title: The association between depressive disorders and health care utilization: results from the São Paulo ageing and health study (SPAH).
abstract: BACKGROUND
  Although depressive disorders are associated with increased health care utilization in the elderly living in high-income countries, few studies have examined this relationship in Latin America.
  
  
  METHODS
  The present study is part of the São Paulo Ageing and Health Study, a population-based epidemiological study of mental disorders in 2072 low-income adults ≥ 65 years old living in São Paulo, Brazil. Depressive disorders defined as major depressive disorder (MDD) and clinically relevant depressive symptoms (CRDS) were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We examined the association between depressive disorders/symptoms and health care utilization (outpatient visits, hospital admissions and medication use in the past 3 months) using count models.
  
  
  RESULTS
  The prevalence of MDD and CRDS was 4.9% and 21.4%, respectively. In the fully adjusted model, older adults with MDD were 36% more likely to have one more outpatient visit (RM: 1.36, 95% CI: 1.11-1.67), while older adults with CRDS were 14% more likely to have one more outpatient visit (RM: 1.14, 95% CI: 1.02-1.28). Elderly individuals with MDD had a prevalence of hospital admissions in the previous 3 months that was twice that of those without depression (PR=2.02, 95% CI: 1.09-3.75). Significant differences were not found for medication use.
  
  
  CONCLUSIONS
  Among low-income older adults living in Brazil, those with MDD are more likely to have a recent hospital admission and outpatient service use than those without depression. Future studies are needed to examine the effectiveness of depression treatments for this population in order to both decrease the burden of illness as well as to minimize health care utilization related to depression.
authors.affiliation: Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA. Electronic address: hhuang@cha.harvard.edu.
authors.forename: Hsiang
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Preventive Medicine, School of Medicine, University of São Paulo, Brazil.
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Menezes
authors.affiliation: Department of Preventive Medicine, School of Medicine, University of São Paulo, Brazil.
authors.forename: Simone A
authors.initials: SA
authors.lastname: da Silva
authors.affiliation: School of Social Work, University of Illinois, Urbana Champaign, IL, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Tabb
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Barkil-Oteo
authors.affiliation: Department of Psychiatry, Laboratory of Psychopathology and Psychiatric Therapeutics (LIM-23), School of Medicine, University of São Paulo, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Scazufca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001938:Brazil / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data*
keywords: Ageing; Brazil; Depression; Depressive symptoms; Health services