title: Depression in veterans with Parkinson's disease: frequency, co-morbidity, and healthcare utilization.
abstract: OBJECTIVE
  To determine the frequency of depression in Parkinson's disease (PD) in routine clinical care, and to examine its association with co-morbid psychiatric and medical conditions and healthcare utilization.
  
  
  METHODS
  Depression diagnoses and healthcare utilization data for all male veterans with PD age 55 or older seen in fiscal year 2002 (n = 41,162) were analyzed using Department of Veterans Affairs (VA) national databases. Frequencies of co-morbid disorders and healthcare utilization were determined for depressed and non-depressed patients; associations with depression were examined using multivariate logistic regression models.
  
  
  RESULTS
  A depression diagnosis was recorded for 18.5% of PD patients, including major depression in 3.9%. Depression decreased in frequency and severity with increasing age. In multivariate logistic regression models, depressed patients had significantly greater psychiatric and medical co-morbidity, including dementia, psychosis, stroke, congestive heart failure, diabetes, and chronic obstructive pulmonary disease than non-depressed patients (all p < 0.01). Depressed PD patients were also significantly more likely to have medical (OR = 1.34, 95% CI = 1.25-1.44) and psychiatric hospitalizations (OR = 2.14, 95% CI = 1.83-2.51), and had more outpatient visits (p < 0.01), than non-depressed PD patients in adjusted models.
  
  
  CONCLUSIONS
  Depression in PD in non-tertiary care settings may not be as common or as severe as that seen in specialty care, though these findings also may reflect under-recognition or diagnostic imprecision. The occurrence of depression in PD is associated with greater psychiatric and medical co-morbidity, and greater healthcare utilization. These findings suggest that screening for depression in PD is important and should be embedded in a comprehensive psychiatric, neuropsychological, and medical evaluation.
authors.affiliation: Division of Geriatric Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. Peijun.chen@med.va.gov
authors.forename: Peijun
authors.initials: P
authors.lastname: Chen
authors.forename: Helen C
authors.initials: HC
authors.lastname: Kales
authors.forename: Daniel
authors.initials: D
authors.lastname: Weintraub
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.forename: Lan
authors.initials: L
authors.lastname: Jiang
authors.forename: Rosalinda V
authors.initials: RV
authors.lastname: Ignacio
authors.forename: Alan M
authors.initials: AM
authors.lastname: Mellow
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology* / Q000523:psychology; D010343:Patient Admission / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*