This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (88)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Depression  • Alert me on articles by topic  Social Bookmarking   What's this?

Wayne J. Katon, MD; Elizabeth Lin, MD, MPH; Joan Russo, PhD; Jürgen Unützer, MD, MPH

Arch Gen Psychiatry. 2003;60:897-903.

Background  We examined whether older adults with depressive symptoms below the diagnostic threshold and those with DSM-IV major depression and/or dysthymia have higher medical costs than those without depression.

Methods  We mailed the PRIME-MD 2-item depression screen to the patients of 2 large primary care clinics of a staff-model health maintenance organization in Seattle, Wash. All 11 679 patients 60 years and older with primary care providers at the participating clinics were included, and 8894 (76.2%) were successfully enrolled. An additional 107 patients were referred to the study by their primary care physician. Nonrespondents were slightly younger and had higher inpatient medical costs in the previous 6 months. Patients with positive findings on at least 1 item or referred by their family physician were offered an interview with the Structured Clinical Interview for DSM-IV. The total cost of medical services for the 6 months before the study was obtained from the cost accounting system of the health maintenance organization.

Results  Total ambulatory costs were 43% to 52% higher and total ambulatory and inpatient costs were 47% to 51% higher in depressed compared with nondepressed elderly patients after adjustment for chronic medical illness. This increase was seen in every component of health care costs, with only a small percentage due to mental health treatment. In mean costs, depressed elderly patients averaged an increase of $763 to $979 in ambulatory costs and $1045 to $1700 in ambulatory and inpatient costs. No differences in costs were noted between patients with subthreshold depressive syndromes and those with DSM-IV depressive disorders.

Conclusion  Depressive symptoms and DSM-IV depressive disorders in elderly patients are associated with significantly higher health care costs, even after adjustment for chronic medical illness.

From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (Drs Katon and Russo), and the Center for Health Studies, Group Health Cooperative of Puget Sound (Dr Lin), Seattle; and the Center for Health Services Research, University of California–Los Angeles Neuropsychiatric Institute (Dr Unützer). Dr Lin is a consultant for Pfizer Inc and Innovative Medical Education.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Structural Relationships Between Social Activities and Longitudinal Trajectories of Depression Among Older Adults
Hong et al.
The Gerontologist 2009;0:gnp006v1-gnp006.
ABSTRACT | FULL TEXT  

Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs
Arnow et al.
Psychiatr. Serv. 2009;60:344-350.
ABSTRACT | FULL TEXT  

Effects of Changes in Depressive Symptoms and Cognitive Functioning on Physical Disability in Home Care Elders
Li and Conwell
J Gerontol A Biol Sci Med Sci 2009;0:gln023v1-gln023.
ABSTRACT | FULL TEXT  

Depression and cardiovascular health care costs among women with suspected myocardial ischemia: prospective results from the WISE (Women's Ischemia Syndrome Evaluation) Study.
Rutledge et al.
J Am Coll Cardiol 2009;53:176-183.
ABSTRACT | FULL TEXT  

Untangling the Complexities of Depression Diagnosis in Older Cancer Patients
Weinberger et al.
The Oncologist 2009;14:60-66.
ABSTRACT | FULL TEXT  

Economic Grand Rounds: Financial Burden of Medical Care and Risk of Forgoing Care Among Europeans With Depressive Symptoms
Peytremann-Bridevaux and Chevrou-Severac
Psychiatr. Serv. 2008;59:840-842.
ABSTRACT | FULL TEXT  

Major Depression and Disability in Older Primary Care Patients With Heart Failure
Friedman et al.
J Geriatr Psychiatry Neurol 2008;21:111-122.
ABSTRACT  

Higher Burden of Depression Among Older Women: The Effect of Onset, Persistence, and Mortality Over Time
Barry et al.
Arch Gen Psychiatry 2008;65:172-178.
ABSTRACT | FULL TEXT  

"Keeping the Bully Out": Understanding Older African Americans' Beliefs and Attitudes Toward Depression
Shellman et al.
J Am Psychiatr Nurses Assoc 2007;13:230-236.
ABSTRACT  

Opportunities for Cost-effective Prevention of Late-Life Depression: An Epidemiological Approach.
Smit et al.
Arch Gen Psychiatry 2006;63:290-296.
ABSTRACT | FULL TEXT  

Cost-Effectiveness and Net Benefit of Enhanced Treatment of Depression for Older Adults With Diabetes and Depression
Katon et al.
Diabetes Care 2006;29:265-270.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Improving Primary Care Treatment of Late-Life Depression
Katon et al.
Arch Gen Psychiatry 2005;62:1313-1320.
ABSTRACT | FULL TEXT  

Depressive Symptoms and Prospective Incidence of Colorectal Cancer in Women
Kroenke et al.
Am J Epidemiol 2005;162:839-848.
ABSTRACT | FULL TEXT  

Long-term Risk for Depressive Symptoms After a Medical Diagnosis
Polsky et al.
Arch Intern Med 2005;165:1260-1266.
ABSTRACT | FULL TEXT  

Black-White Differences in Depressive Symptoms Among Older Adults Over Time
Skarupski et al.
Journals of Gerontology Series B: Psychological Sciences and Social Science 2005;60:P136-P142.
ABSTRACT | FULL TEXT  

Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care
Lin et al.
Diabetes Care 2004;27:2154-2160.
ABSTRACT | FULL TEXT  

Community-Integrated Home-Based Depression Treatment in Older Adults: A Randomized Controlled Trial
Ciechanowski et al.
JAMA 2004;291:1569-1577.
ABSTRACT | FULL TEXT  

Depression Raises Medical Costs
JWatch Psychiatry 2004;2004:9-9.
FULL TEXT  

Depression Raises Medical Costs
JWatch Women's Health 2003;2003:7-7.
FULL TEXT