Factors Influencing the Level of Functioning after Discharge of Inpatients with Depression

Abstract

To elucidate the factors affecting the outcome of patients with depression, we investigated the patients who had been treated in the general (non-closed) ward with special reference to the level of functioning 1 year after discharge. The subjects were 1 14 patients who met DSM-III-R criteria for depressive disorders or bipolar disorder, depressed, admitted to the general ward of Wakayama Medical College Hospital from 1989 to 1993. According to the medical records, age, gender, occupation, history of past depressive episodes, physical complications, maximum daily dosage of antidepressants (imipramine equivalent), severity of the illness and length of hospitalization were recorded for each patient. The subjects were divided into four groups by the reason for a need of hospital care. The criteria of those groups were as follows : (1) group I : Iess improved or prolonged cases by the ordinary outpatient treatment, (2) group 2 : cases with difficulties in being quiet at home, (3) group 3 : cases with a need to unload stress related to job, and (4) group 4 : cases with a need to treat physical complication along with a treatment for depression. The outcome of the subjects at the time of discharge and the level of functioning at I year after discharge were judged as good, poor and drop-out. The result showed that 91.20% Of the subjects were improved at discharge but only 38.6% of the subjects remained to be on the good level of functioning at I year after discharge. No factors but the history of past depressive episode showed a significant relation to the poor outcome at I year after discharge. The length of hospitalization was variously related to the level of functioning after discharge depending on the reasons at hospitalization. That is, for the subjects in the group I who were less influenced by socio-environmental factors, the mean period spent in hospital of those who had a high level of functioning after discharge was significantly longer than those who had a poor level of functioning. Whereas, for the subjects in the groups 2 and 3 who were considerably influenced by socio-environmental factors, the mean length of hospital stay was not different between the subjects who had good or poor level of functioning after discharge. To elucidate the factors affecting the outcome of patients with depression, we investigated the patients who had been treated in the general (non-closed) ward with special reference to the level of functioning 1 year after discharge. The subjects were 1 14 patients who met DSM-III-R criteria for depressive disorders or bipolar disorder, depressed, admitted to the general ward of Wakayama Medical College Hospital from 1989 to 1993. According to the medical records, age, gender, occupation, history of past depressive episodes, physical complications, maximum daily dosage of antidepressants (imipramine equivalent), severity of the illness and length of hospitalization were recorded for each patient. The subjects were divided into four groups by the reason for a need of hospital care. The criteria of those groups were as follows : (1) group I : Iess improved or prolonged cases by the ordinary outpatient treatment, (2) group 2 : cases with difficulties in being quiet at home, (3) group 3 : cases with a need to unload stress related to job, and (4) group 4 : cases with a need to treat physical complication along with a treatment for depression. The outcome of the subjects at the time of discharge and the level of functioning at I year after discharge were judged as good, poor and drop-out. The result showed that 91.20% Of the subjects were improved at discharge but only 38.6% of the subjects remained to be on the good level of functioning at I year after discharge. No factors but the history of past depressive episode showed a significant relation to the poor outcome at I year after discharge. The length of hospitalization was variously related to the level of functioning after discharge depending on the reason