title: Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011.
abstract: To investigate differences in healthcare cost trends over 8 years in adults with diabetes and one of four categories of comorbid depression: no depression, unrecognized depression, asymptomatic depression, or symptomatic depression.
  
  
  
  Data from the 2004-2011 Medical Expenditure Panel Survey (MEPS) was used to create nationally representative estimates. The dependent variable was total healthcare expenditures for the calendar year, including office-based, hospital outpatient, emergency room, inpatient hospital, prescription, dental, and home health care expenditures. The 2004-2011 direct medical costs were adjusted to a common 2014 dollar value. The primary independent variable was four mutually exclusive depression categories created from ICD-9-CM codes and the PHQ-2 depression screening tool. Healthcare expenditures were estimated using a two-part model and were adjusted for age, sex, race, marital status, education, health insurance, metropolitan statistical area status, region, income level, and comorbidities.
  
  
  
  Based on a national sample of adults with diabetes (unweighted sample of 15,548, weighted sample of 17,465,579), 10.2 % had unrecognized depression, 13.6 % had asymptomatic depression, and 8.9 % had symptomatic depression. In the pooled sample, after adjusting for covariates, the incremental cost of unrecognized depression was $2872 (95 % CI 1660-4084), asymptomatic depression increased by $3347 (95 % CI 2568-4386), and symptomatic depression increased by $5170 (CI 95 % 3610-6731) compared to patients with no depression.
  
  
  
  Adjusted analyses showed that expenditures were $2000-3000 higher for unrecognized and asymptomatic depression than no depression, and $5000 higher for symptomatic depression. Higher medical expenditures persisted over time, with only symptomatic depression showing a sustained decrease over time.
authors.affiliation: Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Room 280, PO Box 250593, Charleston, SC, 29425, USA. egedel@musc.edu.|Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, USA. egedel@musc.edu.|Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA. egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
authors.affiliation: Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Room 280, PO Box 250593, Charleston, SC, 29425, USA.|Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Room 280, PO Box 250593, Charleston, SC, 29425, USA.|Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Kinfe
authors.initials: K
authors.lastname: Bishu
authors.affiliation: Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Room 280, PO Box 250593, Charleston, SC, 29425, USA.|Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
authors.forename: Clara E
authors.initials: CE
authors.lastname: Dismuke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D003866:Depressive Disorder / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology*; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends*; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D014481:United States / Q000453:epidemiology