Simon Gregory E, Katon Wayne J, Lin Elizabeth H B, Ludman Evette, VonKorff Michael, Ciechanowski Paul, Young Bessie A
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA.
Gen Hosp Psychiatry. 2005 Sep-Oct;27(5):344-51. doi: 10.1016/j.genhosppsych.2005.04.008.
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.
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.
Total health service costs were approximately 70% higher for individuals with major depression than for those without any depressive disorder (5361 US dollars over 6 months vs. 3120 US dollars, P<.001); this difference was consistent across all categories of health service costs. Diabetes complications were the strongest predictor of total costs (6845 US dollars for those with three or more complications vs. 1719 US dollars for those with none), but depression remained strongly associated with increased costs at all levels of diabetes severity.
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.
本研究旨在评估糖尿病并发症、抑郁症和合并的内科疾病对成年糖尿病患者医疗服务成本的相对影响。
共有4398名成年健康计划成员患有糖尿病，他们完成了一份邮寄调查问卷。使用包含9个条目的患者健康问卷（PHQ）评估抑郁症。使用计算机化的健康计划记录评估医疗服务成本、糖尿病并发症、糖化血红蛋白水平和合并的内科疾病。
患有重度抑郁症的个体的总医疗服务成本比没有任何抑郁症的个体高出约70%（6个月内分别为5361美元和3120美元，P<0.001）；这种差异在所有医疗服务成本类别中都是一致的。糖尿病并发症是总成本的最强预测因素（有三种或更多并发症的患者为6845美元，无并发症的患者为1719美元），但在糖尿病严重程度的所有水平上，抑郁症仍然与成本增加密切相关。
在糖尿病患者中，抑郁症与医疗服务成本增加50 - 75%相关。这种比例差异与一般人群样本中的差异相似，但绝对美元差异要大得多。抑郁症对医疗服务使用的影响无疑是复杂的，并且不限于“健康焦虑者”中无法解释的躯体症状。
