title: Association between parental depression and children's health care use.
abstract: OBJECTIVE
  The objective of this study was to determine the association between parental depression and pediatric health care use patterns.
  
  
  METHODS
  We selected all children who were 0 to 17 years of age, enrolled in Kaiser Permanente of Colorado during the study period July 1997 to December 2002, and linked to at least 1 parent/subscriber who was enrolled for at least 6 months during that period. Unexposed children were selected from a pool of children whose parents did not have a depression diagnosis. Outcome measures were derived from the child's payment files and electronic medical charts and included 5 categories of use: well-child-care visits, sick visits to primary care departments, specialty clinic visits, emergency department visits, and inpatient visits. We compared the rate of use per enrollment month for these 5 categories between exposed and unexposed children within each of the 5 age strata.
  
  
  RESULTS
  Our study population had 24,391 exposed and 45,274 age-matched, unexposed children. For the outcome of well-child-care visits, teenagers showed decreased rates of visits among exposed children. The rate of specialty department visits was higher in exposed children in the 4 oldest age groups. The rates of both emergency department visits and sick visits to primary care departments were higher for exposed children across all 5 age categories. The rate of inpatient visits was higher among exposed children in 2 of the 5 age groups.
  
  
  CONCLUSIONS
  Overall, having at least 1 depressed parent is associated with greater rate of emergency department and sick visits across all age groups, greater use of inpatient and specialty services in some age groups, and a lower rate of well-child-care visits among 13- to 17-year-olds. This pattern of increased use of expensive resources and decreased use of preventive services represents one of the hidden costs of adult depression.
authors.affiliation: Department of Pediatrics, University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80218, USA. sills.marion@tchden.org
authors.forename: Marion R
authors.initials: MR
authors.lastname: Sills
authors.forename: Susan
authors.initials: S
authors.lastname: Shetterly
authors.forename: Stanley
authors.initials: S
authors.lastname: Xu
authors.forename: David
authors.initials: D
authors.lastname: Magid
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003695:Delivery of Health Care; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D010287:Parent-Child Relations; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors