Mental Health
Does the Nationwide Depression Screening Prevent the Hospitalization for Mood Disorders? A Target Trial Emulation Study Using National Health Insurance Service Database in South Korea Hyejin Kim* Hyejin Kim Sun Jae Jung
Background: Over the past two decades, previous studies about the effectiveness of organized depression screening at primary care or national level have reached mixed conclusions. Therefore, we conducted a target trial emulation study to analyze the effectiveness of the 2019 nationwide depression screening program in South Korea.
Methods: We used the National Health Insurance Service (NHIS) database to estimate the effectiveness of depression screening based on the modified intent-to-treat approach (n = 53,688). The study period started on January 1, 2019, and ended on December 31, 2022. The primary outcome was the incidence of hospitalization for mood disorders, with secondary outcomes including initial use of antidepressants, emergency department visits for mood disorders, and suicide and suicidal behaviors. Individuals with a psychiatric diagnosis prior to 2019 or those who had participated in the depression screening before 2019 were excluded. Coarsened exact matching (1:1 ratio) based on age, sex, and subscriber types was used to match the screened and non-screened individuals. The multivariate cause-specific Cox regression models were used to estimate the hazard ratios (HRs), which adjusted for urbanicity, prior health check-ups, income, and the Charlson Comorbidity Index. Subgroup analyses were conducted based on sex, age groups (20–50s and 60–70s), and income levels.
Results: After adjusting for confounders, the screened group showed a 44% lower risk of hospitalization for mood disorders compared to the non-screened group (adjusted hazard ratio [aHR] 0.56, 95% confidence intervals [CI] 0.41–0.76). The initiation of antidepressant use was significantly increased in screened individuals than in non-screened (aHR 1.21, 95% CI 1.10–1.33). The hazards of emergency department visits were significantly lower in the screened group than in non-screened group (aHR 0.71, 95% CI 0.51–0.98). No significant difference was observed in suicide and suicidal behaviors between the screened and non-screened groups (aHR 0.62, 95% CI 0.32–1.21).
Conclusion: The nationwide depression screening in South Korea was linked to improvements in depression-related outcomes.
