title: Impact of Depression on Health and Medical Care Utilization and Expenses in US Adults With Migraine: A Retrospective Cross Sectional Study.
abstract: BACKGROUND
  The association between migraine and depression has been extensively examined and a bidirectional hypothesis of the comorbidity between the 2 diseases has been reported. However, the economic impact of comorbid depression on migraine has not been fully explored.
  
  
  OBJECTIVE
  The purpose of this study is to determine the impact of depression on medical utilization and health care expenses among subjects reporting migraine.
  
  
  METHODS
  The Medical Expenditure Panel Survey (MEPS) household component longitudinal data files (2006-2012) identified subjects (≥ 18 years) with migraines. Two groups were created from all eligible subjects with migraine based on whether comorbid depression was reported or not. The major outcome measures were annualized average total and migraine-related health care expenses and medical utilization during a 2-year period. The impact of depression on health expenses was assessed by multivariable linear regression models with log transformations. Multivariable logistic regression identified factors associated with depression and examined the likelihood of emergency department (ED) visit adjusting for demographic and health-related variables.
  
  
  RESULTS
  Among 2,400 subjects with migraine (approximate 54.3 million United States [US] individuals for years 2006-2012), 804 reported depression (representing 18.4 million individuals in the United States, 33.9%). Among migraineurs, nearly one-third received anti-migraine prescription drugs and approximately 65% with comorbid depression used antidepressants. Race (black vs white, odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.25, 0.52), sex (male vs female, OR: 0.67, 95% CI: 0.51, 0.87), perceived health status (fair to poor vs excellent-very good, OR: 2.58, 95% CI: 2.72. 4.71), insurance coverage (public vs private, OR: 1.59, 95%CI: 1.13, 2.24), and greater comorbidity (OR: 1.70, 95% CI: 1.28, 2.26) were significantly associated with comorbid depression in the subjects with migraine. Compared to migraine subjects without depression, the mean annual total health expenses per person ($10,012 vs. $4,740, P <.001) and mean migraine-related health expenses ($723 vs $499, P = .014) were significantly higher in those with depression. The odds of ED visit in migraineurs with comorbid depression were higher than in those without depression (OR: 1.36, 95% CI: 1.08, 1.71).
  
  
  CONCLUSIONS
  Comorbid depression in subjects with migraine was associated with higher total and migraine-related health expenses and increased likelihood of all-cause ED visits. Comorbid depression management might be incorporated into migraine intervention program to improve treatment outcomes and produce potential cost savings. Further studies are needed to assess long-term effects of depression on migraine progression and health care utilization patterns.
authors.affiliation: Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Davis-Ajami
authors.affiliation: Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Kevin Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000191:economics* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: depression; health care utilization; health expenses; migraine