Association of higher costs with symptoms and diagnosis of depression.
OBJECTIVE
We examined the relationships among depressive symptoms, physician diagnosis of depression, and charges for care.


METHODS
We used a prospective observational design.


METHODS
Five hundred eight new adult patients were randomly assigned to senior residents in family practice and internal medicine.


METHODS
Self-reports of health status assessment (Medical Outcomes Study Short Form-36) and depressive symptoms (Beck Depression Inventory) were determined at study entry and at 1-year follow-up. Physician diagnosis of depression was determined by chart audit; charges for care were monitored electronically.


RESULTS
Symptoms of depression and the diagnosis of depression were associated with charges for care. Statistical models were developed to identify predictors for the occurrence and magnitude of medical charges. Neither depressive symptoms nor diagnosis of depression significantly predicted the occurrence of charges in the areas studied, but physician diagnosis of depression predicted the magnitude of primary care and total charges.


CONCLUSIONS
A complex relationship exists among depressive symptoms, the diagnosis of depression, and charges for medical care. Understanding these relationships may help primary care physicians diagnose depression and deliver primary care to depressed patients more effectively while managing health care expenditures.
Callahan
Edward J
EJ
Center for Health Service Research in Primary Care and Department of Family & Community Medicine, University of California at Davis, 4860 Y Street, Sacramento, CA 95817, USA. ejcallahan@ucdavis.edu
Bertakis
Klea D
KD
Azari
Rahman
R
Robbins
John A
JA
Helms
L Jay
LJ
Leigh
J Paul
JP
D003863:Depression / Q000175:diagnosis / Q000191:economics*; D005194:Family Practice / Q000191:economics*; D005251:Fees, Medical; D017048:Health Care Costs; D006801:Humans; D007388:Internal Medicine / Q000191:economics*; D015233:Models, Statistical; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011897:Random Allocation; D012044:Regression Analysis