Identifying depressive symptoms among elderly Medicare HMO enrollees

Increasing attention has been devoted to the urgent need for identifying depressive symptomatology at the primary care point of contact for older individuals to prevent more serious disease and potential negative behavioral outcomes. Delivering medical care services in a system that is sensitive to the symptoms of depression may lead to greater cost-effectiveness and improved quality of life. This paper examines the correlates of depression in a random sample of 1800 Medicare beneficiaries enrolled in a risk-sharing HMO. Ten percent of the total sample reported a high degree of depressive symptoms, as measured by the CES-D score. The prevalence of depressive symptoms was significantly higher for those who were not married, reported less well-developed social support networks, had low perceived ability to control future health, or had poorer health status. Depressive symptoms were also associated with a greater number of physician office visits and higher ambulatory charges, although no significant relationship was found for inpatient use or total charges. Practical approaches to monitoring depressive symptomatology at the primary care level in an HMO are suggested.