title: Depression and the health care experiences of Medicare beneficiaries.
abstract: OBJECTIVE
  To compare health care experiences of Medicare beneficiaries with and without symptoms of depression and investigate the role of patient confidence in shaping these experiences.
  
  
  METHODS
  Data came from the 2009 CAHPS Medicare 4.0 Fee-for-Service (FFS) Survey, which was fielded to a national probability sample of 298,492 FFS Medicare beneficiaries.
  
  
  METHODS
  Linear regression was used to model associations of depression with four global ratings and three composite measures of health care and to test whether beneficiaries' confidence in their ability to recognize the need for care mediates these associations.
  
  
  RESULTS
  Beneficiaries with depressive symptoms reported worse experiences with care across the full range of patient experience covered by the CAHPS survey. Depressive symptoms were associated with decreased patient confidence and decreased confidence was in turn associated with poorer reports of care.
  
  
  CONCLUSIONS
  Our study highlights depressive symptoms as a risk factor for poorer experiences of health care and highlights depressed patients' confidence in recognizing their need for care and for designing programs to improve the health care of this population.
authors.affiliation: RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665, USA. martino@rand.org
authors.forename: Steven C
authors.initials: SC
authors.lastname: Martino
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.forename: David E
authors.initials: DE
authors.lastname: Kanouse
authors.forename: Donna O
authors.initials: DO
authors.lastname: Farley
authors.forename: Q
authors.initials: Q
authors.lastname: Burkhart
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000628:therapy*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008603:Mental Health; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D020377:Self Efficacy; D014481:United States; D055815:Young Adult