Decomposing differences in utilization of health services between depressed and non-depressed elders in Europe

Abstract

Utilization rates of non-psychiatric health services are often higher in depressed compared to non-depressed adults. We examine whether these differences can be explained by the increased prevalence or the increased impact of demographic, socioeconomic, geographic, and health-related factors. The sample was taken from The Survey of Health, Ageing and Retirement in Europe (Wave 1 Release 2), a prospective observational study of 31,115 randomly selected people ages 50+ living in Austria, Germany, Sweden, the Netherlands, Spain, Italy, France, Denmark, Greece, Switzerland, Belgium, and Israel. Blinder–Oaxaca decomposition methods for multivariate linear regression models were used to estimate the influence of prevalence and impact of covariates on utilization among depressed and non-depressed participants. We find robust evidence that the gap in utilization between depressed and non-depressed can be accounted for by both prevalence (explained) and impact (unexplained) differences. The prevalence effect accounted for 57.7% whereas differences in the impact of covariates between depressed and non-depressed persons explained 42.3% of differences in utilization rates. Despite cross-national differences in quality and coverage of health services, in all countries, the prevalence effect was explained entirely by health measures, including: chronic diseases, functional mobility, painful symptoms, and self-reported health. The impact effect varied cross-nationally, but was largely explained by socioeconomic status and urbanicity. Hospitalization among depressed adults was twice that of non-depressed adults. Policies aimed at improving adherence and improving disease management among depressed adults should be explored.

Does Social Isolation Affect Medical Doctor Visits? New Evidence Among European Older Adults

“…We use data from five panel waves of SHARE (Waves 1, 2, 4, 5 and 6). Precisely, the ones in easySHARE release 6.1.0 (Börsch-Supan et al, 2018).3 Data collection ran in the periods 2004-2005, 2006-2007, 2011-2012 the longitudinal approach of the study led us to retain only the 9 countries whose respondents participated in all the considered waves.…”

Prevalencia de depresión en el adulto mayor que asiste al Centro Municipal Gerontológico, 2013

“…Dentro de esta población van a existir diferentes respuestas, ya sean favorables o inadecuadas, frente a estos cambios. La depresión es uno de los trastornos mentales de mayor complejidad, ya que en el adulto mayor tiene una estrecha relación con factores propios de esta edad, como la dependencia, el deterioro de las funciones cognitivas y el bienestar (Nance, 2010); además de los costos económicos y dificultades en el cuidado del adulto mayor deprimido (Ladin, 2012). En Ecuador, de acuerdo a la Encuesta de Salud, Bienestar y Envejecimiento (SABE, 2009(SABE, -2010 el 39% de los adultos mayores de 75 años tienen depresión leve o moderada.…”

Identifying effects of health and long-term care policies through cross-national analysis

“…They are concerned with the individual and welfare state contexts of providing care. The papers by Schmid et al (2012), and by Geerts and Van den Bosch (2012) look at support and care for the oldest old, while the papers by Jusot et al (2012), and by Ladin (2012) analyze preventive and general health care utilization. They all use variants of multilevel analysis as is appropriate for a crossnational data set like SHARE.…”

“…Health care costs are increasing, not as dramatically in Europe as in the US, but still creating a large implicit debt since the current service promises made by public and private health insurances cannot be covered by the stream of future taxes and contributions at today's tax and contribution rates. The papers by Jusot et al (2012) and by Ladin (2012) are concerned with the quantity dimension of health care costs, namely the utilization of health services. (The price dimension is particularly relevant for the US.)…”

“…Country differences in health care utilization are also the topic of the paper by Ladin (2012), with her specific interest in understanding why the difference in health care utilization among depressed and non-depressed elders is country dependent. Ladin adds another aspect to country differences: differences in prevalence and differences in impact of potential drivers of country variation.…”