The relationship between depressive symptoms in outpatients with chronic illness and health care costs.
OBJECTIVE
To evaluate the relationship between depressive symptoms and health care costs in outpatients with chronic medical illnesses in Korea, we screened for depressive symptoms in 1,118 patients with a chronic medical illness and compared the severity of somatic symptoms and health care costs.


METHODS
Data were compared between outpatients with depressive symptoms and those without depressive symptoms. Depression and somatic symptoms were measured by Zung's Self-rating Depression Scale (SDS) and Patient Health Questionnaire (PHQ)-15, respectively. We also investigated additional data related to patients' health care costs (number of visited clinical departments, number of visits made per patients, and health care costs). A total of 468 patients (41.9%) met the criteria for depressive disorder.


RESULTS
A high rate of severe depressive symptoms was found in elderly, female and less-educated patients. A positive association between the severity of somatic symptoms and depressive symptoms was also identified. The effects of depressive symptoms in patients with chronic illnesses on three measures of health services were assessed by controlling for the effects of demographic variables and the severity of somatic symptoms. We found that the effects of depressive symptoms on the number of visited departments and number of visits made per patients were mediated by the severity of somatic symptoms. However, for health care costs, depressive symptoms had a significant main effect. Furthermore, the effect of gender on health care costs is moderated by the degree of a patient's depressive symptoms.


CONCLUSIONS
In summary, there is clearly a need for increased recognition and treatment of depressive symptoms in outpatients with chronic medical illnesses.
Na
Yu-Mi
YM
Department of Psychiatry, St. Mary's Hospital, The Catholic University of Korea, Medical College, 62 Yoidodong, Youngdeungpo-gu, Seoul 150-713, Korea.
Kim
Kwang-Soo
KS
Lee
Kyoung-Uk
KU
Chae
Jeong-Ho
JH
Kim
Jin-Ho
JH
Kim
Dai-Jin
DJ
Bahk
Won-Myong
WM
Jang
Yun-Sig
YS
Lee
Ae-Kyoung
AK
Woo
Young Sup
YS
Lee
Pyeoung-Soo
PS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics*; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012044:Regression Analysis; D012737:Sex Factors