Arnow Bruce A, Blasey Christine M, Lee Janelle, Fireman Bruce, Hunkeler Enid M, Dea Robin, Robinson Rebecca, Hayward Chris
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305-5722, USA.
Psychiatr Serv. 2009 Mar;60(3):344-50. doi: 10.1176/ps.2009.60.3.344.
Although evidence suggests that patients with depression use more medical services than those without depression, few studies have examined whether specific subgroups of patients with depression have higher utilization than others. The study compared costs for general medical care with and without psychiatric care for patients with major depression and disabling chronic pain (reference group) with costs for five other groups: those with depression and nondisabling chronic pain, those with major depressive disorder alone, those with no depression who had disabling chronic pain, those with depression who had chronic pain that was not disabling, and those who had neither pain nor depression. Costs for the group with major depressive disorder alone were compared to costs for the three groups without depression.
A questionnaire assessing major depressive disorder, chronic pain, and pain-related disability was mailed to a random sample of Kaiser Permanente patients who visited a primary care clinic. A total of 5,808 patients responded (54% participation rate). Costs for a two-year period were obtained from Kaiser Permanente's Cost Management Information System. Analyses were adjusted for presence of any of four major chronic medical illnesses.
Total costs for patients in the reference group were significantly higher than costs for the other five subgroups. Regression analyses indicated that continuous measures of severity of pain and severity of depression were associated with increased costs, but no statistically significant interaction of depression and pain on total cost was observed.
Patients with major depressive disorder and comorbid disabling chronic pain had higher medical service costs than other groups of patients with and without depression. However, findings suggest that the increases in cost from having both pain and depression are additive and not multiplicative.
尽管有证据表明抑郁症患者比非抑郁症患者使用更多的医疗服务，但很少有研究探讨抑郁症患者的特定亚组是否比其他亚组有更高的利用率。该研究比较了患有重度抑郁症和致残性慢性疼痛的患者（参照组）接受和未接受精神科护理的一般医疗护理费用，与其他五组患者的费用：患有抑郁症和非致残性慢性疼痛的患者、仅患有重度抑郁症的患者、没有抑郁症但有致残性慢性疼痛的患者、患有抑郁症但慢性疼痛不致残的患者，以及既没有疼痛也没有抑郁症的患者。将仅患有重度抑郁症组的费用与三组没有抑郁症的患者的费用进行比较。
向随机抽取的在初级保健诊所就诊的凯撒医疗集团患者邮寄一份评估重度抑郁症、慢性疼痛和疼痛相关残疾的问卷。共有5808名患者回复（参与率为54%）。从凯撒医疗集团的成本管理信息系统获取两年期间的费用。分析针对四种主要慢性疾病中的任何一种的存在情况进行了调整。
参照组患者的总费用显著高于其他五个亚组的费用。回归分析表明，疼痛严重程度和抑郁严重程度的连续测量与费用增加相关，但未观察到抑郁和疼痛对总费用有统计学上显著的相互作用。
患有重度抑郁症和合并致残性慢性疼痛的患者比其他有或没有抑郁症的患者组有更高的医疗服务费用。然而，研究结果表明，疼痛和抑郁同时存在导致的费用增加是累加的，而非倍增的。
