title: Insured and non-insured depressed outpatients: how do they compare?
abstract: BACKGROUND
  The purpose of this study was to examine associations between clinical and demographic characteristics of depressed patients and source of payment for care. We attempted to confirm and extend findings from a previous study regarding the first 1500 participants enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with 2541 participants enrolled in later stages of the trial.
  
  
  METHODS
  Demographic, clinical, and presenting symptom features were compared among participants with public, private or no insurance.
  
  
  RESULTS
  Compared to those having private or no insurance, participants with public insurance were older; more likely to be women, Hispanic, widowed or divorced, unemployed, and less educated; were more frequently seen in primary care; had greater medical comorbidity and functional impairment, and a later age of depression onset. The publicly insured also had a longer current episode, but fewer episodes over their lifetime. Both the publicly insured and the uninsured had poorer life satisfaction compared to those with private insurance. Participants without insurance were intermediate between those with public and private insurance regarding several demographic characteristics and measures of severity.
  
  
  CONCLUSIONS
  Depressed outpatients with public insurance demonstrated greater functional impairment, though they did not have a more severe depression per se. Participants without insurance seemed to be a heterogeneous group with a presentation intermediate between those with public and private insurance. Those with public insurance were overrepresented in primary care clinics; therefore, clinicians in these settings need to be particularly vigilant in recognizing depression and offering appropriate treatments.
authors.affiliation: Department of Psychiatry, Harbor-UCLA Medical Center, The Los Angeles Biomedical Research Institute, Los Angeles, CA, USA. ILesser@ladhs.org
authors.forename: Ira M
authors.initials: IM
authors.lastname: Lesser
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Leuchter
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Lori L
authors.initials: LL
authors.lastname: Davis
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: G K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015283:Citalopram / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007358:Insurance, Psychiatric / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D017060:Patient Satisfaction; D010552:Personality Assessment; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram