Does type of first contact in depressive and bipolar disorders predict subsequent hospitalisation and risk of suicide?

Background: Only a few studies have investigated how the type of first contact is associated with the risk of subsequent hospitalisation and the risk of committing suicide for patients with depressive or bipolar disorders. Method: All outpatients (patients in psychiatric ambulatories and community psychiatry centres) and in-patients (patients admitted during daytime or overnight to a psychiatric hospital) with a diagnosis of depressive or bipolar disorder at first contact ever in a period from 1995 to 1999 in Denmark were identified from the Danish Psychiatric Central Research Register (DPCRR). The risk of subsequent hospitalisation and the risk of suicide were compared according to type of first contact. Results: The risk of subsequent hospitalisation was significantly increased for patients who were admitted to inpatient facilities during first contact compared to patients with outpatient treatment as their first contact. Patients with depressive disorder who were admitted also had increased risk of committing suicide eventually. Limitations: The diagnoses are clinician based. Conclusions: Patients referred to inpatient treatment have a poorer long-term prognosis than patients treated as outpatients.