title: Depressive symptoms predict medical care utilization in a population-based sample.
abstract: BACKGROUND
  Several examinations have detected a relation between depressive symptoms and medical utilization. However, selection biases have been involved in most previous examinations. We sought to test the association between depressive symptoms and prospective, increased medical care utilization, in a population-based Canadian sample, while controlling for utilization due to medical illness and controlling for selection bias.
  
  
  METHODS
  Data from the Nova Scotia Health Survey 1995, an age- and sex-stratified random sampling of 3227 Nova Scotian adults, included the Center for Epidemiological Studies-Depression scale and items assessing chronic medical conditions and current limitations in daily activities resulting from medical illness. We linked survey data with medical care utilization measures for the year following the survey, including out-patient visits, reimbursement for out-patient services, hospitalizations, and hospitalization days.
  
  
  RESULTS
  After controlling for age, sex, count of medical diagnoses and current medical severity, those with a greater level of depressive symptoms were at greater risk of having increased medical care utilization in the following year. These results remained after removing mental health care utilization costs.
  
  
  CONCLUSIONS
  In a population-based sample, depressive symptoms predicted greater medical care utilization, independent of a number of medical severity measures. Whether depressive symptoms are a risk marker or a causal risk factor for increased medical utilization remains to be explored.
authors.affiliation: Department of Psychology, University of Alabama, Tuscaloosa, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Rowan
authors.forename: K
authors.initials: K
authors.lastname: Davidson
authors.forename: J A
authors.initials: JA
authors.lastname: Campbell
authors.forename: D G
authors.initials: DG
authors.lastname: Dobrez
authors.forename: D R
authors.initials: DR
authors.lastname: MacLean
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D009674:Nova Scotia / Q000453:epidemiology; D010555:Personality Inventory; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D014600:Utilization Review / Q000706:statistics & numerical data