General Hospital Psychiatry
Volume 27, Issue 5 , Pages 344-351, September 2005

Diabetes complications and depression as predictors of health service costs☆

  • Gregory E. Simon, M.D., M.P.H.

      Affiliations

    • Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA
    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 206 287 2979; fax: +1 206 287 2871.
    • ,
  • Wayne J. Katon, M.D.

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
    • ,
  • Elizabeth H.B. Lin, M.D., M.P.H.

      Affiliations

    • Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA
    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
    • ,
  • Evette Ludman, Ph.D.

      Affiliations

    • Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA
    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
    • ,
  • Michael VonKorff, Sc.D.

      Affiliations

    • Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA
    • ,
  • Paul Ciechanowski, M.D., M.P.H.

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
    • ,
  • Bessie A. Young, M.D., M.P.H.

      Affiliations

    • Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA 98195, USA
    • Primary and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA

Received 11 March 2005; accepted 27 April 2005.

Abstract 

Objective

The aim of this study was to assess the relative contributions of diabetes complications, depression and comorbid medical disorders to health service costs in adults with diabetes.

Methods

A total of 4398 adult health plan members with diabetes completed a mailed survey. Depression was assessed using the nine-item PHQ. Health service costs, diabetes complications, glycohemoglobin levels and comorbid medical conditions were assessed using computerized health plan records.

Results

Total health service costs were approximately 70% higher for individuals with major depression than for those without any depressive disorder (US$5361 over 6 months vs. US$3120, P<.001); this difference was consistent across all categories of health service costs. Diabetes complications were the strongest predictor of total costs (US$6845 for those with three or more complications vs. US$1719 for those with none), but depression remained strongly associated with increased costs at all levels of diabetes severity.

Conclusions

Among people with diabetes, depression is associated with 50-75% increases in health service costs. This proportional difference is similar to that in general population samples, but the absolute dollar difference is much greater. The effect of depression on health service use is undoubtedly complex and not limited to unexplained physical symptoms among the worried well.

Keywords: Diabetes, Depression, Cost, Complications, Utilization

 

☆ This study was supported by NIH Grant R01 MH41739.

PII: S0163-8343(05)00064-2

doi:10.1016/j.genhosppsych.2005.04.008

General Hospital Psychiatry
Volume 27, Issue 5 , Pages 344-351, September 2005

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