title: The effect of comorbid anxiety and depressive disorders on health care utilization and costs among adolescents with asthma.
abstract: OBJECTIVE
  To assess whether youth with asthma and comorbid anxiety and depressive disorders have higher health care utilization and costs than youth with asthma alone.
  
  
  METHODS
  A telephone survey was conducted among 767 adolescents (aged 11 to 17 years) with asthma. Diagnostic and Statistical Manual-4th Version (DSM-IV) anxiety and depressive disorders were assessed via the Diagnostic Interview Schedule for Children. Health care utilization and costs in the 12 months pre- and 6 months post-interview were obtained from computerized health plan records. Multivariate analyses were used to determine the impact of comorbid depression and anxiety on medical utilization and costs.
  
  
  RESULTS
  Unadjusted analyses showed that compared to youth with asthma alone, youth with comorbid anxiety/depressive disorders had more primary care visits, emergency department visits, outpatient mental health specialty visits, other outpatient visits and pharmacy fills. After controlling for asthma severity and covariates, total health care costs were approximately 51% higher for youth with depression with or without an anxiety disorder but not for youth with an anxiety disorder alone. Most of the increase in health care costs was attributable to nonasthma and non-mental health-related increases in primary care and laboratory/radiology expenditures.
  
  
  CONCLUSIONS
  Youth with asthma and comorbid depressive disorders have significantly higher health care utilization and costs. Most of these costs are due to increases in non-mental health and nonasthma expenses. Further study is warranted to evaluate whether improved mental health treatment and resulting increases in mental health costs would be balanced by savings in medical costs.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Box 354920, Seattle, WA 98115, USA. lpr@u.washington.edu
authors.forename: Laura P
authors.initials: LP
authors.lastname: Richardson
authors.forename: Joan E
authors.initials: JE
authors.lastname: Russo
authors.forename: Paula
authors.initials: P
authors.lastname: Lozano
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCauley
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D001249:Asthma / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003365:Costs and Cost Analysis; D003866:Depressive Disorder / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D014600:Utilization Review / Q000706:statistics & numerical data; D014861:Washington
references.citation: Gen Hosp Psychiatry. 2004 Nov-Dec;26(6):430-6
references.pmid: 15567208
references.citation: Pediatrics. 2003 Dec;112(6 Pt 1):e440
references.pmid: 14654642
references.citation: Am J Psychiatry. 1993 Dec;150(12):1779-91
references.pmid: 8238631
references.citation: Med Care. 1999 Sep;37(9):874-83
references.pmid: 10493466
references.citation: Arch Pediatr Adolesc Med. 1996 Feb;150(2):146-53
references.pmid: 8556118
references.citation: Pediatrics. 2002 Jul;110(1 Pt 1):e8
references.pmid: 12093989
references.citation: Psychosom Med. 2004 May-Jun;66(3):349-55
references.pmid: 15184694
references.citation: J Psychiatr Res. 1988;22(3):207-20
references.pmid: 3225790
references.citation: J Am Acad Child Adolesc Psychiatry. 1996 Nov;35(11):1427-39
references.pmid: 8936909
references.citation: Pediatrics. 1999 Dec;104(6):1274-80
references.pmid: 10585977
references.citation: Psychosomatics. 2004 Mar-Apr;45(2):93-9
references.pmid: 15016921
references.citation: MMWR Surveill Summ. 2007 Oct 19;56(8):1-54
references.pmid: 17947969
references.citation: J Asthma. 2001 Jun;38(4):363-73
references.pmid: 11456390
references.citation: J Am Acad Child Adolesc Psychiatry. 2000 Jan;39(1):28-38
references.pmid: 10638065
references.citation: Health Serv Res. 1991 Apr;26(1):53-74
references.pmid: 1901841
references.citation: Annu Rev Public Health. 1999;20:125-44
references.pmid: 10352853
references.citation: Pediatrics. 2006 Sep;118(3):1042-51
references.pmid: 16950996
references.citation: Arch Intern Med. 2002 Sep 9;162(16):1860-6
references.pmid: 12196084
references.citation: Diabetes Care. 2006 Feb;29(2):265-70
references.pmid: 16443871
references.citation: Behav Res Methods Instrum Comput. 2004 Nov;36(4):717-31
references.pmid: 15641418
references.citation: J Pers Soc Psychol. 1986 Dec;51(6):1173-82
references.pmid: 3806354
references.citation: J Asthma. 2005 Apr;42(3):179-84
references.pmid: 15962874
references.citation: Gen Hosp Psychiatry. 2007 May-Jun;29(3):214-22
references.pmid: 17484938
references.citation: Pediatrics. 1997 Jun;99(6):757-64
references.pmid: 9164766
references.citation: J Allergy Clin Immunol. 1999 Nov;104(5):957-63
references.pmid: 10550739
references.citation: Psychol Med. 2004 Nov;34(8):1465-74
references.pmid: 15724877
references.citation: J Asthma. 2003 Apr;40(2):139-45
references.pmid: 12765315
references.citation: J Adolesc Health. 2007 Nov;41(5):455-63
references.pmid: 17950165
references.citation: J Clin Psychiatry. 1997;58 Suppl 3:34-8; discussion 39-40
references.pmid: 9133491
references.citation: Psychosom Med. 2005 Nov-Dec;67(6):989-96
references.pmid: 16314605
references.citation: Arch Gen Psychiatry. 2002 Dec;59(12):1098-104
references.pmid: 12470125
references.citation: Arch Pediatr Adolesc Med. 2004 Sep;158(9):875-83
references.pmid: 15351753
references.citation: Gen Hosp Psychiatry. 2005 Sep-Oct;27(5):344-51
references.pmid: 16168795
references.citation: J Asthma. 2005 Oct;42(8):643-7
references.pmid: 16266954
references.citation: J Nerv Ment Dis. 2002 May;190(5):275-81
references.pmid: 12011605
references.citation: Psychosomatics. 2006 Jul-Aug;47(4):333-9
references.pmid: 16844893
references.citation: J Psychiatr Res. 1993 Jul-Sep;27(3):247-52
references.pmid: 8295157
references.citation: Arch Intern Med. 2000 Nov 27;160(21):3278-85
references.pmid: 11088090