The Maudsley long-term follow-up of child and adolescent depression. Predicting costs in adulthood.
BACKGROUND
Little is known about the long-term economic impact of childhood depression. The aim of this study is to identify and examine the links between the characteristics of children with depression and the costs of services used in adulthood.


METHODS
Subjects (N=149) who had attended psychiatric services in South London for depression were followed up on average 20.7 years later. Sociodemographic and illness characteristics were recorded in childhood and service use in adulthood was measured. Costs were calculated and multiple regression models were developed to explain variations in cost, with a comparison between ordinary least squares estimation and a generalised linear model.


RESULTS
Service use and cost data were available on 140 subjects. The mean annual cost was 890 pounds Sterling (range 0 pounds Sterling-7532 pounds Sterling). Predictors of cost variations in both models were age at initial referral, level of childhood anxiety, and the presence of comorbid conduct disorder. In the ordinary least squares model, a family history of psychiatric illness was inversely related to cost, whilst in the generalised linear model there was an inverse link between peer/sibling relationship problems and costs. The models could explain 24 % and 20% of cost variation, respectively.


CONCLUSIONS
It is possible to explain a reasonable amount of variation in adult service costs from factors describing the characteristics of children at the time of receiving care.
McCrone
Paul
P
Centre for the Economics of Mental Health, Health Services Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.
Knapp
Martin
M
Fombonne
Eric
E
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D015897:Comorbidity; D003866:Depressive Disorder / Q000191:economics* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011379:Prognosis; D012017:Referral and Consultation