The objective of the study was to determine the effect of depression on the utilization of health care resources, after adjusting for age and comorbidity from data obtained on routine clinical practice.
Method:
The study is an observational cohort of 15,186 patients followed over a one-year period beginning December 1993. Comprehensive demographic, clinical, and utilization data were available from the computerized medical information system generated database of a general internal medicine practice in an urban academic medical center.
Results:
Four point seven percent of patients carried a provider-coded diagnosis of depression. With regards to utilization of health care resources, even after controlling for age and comorbidity, depressed patients had more primary care visits (5.3 vs. 2.9 visits, p < .001), higher rates of referral to specialists (1.1 vs. 0.5, p < .002), and radiologic tests (0.9 vs. 0.4 tests, p < .001). They had higher total outpatient charges ($1,324 vs. $701, p < .001) and total charges ($2,808 vs. $1,891, p < .001). Depressed patients also had longer length of stay when hospitalized (14.1 vs. 9.5 days, p < .002).
Conclusions:
Patients diagnosed as depressed had significantly higher resource utilization of all types, even after controlling for the higher burden of comorbid medical illness associated with depression.
RegierDAQMyersKKramerM. The NIMH epidemiological catchment area (ECA) program: Historical context, major objectives and study population characteristics. Archives of General Psychiatry1984;41:934–941.
2.
RegierDAQNarrowWERaeDSManderscheidRWLockeBZGoodwinFK. The defacto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry1993;50:85–94.
3.
LeafPJLivingstonMMTischlerGL. Contact with health professionals for the treatment of psychiatric and emotional problems. Medical Care1985;23:1322–1337.
4.
CallahanCMHendrieHCTierneyWM. The recognition and treatment of late-life depression: A view from primary care. International Journal of Psychiatry in Medicine1996;26:155–171.
5.
CharlsonMEPompeiPAlesKMacKenzieCR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Disease1987;40:373–383.
6.
DeyoRACherkinDCCiolMA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology1992;45:613–619.
7.
WongMDHollenbergJPCharlsonME. A comparison of clinical performance of primary care and traditional internal medicine residents. Medical Care1999;37:773–783.
8.
PROC GLM SAS Institute Inc. SAS Procedures Guide, Version 6.12Cary, NC1995.
9.
BartelsSJHornSSharkeyPLevineK. Treatment of depression in older primary care patients in health maintenance organizations. International Journal of Psychiatry in Medicine1997;27:215–231.
10.
SherbourneCDWellsKBHaysRDRogersWBurnamMAJuddLL. Subthreshold depression and depressive disorder: Clinical characteristics of general medical and mental health specialty outpatients. American Journal of Psychiatry1994;151(12):1777–1784.
11.
SchulbergHCBurnsBJ. Mental disorders in primary care: Epidemiologic, diagnostic, and treatment research directions. General Hospital Psychiatry1988;10:79–87.
12.
BorsonSBarnesRAKukullWA. Symptomatic depression in elderly medical outpatients. Prevalence, demography, and health care utilization. Journal of American Geriatrics Society1986;34:314–347.
13.
OxmanTEBarrettJEBarrettJGerberP. Symptomatology of late-life minor depression among primary care patients. Psychosomatics1990;31:174–180.
14.
EvansSKatonaC. Epidemiology of depressive symptoms in elderly primary care attenders. Dementia1993;4:327–333.
15.
CallahanCMHendrieHCDittusRSBraterDCHuiSLTierneyWM. Improving treatment of late-life depression in primary care: A randomized clinical trial. Journal of the American Geriatrics Society1994;42:839–846.
16.
JenkinsDMacDonaldA. Should general practitioners refer more of their elderly patients to psychiatric services. International Journal of Geriatric Psychiatry1994;9:461–465.
17.
TurrinaCCarusoREsteRLucchiF. Affective disorders among elderly general practice patients: A two phase survey in Brescia, Italy. British Journal of Psychiatry1994;165:533–537.
18.
BarrettJEBarrettJAOxmanTEGerberPD. The prevalence of psychiatric disorders in a primary care practice. Archives of General Psychiatry1988;45:1100–1106.
19.
KeonigHGMeadorKCohenHGBlazerD. Depression in elderly men hospitalized with medical illness. Archives of Internal Medicine1988;148:1929–1936.
20.
KatonW. The epidemiology of depression in medical care. International Journal of Psychiatry in Medicine1987;17:93–111.
21.
PatrickL CooperCrumRMFordDE. Characteristics of patients with major depression who received care in general medical and specialty mental health settings. Medical Care1994;32:15–24.
22.
TiemensBGOrmelJSimonGE. Occurrence, recognition, and outcome of psychological disorders in primary care. American Journal of Psychiatry1996;153:636–644.
23.
Depression Guideline Panel: Depression in primary care; treatment of major depression, Vols 1 and 2. Clinical Practice Guideline Number 5. Washington, DC, U.S. Dept. of Health and Human Services (DHHS), Public Health Service Agency of Health-Care Policy and Research. AHCPR Publication No. 93-0551, April 1993.
24.
HaysRDWellsKBSherbourneCDRogersWSpitzerK. Functioning and well-being outcomes of patients with depression compared with chronic general medical illness. Archives of General Psychiatry1995;52:11–19.
25.
WellsKBBurmanMA. Caring for depression in America: Lessons learned from early findings of the Medical Outcomes Study. Psychiatric Medicine1991;9:503–519.
26.
JuddJLPaulusMPWellsKBRapaportMH. Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. American Journal of Psychiatry1996;153:1411–1417.
27.
AlexopolousGSMyersBSYoungRCKakumaTSilversweigDCharlsonME. Clinically defined vascular depression. American Journal of Psychiatry1997;154:562–565.
28.
WeinerJPStarfieldBHSteinwachsDMMumfordLM. Development and application of a population-oriented measure of ambulatory care case-mix. Medical Care1991;29(5):452–472.
29.
AndersonGFSteinbergEPPoweNRAntebiSWhittleJHornSHerbertR. Setting payment rates for capitated systems: A comparison of various alternatives. Inquiry1990;27:225–233.
30.
NewhouseJPManningWGKeelerEBSlossEM. Adjusting capitation rates using objective health measures and prior utilization. Health Care Financing Review1989;10(3):41–54.
31.
ShwartzMIezzoniLIMoskowitzMAAshASSawitzE. The importance of comorbidities in explaining difference in patient costs. Medical Care1996;34(8):767–782.
32.
FishmanPVon KorffMLozanoPHechtJ. Chronic care costs in managed care. Health Affairs1997;16(3):239–247.
33.
CallahanCMHuiSLNienaberNAMusickBSTierneyWM. Longitudinal study of depression and health services use among elderly primary care patients. Journal of the American Geriatrics Society1994;42:833–838.
34.
BarskyAJWyshakGKlermanGL. Medical and psychiatric determinants of outpatient medical utilization. Medical Care1986;24:548–560.
35.
LevensonJLHamerRMRossiterLF. Psychopathology and pain in medical patients predict resource use during hospitalization but not rehospitalization. Journal of Psychosomatic Research1992;26:585–592.
36.
ManningWGWellsKB. The effects of psychological distress and psychological well-being on use of medical services. Medical Care1992;30:541–553.
37.
WidmerRBCadoretRJ. Depression in family practice: Changes in pattern of patient visits and complaints during subsequent developing depression. Journal of Family Practice1979;9:1017–1021.
38.
KoenigHGShelpFGoliVCohenHJBlazerDG. Survival and health care utilization in elderly medical inpatients with major depression. Journal of American Geriatrics Society1989;37:599–606.
39.
GreenburgPEStiglinLEFinklesteinSNBerndtER. The economic burden of depression in 1990. Journal of Clinical Psychiatry1993;54:405–418.
40.
Von KorffMOrmelJKatonWLinEHB. Disability and depression among high utilizers of health care: A longitudinal analysis. Archives of General Psychiatry1992;49:91–100.
