The profiles of health care utilization among a non-depressed population and patients with depressive symptoms with and without clinical depression

Abstract

Objective: To examine health service (HS) utilization profiles among a non-depressive population and patients with depressive symptoms (DS) with and without clinical depression. Design, subjects and setting: The study population was based on primary care patients with DS scoring ≥10 in the 21-item Beck Depression Inventory (BDI) and who were at least 35 years old and had been referred to depression nurse case managers ( n = 705). Their psychiatric diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (M.I.N.I.). Of these patients, 447 had clinical depression. The number of patients with DS without clinical depression was 258. The control group consisted of a random sample of 414 residents with a BDI score < 10. Use of HS (visits and phone calls to a doctor and a nurse) was based on patient records. Main outcome measures: Number of visits and calls to physicians and nurses. Results: Patients with DS regardless of their depression diagnosis used primary health care (PHC) services three times more than the controls ( p < 0.001). In the secondary care, the differences were smaller but significant. Of the controls, 70% had 0–4 HS contacts per year whereas a majority of the patients having DS had more than 5 contacts per year. The number of contacts correlated with the BDI from a score of 0 to 10 but not as clearly in the higher scores. Conclusion: Depressive symptoms, both with or without clinical depression, are associated with increased HS use, especially in PHC. This study suggests that even mild depressive symptoms are associated with an increased use of HS. KEY POINTS We analyzed the health service (HS) use among primary health care patients screened for depression and non-depressive population. Screen positive patients without clinical depression used as much HS as those having clinical depression. Regardless of depression diagnosis, screen positive patients visited a GP and nurse three times more often than the control population. In the screen negative control population, milder depressive symptoms were correlated with the use of HS. Primary health care was responsible for most of the HS use among patients having depressive symptoms.

Depression and cardiovascular disease are not linked by high blood pressure: findings from the SAPALDIA cohort

“…Our findings are consistent with the large body of evidence on the association between depression and the incidence of hypertension, which often includes hypertension diagnosis solely or as part of its definition 15 , 16 , 18 , 48 , 49 . We interpret our findings as an indication that people with depression are more likely to have underlying hypertension diagnosed, likely mediated by increased healthcare-seeking behaviour 28 . We could not adjust for healthcare utilization in our study because data collection on health-seeking behaviours began in SAPALDIA4.…”

“…However, many people remain unaware that they have high BP, especially if they do not experience symptoms and fail to get a diagnosis. Depression is associated with higher healthcare utilization 28 , thus people living with depression might be more likely to have underlying hypertension diagnosed than those without depression.…”

A prospective observational study exploring the association of comorbid chronic health conditions with total healthcare expenditure in people with mental health conditions in an Asian setting

“…Though past literature has consistently included age as a covariate in the analyses of healthcare utilization and costs related to MHC [ 4 , 5 , 19 ], none have described the varying association of age with total healthcare expenditure in those with and without MHC. To the best of our knowledge, we are the first to report differences in the pattern of association of age with total and specific types of healthcare expenditure in respondents with and without MHC.…”

“…While respondents with MHC in the 35–49 years age group had lower SOC and PC related healthcare expenditure as compared to those in the 18–34 years age group, this was not statistically significant. A recent study from Finland compared the PC utilization in those with depressive symptoms versus those without, using a matched control study design and reported those with MHC to have 3 times higher use of primary health care services as compared to those without depressive symptoms [ 19 ]. The difference in primary care utilization pattern across both studies could be due to relatively older participants (with a mean age of 51 years) in this study who may be either more open to seeking care for MHC (as compared to respondents in our study who had a mean age of 38.6 years) or may have more regular touchpoints with the healthcare system due to age-related healthcare needs.…”

“…The model specifications were informed by prior literature on healthcare expenditures [ 16 – 18 ]. The selection of covariates was guided by clinical relevance, information availability and prior literature [ 4 , 5 , 19 ]. Model 1 or unadjusted base model included only MHC variable as the independent variable and total healthcare expenditure as the dependent variable.…”