In this exploratory analysis, we examined the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics. This issue was examined using an analysis of spatially-referenced datasets containing county level information about hospitalizations, socio-demographics, economics, and health care systems. In addition, we examine the variation in hospital admission rates to identify counties with elevated rates. The overall depression hospitalization rate in these 520 counties was 8.3 per 1000 residents ages 20 and above. Counties with a higher percentage of African Americans and higher percentages of Asian Americans had significantly lower rates of depression hospitalizations. Counties with higher poverty rates had significantly higher hospitalization rates while those classified as housing stressed had significantly lower rates. Counties classified as the most rural had a lower hospitalization rate than counties classified as the most urban. The supply of non-psychiatrist physicians and the presence of a community mental health center were positively and significantly correlated with hospitalization rates. Our results highlight the large number of depression related hospitalizations, many of which may have been preventable. Similar to Wennberg's research, we found substantial geographic variation in hospitalization rates. This geographic variation should be of interest to health plans and self-insured employers/payers seeking to control high-cost hospitalizations. Much of the geographic variation in hospitalization rates was explained by community-level characteristics. Importantly, greater access to psychiatrists reduced the risk of depression hospitalizations. This suggests that improving access to high quality depression treatment in the outpatient setting may reduce the need for high cost inpatient treatment.

Publications

• Community-Level Risk Factors for Depression Hospitalizations
  Policy Brief
  WICHE Center for Rural Mental Health Research
  Date: 09/2005
  This policy brief examines the association between depression hospitalization rates and community-level socio-demographic, economic, and healthcare system characteristics.