Related Experiment Videos
Depression among high utilizers of medical care
S D Pearson1, D J Katzelnick, G E Simon
1Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Boston, MA 02215, USA.
Insights
Many high-utilizing medical patients have untreated or undertreated depression, increasing healthcare resource use. Those without nonspecific complaints had lower depression risk, suggesting a potential screening opportunity.
Area of Science:
- Healthcare utilization research
- Mental health services research
- Primary care research
Background:
- High medical care utilizers often have undiagnosed or undertreated depression.
- Depression significantly impacts patient health and healthcare resource consumption.
- Understanding the link between depression, comorbidities, and utilization is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of unrecognized or unsuccessfully treated depression among high medical care utilizers.
- To describe the relationship between depression, medical comorbidities, and healthcare resource utilization in this population.
Main Methods:
- A survey methodology was employed across three Health Maintenance Organizations (HMOs) in the United States.
- 10,461 high-utilizing patients meeting eligibility criteria underwent depression screening using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
- Data on medical comorbidities and healthcare resource utilization (office visits, hospital days) were collected.
Main Results:
- 20.3% of high utilizers screened positive for current major depression or major depression in partial remission.
- Among those with depression, 42.4% had recent mental health specialist contact or a depression diagnosis.
- Depressed high utilizers demonstrated significantly higher annual office visits and hospital days compared to non-depressed individuals.
Conclusions:
- A substantial proportion of high medical care utilizers experience active depression, often unrecognized or inadequately treated.
- The absence of visits for nonspecific complaints was associated with a lower risk of depression.
- Depression is a significant factor contributing to increased healthcare resource utilization among high-need patients.
Objective:
To determine the prevalence of unrecognized or unsuccessfully treated depression among high utilizers of medical care, and to describe the relation between depression, medical comorbidities, and resource utilization.
Design:
Survey.
Setting:
Three HMOs located in different geographic regions of the United States.
Patients:
A total of 12,773 HMO members were identified as high utilizers. Eligibility criteria for depression screening were met by 10,461 patients.
Measurements And Main Results:
Depression status was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Depression screening was completed in 7,203 patients who were high utilizers of medical care, of whom 1,465 (20.3%) screened positive for current major depression or major depression in partial remission. Among depressed patients, 621 (42.4%) had had a visit with a mental health specialist or a diagnosis of depression or both within the previous 2 years. The prevalence of well-defined medical conditions was the same in patients with and patients without evidence of depression (41.5% vs 41.5%, p = .87). However, high-utilizing patients who had not made a visit for a nonspecific complaint during the previous 2 years were at significantly lower risk of depression (13.1% vs 22.4%, p < .001). Patients with current depression or depression in partial remission had significantly higher numbers of annual office visits and hospital days per 1,000 than patients without depression.
Conclusions:
Although there was evidence that mental health problems had previously been recognized in many of the patients, a large percentage of high utilizers still suffered from active depression that either went unrecognized or was not being treated successfully. Patients who had not made visits for nonspecific complaints were at significantly lower risk of depression. Depression among high utilizers was associated with higher resource utilization.