Katon Wayne J, Lin Elizabeth, Russo Joan, Unutzer Jurgen
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, 98195-6560, USA.
Arch Gen Psychiatry. 2003 Sep;60(9):897-903. doi: 10.1001/archpsyc.60.9.897.
We examined whether older adults with depressive symptoms below the diagnostic threshold and those with DSM-IV major depression and/or dysthymia have higher medical costs than those without depression.
We mailed the PRIME-MD 2-item depression screen to the patients of 2 large primary care clinics of a staff-model health maintenance organization in Seattle, Wash. All 11 679 patients 60 years and older with primary care providers at the participating clinics were included, and 8894 (76.2%) were successfully enrolled. An additional 107 patients were referred to the study by their primary care physician. Nonrespondents were slightly younger and had higher inpatient medical costs in the previous 6 months. Patients with positive findings on at least 1 item or referred by their family physician were offered an interview with the Structured Clinical Interview for DSM-IV. The total cost of medical services for the 6 months before the study was obtained from the cost accounting system of the health maintenance organization.
Total ambulatory costs were 43% to 52% higher and total ambulatory and inpatient costs were 47% to 51% higher in depressed compared with nondepressed elderly patients after adjustment for chronic medical illness. This increase was seen in every component of health care costs, with only a small percentage due to mental health treatment. In mean costs, depressed elderly patients averaged an increase of 763 US dollars to 979 US dollars in ambulatory costs and 1045 US dollars to 1700 US dollars in ambulatory and inpatient costs. No differences in costs were noted between patients with subthreshold depressive syndromes and those with DSM-IV depressive disorders.
Depressive symptoms and DSM-IV depressive disorders in elderly patients are associated with significantly higher health care costs, even after adjustment for chronic medical illness.
我们研究了抑郁症状低于诊断阈值的老年人以及患有《精神疾病诊断与统计手册》第四版（DSM-IV）中重度抑郁症和/或心境恶劣障碍的老年人的医疗费用是否高于无抑郁症的老年人。
我们将PRIME-MD两项抑郁筛查问卷邮寄给华盛顿州西雅图市一家员工模式健康维护组织的两家大型初级保健诊所的患者。纳入了所有11679名60岁及以上且在参与诊所设有初级保健医生的患者，其中8894名（76.2%）成功入组。另外107名患者由其初级保健医生转诊至本研究。未回复者年龄稍小，且在前6个月的住院医疗费用较高。至少有一项筛查结果为阳性或由家庭医生转诊的患者接受了DSM-IV结构化临床访谈。研究前6个月的医疗服务总费用从健康维护组织的成本核算系统中获取。
在对慢性疾病进行调整后，与未患抑郁症的老年患者相比，抑郁症患者的门诊总费用高出43%至52%，门诊和住院总费用高出47%至51%。这种费用增加在医疗保健费用的各个组成部分中均有体现，其中仅有小部分归因于心理健康治疗。在平均费用方面，抑郁症老年患者的门诊费用平均增加763美元至979美元，门诊和住院费用平均增加1045美元至1700美元。阈下抑郁综合征患者与DSM-IV抑郁症患者之间的费用未发现差异。
即使对慢性疾病进行调整后，老年患者的抑郁症状和DSM-IV抑郁症仍与显著更高的医疗保健费用相关。
