title: Annual direct health care expenditures and employee absenteeism costs in high-risk, low-income mothers with major depression.
abstract: BACKGROUND
  To determine the health care and labor productivity costs associated with major depressive disorder in high-risk, low-income mothers.
  
  
  METHODS
  This study was conducted using the 1996-2011 Medical Expenditure Panel Survey (MEPS). The MEPS is a nationally-representative database that includes information on health care utilization and expenditures for the civilian, non-institutionalized population in the United States. High-risk mothers were between the ages of 18-35 years, and either unmarried, receiving Medicaid, or with incomes less than 300% of the Federal Poverty Level. Mothers were categorized as being depressed if they had an ICD-9 diagnosis code of 296 or 311 (N=2310) or not depressed (N=18,221). Insurer expenditures, out-of-pocket (OOP) expenses, and lost wage earnings were calculated.
  
  
  RESULTS
  After controlling for comorbidities, demographics, region, and year, high-risk depressed mothers were more likely to incur insurer (0.84 vs. 0.79) and OOP expenses (0.84 vs. 0.81) and to have higher insurer ($4448 vs. $3072) and OOP expenses ($794 vs. $523). Depression significantly increased the likelihood of missing work days (OR=1.40; p<0.01). Depression increased overall direct health care expenditures by $1.89 billion (range=$1.28-$2.60 billion) and indirect costs by $523 million annually, with a range of $353-$719 million.
  
  
  CONCLUSIONS
  In this high-risk population, the direct and indirect aggregate costs of depression-related to health care expenditures and lost work productivity were substantial. These findings establish a quantifiable cost for policy makers and highlight the need to target this population for prevention and treatment efforts.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: robert.ammerman@cchmc.org.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Ammerman
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: CTI Clinical Trial and Consulting, Inc., Cincinnati, OH, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mallow
authors.affiliation: Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Rizzo
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Alonzo T
authors.initials: AT
authors.lastname: Folger
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Judith B
authors.initials: JB
authors.lastname: Van Ginkel
mesh_terms: D000041:Absenteeism; D000328:Adult; D017281:Cost of Illness; D016208:Databases, Factual; D003865:Major Depressive Disorder / Q000191:economics* / Q000523:psychology; D004526:Efficiency; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008484:Medicaid; D009035:Mothers / Q000523:psychology*; D011203:Poverty; D012456:Salaries and Fringe Benefits / Q000191:economics; D014481:United States; D055815:Young Adult