatient depression treatment exist between different healthcare systems. A better understanding of these differences could be useful for the optimisation of healthcare systems.

Acknowledgement: We thank the World Health Organization (WHO) and the European Union (EU) for sharing data and Dr I Bermejo for his valuable advice.
Keywords
Depression, patient care, hospitalisation, length of stay, review, world health
Disclosure The authors have no conflicts of interest to declare.
Received: February 22, 2011 Accepted March 23, 2011
Correspondence: Lars P Hölzel, Section Clinical Epidemiology and Health Services Research, Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr 5, D-79104 Freiburg, Germany. E: lars.hoelzel@uniklinik-freiburg.de

Depression is one of the most prevalent medical conditions worldwide, affecting about 16% of adults in the course of their lifetime.1 It is also the leading cause of years spent living with disability.2 In addition, depression has an effect on somatic diseases. Taking into account these indirect effects, the global burden of depression is likely to be even higher. Given the high impact of depression on health, interventions aiming to improve public health should also consider adequate mental health policies, in particular regarding depression treatment.3

Inpatient depression treatment is a central component of depression management. It is highly effective4 and is generally recommended for suicidal patients; for other indications, such as treatment resistance, chronicity, severe major depression or psychotic symptoms, the recommendations of national guidelines are much more inconsistent.5–9 These inconsistencies may be accompanied by national differences in the relative frequency of inpatient depression treatments.

Wide differences in mental health systems have been found for several indicators, e.g. total number of beds in inpatient facilities, admissions to inpatient units and visits to outpatient facilities.10,11 However, as mental disorders are a highly heterogeneous category, it remains unclear whether these differences affect all disorders to a similar degree. Investigations on cross-national differences that focus exclusively on depression are so far lacking. Thus, the objective of this study was to examine cross-national differences in inpatient depression treatment.

Methods

A cross-national comparison of census data was conducted and data on the inpatient treatment of patients with unipolar depression were included. Unipolar depression was defined as a depressive episode (F32) or a recurrent depressive disorder (F33) according to the International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10).12 The usage of inpatient depression treatment was operationalised as ‘number of patients treated’ and ‘average length of stay’ (ALOS). In order to control for differences in the population size of the various countries, the number of inpatient treatments (discharges) was standardised per 100,000 inhabitants. Specifically, ALOS was defined as the average number of days, that patients diagnosed with F32/33, were hospitalised in the last year. Possible bias due to large socio-cultural and economic differences between countries was limited, by homogenising the sample through considering only Western countries categorised as ‘advanced economies’ according to the International Monetary Fund.13 Data were collected from international databases of the World Health Organization (WHO), the European Union (EU), and from national ministries. Descriptive analyses were conducted, and mean and median scores were calculated for the number of patients treated and average length of stay.

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