PMH51 WHAT ARE THE ATTRIBUTES THAT PSYCHIATRISTS CONSIDER IN THE DECISION TO DISCHARGE ADULTS WITH MAJOR DEPRESSIVE DISORDER WHO HAVE BEEN HOSPITALIZED WITH ACTIVE SUICIDAL IDEATION WITH INTENT?

Abstract

To ascertain the relative importance of various attributes that US-based psychiatrists consider when deciding to discharge adults hospitalized with major depressive disorder and active suicidal ideation with intent (MDSI). A choice-based conjoint (CBC) analysis was conducted via online survey among psychiatrists actively managing patients with MDSI. Potential attributes and levels within each attribute were identified through literature review with expert consultation and validated through qualitative interviews with 10 US-based psychiatrists. In the final CBC analysis, psychiatrists assessed which of three patients in hypothetical scenarios (in which levels for each attribute varied across patients) were most appropriate for discharge. A hierarchical Bayesian multinomial-logit analysis using a Markov Chain Monte Carlo algorithm was used to calculate model parameters (utilities). Ranges of utilities were used to determine the relative importance of attributes (scaled to sum to 100). 100 psychiatrists completed the survey; 48% were affiliated with a teaching/university hospital, and participants reported a mean of 14.5 years (standard deviation: 8.5) in practice. The relative importance of attributes considered in determining appropriateness for discharge were (from most to least important): current major depressive disorder (MDD) severity (24.8 [95% confidence interval: 23.3, 26.3]); clinician assessment of current suicidal ideation (SI) (20.8 [18.5, 23.0]); previous history of suicide attempts (16.7 [15.9, 17.6]); psychosocial support at discharge (13.0 [11.7, 14.4]); post-discharge outpatient follow-up plan (immediacy and frequency of visits) (9.8 [8.8, 10.8]); current length of hospital stay (9.2 [8.1, 10.3]); and clinician assessment of SI at admission (5.7 [4.8, 6.6]). Current level of symptoms of MDD, including overall depression severity and SI, were the most important attributes that psychiatrists reported considering when discharging patients hospitalized with MDSI. Further research should be conducted to determine whether treatment approaches targeting modifiable attributes (e.g. MDD symptom severity and SI) could reduce length of stay for these patients.