Depressive Pattern, Social Background, and Hospitalization

All admissions to three different psychiatric inpatient facilities were screened, and patients fitting defined criteria for depression were further studied by semistructured interview, rating scales, and self-report questionnaires. The three facilities, all serving the same area, were the psychiatric ward of a general hospital, a mental health center, and a state mental hospital. Differences in the depressed patient groups admitted to the three facilities were examined. Major differences were found among the three facilities regarding social class and other related social indices. The general hospital admitted patients of highest and the state mental hospital patients of lowest social class, with the mental health center intermediate. Clinical differences were less striking but suggested a higher incidence of endogenous depression in the general hospital patients, with an even higher incidence in a group of patients subsequently studied who were admitted to a clinical research ward. The state mental hospital group showed a particularly high incidence of recurrent illnesses. These results contrast with previous findings that when outpatients and partially hospitalized patients are compared with inpatients, a continuum of degree of hospitalization can be demonstrated, in which the main distinguishing features are clinical rather than sociodemographic. The findings emphasize the heterogeneity of depression and the need for caution in generalizing from selected samples of depressives in clinical and biological research. They illustrate aspects of the sorting process within a community by which patients are admitted to different facilities, and suggest that, within a single level of hospitalization, social factors are the most important.