Depressive Symptoms and Total Healthcare Costs: Roles of Functional Limitations and Multimorbidity

Abstract

OBJECTIVES Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity. DESIGN Prospective cohort study (Study of Osteoporotic Fractures [SOF]). SETTING Four US sites. PARTICIPANTS A total of 2508 community‐dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data. MEASUREMENTS At Y10, depressive symptoms were measured using the 15‐item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0‐5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data. RESULTS Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0‐1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2‐5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self‐reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14‐1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99‐1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms). CONCLUSION Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs. J Am Geriatr Soc 67:1596–1603, 2019

Changes in Health Care Use Among Undocumented Patients, 2014-2018

“… 18 The Elixhauser comorbidity index is a widely used comorbidity classification system developed for use with administrative data and has been validated as a predictor of inpatient mortality and health care use outcomes. 19 , 20 , 21 Our model is represented by the following formula: ln( μ ij ) = β 0 + β 1 Cohort i + β 2 Prepost ij + β 3 Cohort i × Prepost ij + β 4 BirthYear i + β 5 Gender i + β 6 Elixhauser i + β 7 Gender i × Prepost ij + β 8 BirthYear i × Prepost ij + ln(time ij ), where the outcome μ specifies the number of encounters, the i subscript refers to each individual, and the j subscript specifies the period (ie, pre- or postannouncement). The offset for no-show and cancellation rates is ln(number of scheduled visits) instead of ln ( time).…”

Functional limitations in people with multimorbidity and the association with mental health conditions: Baseline data from the Canadian Longitudinal Study on Aging (CLSA)

“…Higher functional limitation and multimorbidity in those with mental health disorders has also been reported in the recent literature. For example, Schousboe et al [ 19 ] found that for a Geriatric Depression Score of 0–1 versus 6+, the proportion with 4+ medical conditions increased from 16% to 33% and the proportion with IADL impairments rose from 14% to 58%. Similarly, a meta-analysis of population data involving 190,593 people across 43 low and middle-income countries reported odds of multimorbidity of 2.62 versus 3.44 for those with no depression versus those with depressive episodes [ 56 ].…”

“…Two recent Canadian studies provide supportive evidence of the negative effects of mental and physical co-morbidity: Guerra et al [ 16 ] reported higher odds of IADL disability for multimorbidity clusters that included mental health conditions compared to those without in a study of older adults from Quebec (Canada), and Dai et al’s study of a nationally-representative population [ 37 ] found that in people with the same number of chronic conditions those with mental disorders or physical and mental comorbidity showed higher prevalence of functional limitations (impaired HRQoL, higher service use). Studies from other countries show similar effects for functional limitations [ 57 ] and related outcomes such as frailty [ 23 ], HRQoL [ 12 , 13 , 57 ], subjective well-being [ 33 ], and service use/cost [ 19 ].…”

“…Research suggests that the clustering of mental health disorders with physical comorbidities adds to the complexity of functional limitation. For example, mental health conditions have been shown to affect a range of outcomes including functional limitations and disability in people with multimorbidity, due in part to these conditions being a substantial burden in their own right [ 18 , 19 ]. Disease clusters that include depressive symptoms were associated with the highest level of disability in the study by Quinones et al [ 11 ] and linked to increased future disability risk in longitudinal research [ 20 ].…”

Multimorbidity in General Practice: Unmet Care Needs From a Patient Perspective

“…Besides physical issues, there are often psychological, social, and cognitive problems ( 2 ). Furthermore, multimorbid patients have a poorer quality of life and higher health care utilization than patients with one chronic disease ( 3 ).…”