Depressive Symptoms and the Cost of Health Services in HMO Patients Aged 65 Years and Older

Unützer, Jürgen

doi:10.1001/jama.1997.03540440052032

Cited by 547 publications

(144 citation statements)

References 61 publications

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“…Contrary to our findings within the sample of healthy individuals, a greater proportion of younger patients with long-term medical conditions presented GHQ scores indicative of severe psychological distress. Although studies in the general population that included medical comorbidity as a covariate reported that young people experience a higher prevalence of psychological distress than older groups irrespective of the presence of chronic conditions [21], studies in the primary care setting provided evidence that younger patients may be more vulnerable to psychological distress, in line with the present findings [50][51][52]. Our findings are further supported by a study from eight US primary care sites [20].…”

Section: Discussionsupporting

confidence: 89%

Does psychological distress vary between younger and older adults in health and disease?

Goulia

Papadimitriou

Machado

et al. 2012

Journal of Psychosomatic Research

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Section: Discussionsupporting

confidence: 89%

Does psychological distress vary between younger and older adults in health and disease?

Goulia

Papadimitriou

Machado

et al. 2012

Journal of Psychosomatic Research

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“…[28][29][30][31] As a result, depression remains a difficult condition to treat. 32 Thus, preventing depression may be more sensible, and perhaps more cost-effective, than waiting to treat it once it occurs or failing to treat it at all.…”

Section: Commentmentioning

confidence: 99%

Preventing Depression in Age-Related Macular Degeneration

Rovner¹,

Casten²,

Hegel³

et al. 2007

Arch Gen Psychiatry

161

172

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Context: Age-related macular degeneration is a prevalent disease of aging that may cause irreversible vision loss, disability, and depression. The latter is rarely recognized or treated in ophthalmologic settings.Objective: To determine whether problem-solving treatment can prevent depressive disorders in patients with recent vision loss.Design: Randomized, controlled trial.Setting: Outpatient ophthalmology offices in Philadelphia, Pennsylvania.Patients: Two hundred six patients aged 65 years or older with recent diagnoses of neovascular age-related macular degeneration in one eye and pre-existing age-related macular degeneration in the fellow eye.Intervention: Patients were randomly assigned to problem-solving treatment (n = 105) or usual care (n=101). Problem-solving treatment therapists delivered 6 sessions during 8 weeks in subjects' homes. Main Outcome Measures:Outcomes were assessed at 2 months for short-term effects and 6 months for maintenance effects. These included DSM-IV-defined diagnoses of depressive disorders, National Eye Institute Vision Function Questionnaire-17 scores, and rates of relinquishing valued activities.Results: The 2-month incidence rate of depressive disorders in problem-solving-treated subjects was significantly lower than controls (11.6% vs 23.2%, respectively; odds ratio, 0.39; 95% confidence interval, 0.17-0.92; P=.03). Problem-solving treatment also reduced the odds of relinquishing a valued activity (odds ratio, 0.48; 95% confidence interval, 0.25-0.96; P =.04). This effect mediated the relationship between treatment group and depression. By 6 months, most earlier observed benefits had diminished, though problem-solving treatment subjects were less likely to suffer persistent depression ( 2 1,3 =8.46; P =.04). Conclusions: Problem-solving treatment prevented depressive disorders and loss of valued activities in patients with age-related macular degeneration as a shortterm treatment, but these benefits were not maintained over time. Booster or rescue treatments may be necessary to sustain problem-solving treatment's preventative effect. This study adds important new information to the emerging field of enhanced-care models to prevent or treat depression in older persons.Trial Registration: clinicaltrials.gov Identifier: NCT00042211 Arch Gen Psychiatry. 2007;64(8):886-892

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“…Depression burdens nearly one in six persons over age 65 with substantial morbidity, mortality, and costs (1)(2)(3). Although treatment consists almost entirely of antidepressants (4,5), pharmacotherapy for depression among older populations can be problematic (6,7).…”

mentioning

confidence: 99%

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

Wang¹,

Patrick²,

Dormuth³

et al. 2008

Psychiatric Services

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Objective-Antidepressant therapies are underused among older adults and could be further curtailed by patient cost-sharing requirements. The authors studied the effects of two sequential costsharing policies in a large, stable population of all British Columbia seniors: change from full prescription coverage to $10-$25 copayments (copay) in January 2002 and replacement with incomebased deductibles and 25% coinsurance in May 2003.Methods-PharmaNet data were used to calculate monthly dispensing of antidepressants (in imipramine-equivalent milligrams) among all British Columbia residents age 65 and older beginning January 1997 through December 2005. Monthly rates of starting and stopping antidepressants were calculated. Population-level patterns over time were plotted, and the effects of implementing costsharing policies on antidepressant use, initiation, and stopping were examined in segmented linear regression models.Results-Implementation of the copay policy was not associated with significant changes in level of antidepressant dispensing or the rate of dispensing growth. Subsequent implementation of the income-based deductible policy also did not lead to a significant change in dispensing level but led to a significant (p=.02) decrease in the rate of growth of antidepressant dispensing. The copay policy was associated with a significant (p=.01) drop in the frequency of antidepressant initiation among persons with depression. Income-based deductibles reduced the rate of increase in antidepressant This research was presented in a poster session at the 22nd

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Depressive Symptoms and the Cost of Health Services in HMO Patients Aged 65 Years and Older

Abstract: Depressive symptoms in older adults are associated with a significant increase in the cost of medical services, even after adjusting for the severity of chronic medical illness.

Cited by 547 publications

References 61 publications

Does psychological distress vary between younger and older adults in health and disease?

Does psychological distress vary between younger and older adults in health and disease?

Preventing Depression in Age-Related Macular Degeneration

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

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