Association of depressive symptoms with health care utilization in older adults: Longitudinal evidence from the Survey of Health, Aging, and Retirement in Europe

Abstract

Objectives Many older adults with depression do not receive adequate treatment. Differences in treatment utilization may reflect the heterogeneous nature of depression, encompassing multiple distinct symptoms. We assessed whether depressive symptoms are differentially associated with subsequent health care utilization with respect to three outcomes as follows: (1) contact with a medical doctor (MD), (2) depression‐specific treatment, and (3) inpatient psychiatric admission. Methods/Design Longitudinal analyses were based on data from three follow‐up cycles conducted between 2004 and 2013 among 53,139 participants from the Survey of Health, Aging, and Retirement in Europe. Depressive symptoms were self‐reported at baseline of each follow‐up cycle using the 12‐item EURO‐D scale. Health care utilization was self‐reported at the end of each follow‐up cycle. Results After adjustment for sex, age, country of interview, follow‐up time, educational attainment, presence of a partner in household, body‐mass index, the number of chronic diseases, disability, average/prior frequency of contact with an MD, and all other depressive symptoms, people with more frequent contact with an MD had most often reported sleep problems (IRR = 1.10) and fatigue (IRR = 1.10), followed by sad/depressed mood, tearfulness, concentration problems, guilt, irritability, and changes in appetite. Those treated for depression had most often reported sad/depressed mood (OR = 2.18) and suicidal ideation (OR = 1.72), but also sleep problems, changes in appetite, fatigue, concentration problems, hopelessness, and irritability. Sad/depressed mood (OR = 2.87) was also associated with psychiatric inpatient admission. Similarly to other outcomes, appetite change, fatigue, and sleep problems were associated with inpatient admission. Conclusions Specific symptoms of depression may determine utilization of different types of health care among elderly.

Associations between depressive symptom clusters and care utilization and costs among community‐dwelling older adults

“…Previous research has linked somatic symptoms to poor physical health and a high frequency of medical doctor consultations. 10 Although our study found that somatic symptoms were linked to a greater likelihood of non-psychiatric care use, we found no significant association with non-psychiatric care expenditure/marginal effects. Perhaps NVSE explained away the association between somatic symptoms and nonpsychiatric care expenditure as we included all four symptom clusters in models, and previous studies have shown that somatic symptoms intensified depressed mood/anhedonia.…”

“…A previous study found that individual depressive symptoms were differently associated with different domains of psychosocial functioning (e.g., home management, social activities) and that depressed mood and concentration problems had the largest associations with functioning impairment. 9 Furthermore, a recent study from Komulainen and colleagues found that individual depressive symptoms were differently associated with healthcare utilization 10 : people reporting more sleep problems and fatigue had more frequent contacts with a medical doctor while depressed mood was associated with psychiatric inpatient admission. However, Komulainen et al's study was limited by its exclusive focus on healthcare and ignoring interaction effects of different symptoms.…”

“…However, Komulainen et al's study was limited by its exclusive focus on healthcare and ignoring interaction effects of different symptoms. 10 So far, no study has attempted to examine economic impacts of depressive symptom clusters and their interactions on healthcare/ social care utilization. Understanding of the associations between symptom clusters and care utilization can provide an untapped source of economic evidence and refine information for resource allocation.…”

Factors associated with insomnia in older adult outpatients vary by gender: a cross-sectional study

“…In addition, another systematic review and meta-analysis of randomized controlled trials for evaluating the effect of exercise on sleep quality and insomnia in middle-aged women, reported that moderate levels of programmed exercise rather than low levels of physical activity had a positive effect on sleep quality, but physical activity didn’t show an effect on reducing the severity of insomnia [ 58 ]. Older females had higher risk of suffering from depressive symptoms, and changes in appetite was an important symptom for which patients with depression searched for help [ 59 ]. Therefore, poor appetite may help to account for a higher risk of insomnia in females.…”

A New Perspective of Urban-rural Differences: the Impact of Supply and Demand on Healthcare Services for the Older Adults: a Case Study of Shaanxi Province

“…The higher the drug usage rate, the higher the utilization rate of healthcare services [28][29]. The research of Yonatan (2020) shows that providing psychedelic therapy is economically bene cial to the healthcare system, reducing the utilization and cost of healthcare services [30]. Chronic diseases and major diseases will increase the use of healthcare services by the older adults [31].…”