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Psych Congress  

Real-world outcomes associated with major depressive disorder with mixed features

Daisy Ng-Mak, PhD
Gary Sachs, MD
Pankaj Patel, PhD
Krithika Rajagopalan, PhD
Rachel Halpern, PhD
Chien-Chia Chuang, PhD
Fred Grossman, DO
Antony Loebel, MD
Sunovion Pharmaceuticals Inc.

Objective: The DSM-5 classification added a mood "specifier" to account for subthreshold manic symptoms (mixed features) among patients with major depressive episode. Real-world data on outcomes in patients with major depressive disorder (MDD) with mixed features are sparse. This analysis compared outcomes between MDD patients with and without mixed features in the real-world setting. Methods: A retrospective cohort analysis of incident adult MDD patients was conducted using the Optum Research Database (1/1/2009-10/31/2014). Inclusion criteria included continuous enrollment ≥12 months before and after their initial MDD diagnosis (index date). In the absence of a specific mixed features code, patients with MDD with mixed features were defined as having ≥1 hypomania diagnosis (ICD-9 code: 296.89) ≤30 days after an MDD diagnosis anytime during post-index. Suicidal ideation/suicide attempt/anxiety disorder/substance abuse/healthcare utilization and costs during post-index were compared between cohorts using chi-square or t-tests. Results: Of 130,626 MDD patients, 652 (0.5%) met the definition as having mixed features. During post-index, MDD patients with mixed features had higher rates of suicidal ideation (14.1% vs. 2.7%), suicide attempt (2.0% vs. 0.5%), anxiety disorder (46.8% vs. 34.0%), substance abuse (15.5% vs. 6.1%), greater use of emergency department visits (52.5% vs. 35.6%), hospitalizations (24.2% vs. 10.5%) and higher total healthcare costs (mean: $15,660 vs. $10,744) compared with those without mixed features (all p<0.01). Conclusion: MDD patients with mixed features had greater comorbidities, worse outcomes, greater use of healthcare resources and higher costs. Identifying optimal treatment regimens for this population represents an urgent medical need.

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