title: The burden of depression in prostate cancer.
abstract: OBJECTIVE
  We sought to analyze the prevalence and incremental burden of depression among elderly with prostate cancer.
  
  
  METHODS
  We adopted a retrospective cohort design using the Surveillance, Epidemiology and End Results-Medicare linked database between 1995 and 2003. Patients with prostate cancer diagnosed between 1995 and 1998 were identified and followed retrospectively for 1 year pre-diagnosis and up to 8 years post diagnosis. In this cohort of patients with prostate cancer, depression during treatment phase (1 year after diagnosis of prostate cancer) or in the follow-up phase was identified using the International Classification of Diseases-Ninth Revision depression-related codes. Poisson, general linear (log-link) and Cox regression models were used to determine the association between depression status during treatment and follow-up phases and outcomes-health resource utilization, cost and mortality.
  
  
  RESULTS
  Of the 50,147 patients newly diagnosed with prostate cancer, 4285 (8.54%) had a diagnosis of depression. A diagnosis of depression during treatment phase was associated with higher odds of emergency room visits (odds ratio (OR) = 4.45, 95% CI = 4.13, 4.80), hospitalizations (OR = 3.22, CI = 3.08, 3.37), outpatient visits (OR = 1.71, CI = 1.67, 1.75) and excess risk of death over the course of the follow-up interval (hazard ratio = 2.82, CI = 2.60, 3.06). Health care costs associated with depression remained elevated compared with costs for men without depression, over the course of the follow-up.
  
  
  CONCLUSIONS
  Depression during the treatment phase was associated with significant health resource utilization, costs and mortality among men with prostate cancer. These findings emphasize the need to effectively identify and treat depression in the setting of prostate cancer.
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. jravi@mail.med.upenn.edu
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Jayadevappa
authors.forename: S Bruce
authors.initials: SB
authors.lastname: Malkowicz
authors.forename: Sumedha
authors.initials: S
authors.lastname: Chhatre
authors.forename: Jerry C
authors.initials: JC
authors.lastname: Johnson
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D018588:Fee-for-Service Plans; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008498:Medical Record Linkage; D006278:Medicare; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000191:economics* / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D012189:Retrospective Studies; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology