title: Perceived burden of illness in patients entering for treatment in a university hospital--is the threshold to secondary care higher for patients with depression than for those with somatic disorders?
abstract: BACKGROUND
  The threshold to secondary health care should be similar for all patients independent of the underlying disease. This study compared, using a validated health-related quality of life (HRQoL)-instrument, whether the perceived burden of illness is similar in patients admitted for secondary care treatment into a university hospital because of one of six common conditions.
  
  
  METHODS
  HRQoL, assessed by the generic 15D instrument before elective treatment, was compared in six groups: operative treatment of cataract (n=219), operative treatment of cervical or lumbar radicular pain (n=270), hysterectomy due to benign uterine conditions (n=337), hip or knee replacement surgery (n=223), coronary angiography due to suspected coronary artery disease (n=261), and secondary care treatment of depression (n=89).
  
  
  RESULTS
  Mean (±SD) HRQoL score was clearly highest in patients with benign uterine conditions (0.908±0.071) and lowest in patients with depression (0.729±0.120) (P<0.001 between the groups). Also all the other groups had a significantly (P<0.001) higher baseline HRQoL score (ranging from 0.802 to 0.824) than patients with depression. Outcome of treatment, in terms of HRQoL improvement, was in depressive patients at least equal, and in some cases even better, than that in the other groups.
  
  
  CONCLUSIONS
  Our results imply that, at least concerning perceived burden of illness, patients with depression are worse off when admitted to secondary care treatment than patients with many somatic conditions. That may be a consequence of poor motivation of depressive patients to seek treatment or that, contradictory to guidelines, the health care system does nor give priority to those worst off and sets a higher threshold for specialized care of patients with depression than of those with common somatic disorders.
authors.affiliation: Helsinki University Central Hospital, Department of Psychiatry, Jorvi Hospital, P.O. Box 800, 00029 HUS, Finland. kirsi.suominen@hus.fi
authors.forename: K
authors.initials: K
authors.lastname: Suominen
authors.forename: H
authors.initials: H
authors.lastname: Karlsson
authors.forename: A
authors.initials: A
authors.lastname: Rissanen
authors.forename: H M
authors.initials: HM
authors.lastname: Valtonen
authors.forename: P
authors.initials: P
authors.lastname: Räsänen
authors.forename: H
authors.initials: H
authors.lastname: Sintonen
authors.forename: R P
authors.initials: RP
authors.lastname: Roine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000523:psychology* / Q000628:therapy; D017281:Cost of Illness; D003863:Depression / Q000150:complications / Q000523:psychology / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006785:Hospitals, University / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D059408:Pain Management / Q000009:adverse effects / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology; D011859:Radiography; D012107:Research Design; D018434:Sickness Impact Profile; D013315:Stress, Psychological / Q000209:etiology*; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000523:psychology*