Association of early treatment with chronicity and hazard of hospitalization after new adjustment disorder

Objective: This study aimed to examine the effect of early treatment with psychotherapy or psychoactive medications on later hospitalizations for patients with a new diagnosis of adjustment disorder. Methods: Commercial claims data from Truven Health MarketScan were used. Patient-level propensity score matching was performed, and the authors fit an inverse probability of treatment weighting to a Cox proportional hazard model. Results: Early receipt of psychoactive medication instead of psychotherapy was associated with an increased hazard of later psychiatric hospitalization (hazard ratio [HR]=2.61, 95% confidence interval [CI]=2.07-3.28) and overall hospitalization (HR=1.12, 95% CI=1.04-1.21). Specifically, benzodiazepines were associated with increased hazard of later psychiatric hospitalization (HR=1.59, 95% CI=1.02-2.51), which did not differ from medications overall. In contrast, early receipt of psychotherapy was associated with a small decrease in the hazard of later psychiatric hospitalization (HR=0.85, 95 % CI=0.73-0.99) but had no effect on overall hospitalizations. Conclusions: Early medication treatment for adjustment disorder was associated with greater overall and psychiatric hospitalization compared with no early medication treatment. This study suggests that an observed provider preference to use medications to treat patients who have comorbid physical illness may have deleterious long-term effects.