Is the impact of depressive complaints on the use of general health care services dependent on severity of somatic morbidity?
OBJECTIVE
The aim of this study was to examine the effects of depressive complaints and chronic medical illnesses on prospective somatic health care utilization and the possible heterogeneity of the effect of depressive complaints across levels of medical illness severity.


METHODS
Data from a community-based sample of adults (n=9428) were used, of whom a health survey and claims data, indicating health care use, were available. Assessments of depressive complaints and somatic illnesses were based on self-report. Binomial regression analyses were used to study the expected relations.


RESULTS
Depressive complaints and somatic morbidity were both positively related to general health care utilization. Somatic morbidity has an attenuating effect on the impact of depressive complaints: If it becomes more severe, the impact of depressive complaints on utilization is reduced. Depressive complaints are especially related to the use of paramedic services, use of prescription drugs, and consultations of medical specialists.


CONCLUSIONS
Depressive complaints predict somatic health care utilization, but somatic morbidity attenuates this relation. Future research on this subject should include interaction effects of depressive complaints and somatic morbidity. Interventions aiming to reduce excess use related to mental distress should be primarily targeted on subjects with mental distress who have no comorbid somatic morbidity.
Koopmans
Gerrit T
GT
Department of Health Policy and Management, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. g.koopmans@erasmusmc.nl
Lamers
Leida M
LM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology; D003153:Community Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D004185:Disability Evaluation; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006306:Health Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013001:Somatoform Disorders / Q000453:epidemiology* / Q000523:psychology; D013038:Specialization; D013223:Statistics as Topic; D014600:Utilization Review