This
article appeared in Aging Today, January/February 1998, copyright American
Society on Aging, 1998. It appeared in the newspaper's Research Today section,
aupported by a grant from the AARP Andrus
Foundation.
Study Reveals 50% Jump
DEPRESSION RAISES MEDICAL COSTS
Older patients reporting symptoms of depression incur medical expenses about 50% higher than those of older patients who are not depressed, according to research led by Jürgen Unützer of the University of Washington, Seattle. The four-year study included 2,558 Medicare patients.
Even after adjusting for the severity of chronic medical illness, "in this cohort of older adults, depressive symptoms were common, persistent and associated with a significant increase in the cost of general medical services," Unützer wrote in the May 28, 1997, issue of the Journal of the American Medical Association. "Patients with significant depressive symptoms at baseline had higher median costs during the first year after the baseline survey ($2,147) than patients without depressive symptoms ($1,461)."
The subjects, all aged 65 or more, were receiving care at outpatient clinics of the Group Health Cooperative of Puget Sound, a large health maintenance organization (HMO) in western Washington state. Because all of the patients belonged to an HMO with a very accurate cost accounting system, the research team was able to identify virtually all of the healthcare services used by the study's participants, according to Unützer.
20 QUESTIONS
The patients answered 20 questions that assess common aspects of depression, using a survey instrument known as the Center for Epidemiological Studies Depression Scale (CES-D--a questionnaire developed to screen for depressive disorders in primary care settings. When the study began, 14% of the patients had scores of 16 or higher on the CES-D, which is generally regarded as the threshold for significant symptoms of depression. Four years later, the researchers found that the proportion had grown to 18%.
"It is likely that improved recognition and treatment of depressive disorders in primary care would improve the quality of life for those with depression," said the authors, adding that "improved care of depressed patients may not be cheaper than current treatments, but it may be more cost-effective" because of better health outcomes.