Depression is a common mental health condition that negatively impacts how you feel, think, and handle daily activities. At its most severe, depression can lead to suicidal thoughts and hospitalization may be required to keep someone safe. This article explores whether and how depression can result in hospitalization.
What is depression?
Depression is a mood disorder characterized by persistent feelings of sadness, emptiness, or irritability accompanied by physical and cognitive changes. Symptoms of depression include:
- Feeling sad, empty, or tearful most of the time
- Loss of interest in previously enjoyed activities
- Significant weight loss or gain
- Sleep disturbances, either insomnia or sleeping too much
- Slowed speech and body movements
- Fatigue and lack of energy
- Feelings of worthlessness, guilt, or hopelessness
- Difficulty concentrating and making decisions
- Recurrent thoughts of death or suicide
These symptoms persist for at least two weeks and impair daily functioning. Depression can range from mild to severe. In its mildest form, depression may not significantly impact daily activities. However, more severe major depressive disorder can make even basic tasks seem impossible and suicidal ideation becomes a real concern.
Prevalence of depression
Depression is common. According to the National Institute of Mental Health, in 2019:
- 21 million U.S. adults experienced at least one major depressive episode.
- Depression was most prevalent among adults aged 18-25 (14.4%).
- Women are nearly twice as likely as men to develop depression.
- About 3.7% of U.S. adults had persistent depressive disorder.
Globally, the World Health Organization estimates that over 300 million people suffer from depression. It is a leading cause of disability worldwide. With such high prevalence, depression accounts for a significant burden of disease.
Severity levels
There are different levels of depression severity:
- Mild depression – A few symptoms are present but manageable. Can usually continue daily activities.
- Moderate depression – More symptoms present and difficulty continuing with normal routines. Tasks require extra effort.
- Severe depression – Many symptoms present that are extremely disruptive to daily life. Extreme impairment of functioning.
The more severe the depression, the more likely hospitalization may be required for safety. Mild depression usually does not need intensive inpatient treatment.
Suicide risk
The most significant risk of severe, major depression is the increased chance of suicide. According to the American Psychiatric Association:
- Over 30% of people with severe depressive disorders have some form of suicidal thoughts.
- About 15% of people with severe depression die by suicide.
- Up to 80% of people who die by suicide had depression or another mood disorder.
Suicidal thoughts and behaviors are a psychiatric emergency requiring immediate intervention. Hospitalization provides a safe environment to manage suicidal crises.
Warning signs
Warning signs that someone may be at risk of suicide if severely depressed include:
- Talking about dying or wanting to die
- Making statements about feeling hopeless or useless
- Actively looking for ways to kill themselves, like seeking firearms or medication
- Talking about great guilt or shame
- Out of control, reckless behaviors
- Withdrawing from family and friends
- Saying goodbye to people as if they won’t be seen again
- Prior suicide attempts
Any suicidal thoughts or statements should be taken extremely seriously.
Causes of hospitalization
The two main reasons someone with severe depression may need hospitalization are:
Suicide risk
As discussed above, suicidal ideation is common in severe depression and can be life-threatening. Hospitalization keeps someone safe during acute suicidal crises when the risk of self-harm is high but likely short-term.
Inability to care for oneself
Severe depression can make someone unable to adequately care for themselves. Self-care tasks like hygiene, eating, and drinking become neglected. Hospitalization allows medical professionals to oversee and assist with daily living activities until the deep depression begins to improve.
Inpatient treatment process
The hospitalization process for severe depression usually involves:
- Emergency department – Patients typically first go to the emergency room for initial assessment and intervention. Suicide risk is evaluated.
- Psychiatric unit admission – After ER stabilization, patients get admitted to an inpatient psychiatric unit.
- Treatment and recovery – During hospitalization, a combination of therapeutic interventions and medications help improve depression. Treatment addresses safety concerns and ability to function.
- Discharge planning – Before discharge, mental health providers coordinate follow-up care and services to help the transition home.
The length of stay depends on the individual but averages 5-7 days. Treatment is focused on managing immediate safety risks and acute symptoms to prepare for outpatient treatment.
Treatment options
Common treatments during inpatient depression care include:
Medications
Such as antidepressants and anti-anxiety medications. Helps rapidly improve mood and suicidal thoughts.
Psychotherapy
Including cognitive behavioral therapy, family therapy, and dialectical behavior therapy. Provides coping skills.
Brain stimulation
Like electroconvulsive therapy for severe depression unresponsive to other treatments.
Wellness activities
Such as exercise, nutrition counseling, meditation, and yoga. Helps provide coping outlets.
Treatment is personalized based on the individual’s symptoms, needs, and response to care. The focus is on acute stabilization prior to transitioning to outpatient care for ongoing recovery.
Hospitalization criteria
Specific criteria for psychiatric hospitalization for depression includes:
- Presents imminent danger to self, either from suicide, self-harm, or inability to care for self
- Depression symptoms are severe enough to significantly impair judgment and undermine impulse control
- Depressive episode does not respond to outpatient treatment and poses significant health risks
- Presence of other factors that make outpatient treatment unsafe or unlikely to succeed, like psychosis, mania, or severe anxiety
- Support system is lacking that makes outpatient treatment too difficult
Hospitalization is not automatically needed for a depression diagnosis. Only in certain severe cases where safety is compromised or someone cannot adequately function even with outpatient resources.
Involuntary vs. voluntary admission
Psychiatric hospitalization can be:
Voluntary
The person chooses to be admitted themselves. This is ideal when the patient realizes they need inpatient treatment and are willing to undergo the process. They can also request to be discharged at any time.
Involuntary
The person is forced into hospitalization, usually via court order. Laws allow involuntary admission if someone is an imminent threat to themselves or others and unwilling to be hospitalized voluntarily.
Involuntary hospitalization criteria:
- Has a mental illness (such as severe major depression)
- Is a current danger to self or others due to the mental illness
- Needs acute inpatient treatment to stabilize the psychiatric emergency
Involuntary admission is only used when voluntary hospitalization cannot be agreed upon but the need for inpatient treatment is critical.
Predicting need for hospitalization
It can be difficult to predict when someone’s depression may worsen to the point of needing hospitalization. Some factors that increase risk include:
- History of hospitalization for depression
- Prior suicide attempts
- Presence of psychotic symptoms
- Co-occurring substance abuse issues
- Impulsive behaviors and limited self-control
- Chronic physical health conditions
- Stressful life events like trauma, death of a loved one, divorce
- Poor social support system
- Non-compliance with medications and therapy
Rapid worsening of symptoms or any suicidal behaviors should prompt an immediate psychiatric assessment.
Outcomes
Research shows that psychiatric hospitalization for depression can:
- Improve symptoms and stabilize moods
- Reduce suicide risk and prevent mortality
- Safely manage self-care deficits until functioning improves
- Determine diagnosis and effective medications when depression is treatment-resistant
However, hospitalization also carries risks:
- High cost of inpatient care
- Disruption of normal routines and activities
- Potential stigma of psychiatric treatment
- Risk of worsening depression from the stress of hospitalization
Still, for cases of severe depression where there are safety concerns, the benefits tend to outweigh the risks.
Preventing the need for hospitalization
Some ways to potentially avoid hospitalization for depression include:
- Seek professional help early when symptoms first develop
- Comply with recommended medications and psychotherapy
- Attend regular visits with mental health professionals
- Develop a strong support system of family and friends
- Learn coping strategies and self-care skills
- Identify triggers that worsen depression
- Have an emergency plan if depression rapidly escalates
- Limit access to means of self-harm
- Avoid drugs and alcohol
While not always preventable, early intervention and proper outpatient treatment is key to managing depression and reducing the likelihood of hospitalization.
Conclusion
Severe depression accompanied by suicidal thoughts, psychotic symptoms, or an inability to function may require inpatient psychiatric hospitalization. Hospitalization provides safety, intensive treatments, and 24/7 monitoring that cannot be easily replicated in outpatient settings. Criteria for involuntary admission may be met if the person does not voluntarily agree to hospitalization. While hospitalization has risks, it is sometimes the only way to stabilize acute crises. Ongoing outpatient treatment after discharge can help manage depression and maintain stability. With proper support, even severe depression can often be treated on an outpatient basis, avoiding the disruption of hospitalization.