Comorbid Depression is Associated With Increased Health Care Use and Expenditures in Individuals With Diabetes

Egede, Leonard E.; Zheng, Deyi; Simpson, Kit N.

doi:10.2337/diacare.25.3.464

Cited by 700 publications

(579 citation statements)

References 22 publications

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“…It is therefore not surprising that depression is also associated with an increased number of diabetes-related complications (de Groot et al, 2001), health service utilisation and healthcare costs (Egede et al, 2002) and mortality (Katon, 2011;Ismail et al, 2007). Concerning the latter, people with diabetes and major and minor depression have a 2.3 and 1.67 fold increase in mortality respectively compared to those without depression (Katon et al, 2005).…”

Section: Consequences Of Depression In People With Diabetesmentioning

confidence: 99%

Epidemiology of depression in diabetes: International and cross-cultural issues

Lloyd¹,

Roy²,

Nouwen³

et al. 2012

Journal of Affective Disorders

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This paper reviews the most up-to-date epidemiological evidence of the relationship between depression and diabetes, and considers the risk factors for the development of depression and the consequences of depression in diabetes with an emphasis on international and cross-cultural data. The difficulties that researchers face when epidemiological studies require assessment of psychological phenomena, such as depression, across different cultural settings are explored. Methods:Relevant papers were sought on the epidemiology of diabetes and depression in people with diabetes by undertaking a literature search of electronic databases including MEDLINE, Psych-INFO, CINAHL and EMBASE. These papers were assessed by the authors and a narrative review of the relevant literature was composed.Results: Systematic reviews of the prevalence of depression in people with diabetes have focused on studies conducted in English speaking countries and emerging data suggest that there may be international variations in prevalence and also in how symptoms of depression are reported. There appears to be a bi-directional relationship between depression and diabetes, with one influencing the other; however, research in this area is further complicated by the fact that potential risk factors for depression in people with diabetes often interact with each other and with other factors. Further research is needed to elucidate the causal mechanisms underlying these associations. Limitations:Data from non-English speaking countries remain scarce and so it is difficult to come to any firm conclusions as to the international variation in prevalence rates of comorbid diabetes and depression in these countries until further research has been conducted. Conclusion:It is important to take a culture-centered approach to our understanding of mental health and illness and has outlined some of the key issues related to the development of culturally sensitive depression screening tools. In order to come to any firm conclusions about the international variation in prevalence of co-morbid diabetes and depression, issues of culture and diversity must be taken into account prior to conducting international epidemiological studies.

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Section: Consequences Of Depression In People With Diabetesmentioning

confidence: 99%

Epidemiology of depression in diabetes: International and cross-cultural issues

Lloyd¹,

Roy²,

Nouwen³

et al. 2012

Journal of Affective Disorders

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“…Healthcare costs were examined in various facets in the studies included. Inpatient costs were assessed in terms of hospitalisation rates or hospitalisation costs (n=15) [4,6,8,15,20,25,29,31,34,37,39,[42][43][44]46], and length of stay (n=9) [7,15,19,20,25,26,30,42,46]. Outpatient costs were assessed in terms of frequency and costs of outpatient visits (n=19) [4, 6-8, 14, 15, 18-21, 23, 25, 26, 30, 31, 34, 37, 42, 45], mental health specialist visits and costs (n=4) [4,7,8,21,36], emergency department visits (n=11) [4,16,20,21,29,30,34,37,39,42,44] and medication costs (n=6) [4,20,31,34,37,40].…”

Section: Characteristics Of Primary Studiesmentioning

confidence: 99%

“…Outpatient costs were assessed in terms of frequency and costs of outpatient visits (n=19) [4, 6-8, 14, 15, 18-21, 23, 25, 26, 30, 31, 34, 37, 42, 45], mental health specialist visits and costs (n=4) [4,7,8,21,36], emergency department visits (n=11) [4,16,20,21,29,30,34,37,39,42,44] and medication costs (n=6) [4,20,31,34,37,40]. Total healthcare costs or utilisation were studied in 13 primary studies [4,8,9,14,20,25,27,28,31,34,37,40,41] and diabetes-related preventive services in five studies [7-9, 19, 23]. Indirect costs of absence from work were investigated in seven studies [6,22,33,41,42,46,47] (ESM Table 1).…”

Section: Characteristics Of Primary Studiesmentioning

confidence: 99%

Healthcare costs in patients with diabetes mellitus and comorbid mental disorders—a systematic review

2010

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Aims/hypothesis We systematically reviewed the impact of comorbid mental disorders on healthcare costs in persons with diabetes. Method We conducted a comprehensive search for studies investigating adult persons (≥18 years old) with diabetes mellitus. All studies that allowed comparison of healthcare costs between diabetic patients with mental disorders and those without were included. Results We identified 4,273 potentially relevant articles from a comprehensive database search. Of these, 31 primary studies (39 publications) fulfilled inclusion criteria, of which 27 examined comorbid depression. Hospitalisation rates and hospitalisation costs, frequency and costs of outpatient visits, emergency department visits, medication costs and total healthcare costs were mainly increased with small to moderate effect sizes in patients with diabetes and comorbid mental disorders compared with diabetic patients without such problems. Frequency (standardised mean difference [SMD]=0.35-1.26) and costs (SMD= 0.33-0.85) of mental health specialist visits were increased in the group with mental health comorbidity. Results regarding diabetes-related preventive services were inconsistent but point to a reduced utilisation rate in diabetic patients with comorbid mental disorders. Statistical heterogeneity between studies was high (I 2 range 64-98%).Pooled overall effects are therefore not reported. Studies included differ substantially regarding sample selection, assessment of diabetes and comorbid mental disorders, as well as in assessment of cost variables. Conclusions/interpretation In light of the increased healthcare costs and inadequate use of preventive services, comorbid mental disorders in patients with diabetes must become a major focus of diabetes healthcare and research.

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“…10 A greater proportion of individuals with osteoarthritis are reported to have depression (12.4 %) as compared to individuals without osteoarthritis. 8 Although several studies have examined the excess healthcare expenditures associated with depression in other chronic conditions such as diabetes, cardiovascular disease (CVD), and asthma, [13][14][15] no previous US study has estimated excess healthcare expenditures associated with depression among individuals with osteoarthritis or factors that contribute to these excess expenditures.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach

Agarwal

Sambamoorthi

2015

J GEN INTERN MED

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BACKGROUND: Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. DESIGN: Adults with self-reported osteoarthritis (n= 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. KEY RESULTS: Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p<0.001) compared to those without depression. Postregression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. CONCLUSIONS: Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

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Comorbid Depression is Associated With Increased Health Care Use and Expenditures in Individuals With Diabetes

Cited by 700 publications

References 22 publications

Epidemiology of depression in diabetes: International and cross-cultural issues

Epidemiology of depression in diabetes: International and cross-cultural issues

Healthcare costs in patients with diabetes mellitus and comorbid mental disorders—a systematic review

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach

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