Chiu Maria, Lebenbaum Michael, Cheng Joyce, de Oliveira Claire, Kurdyak Paul
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2017 Sep 5;12(9):e0184268. doi: 10.1371/journal.pone.0184268. eCollection 2017.
The objective of our study was to estimate direct healthcare costs incurred by a population-based sample of people with psychological distress or depression. We used the 2002 Canadian Community Health Survey on Mental Health and Well Being and categorized individuals as having psychological distress using the Kessler-6, major depressive disorder (MDD) using DSM-IV criteria and a comparison group of participants without MDD or psychological distress. Costs in 2013 USD were estimated by linking individuals to health administrative databases and following them until March 31, 2013. Our sample consisted of 9,965 individuals, of whom 651 and 409 had psychological distress and MDD, respectively. Although the age-and-sex adjusted per-capita costs were similarly high among the psychologically distressed ($3,364, 95% CI: $2,791, $3,937) and those with MDD ($3,210, 95% CI: $2,413, $4,008) compared to the comparison group ($2,629, 95% CI: $2,312, $2,945), the population-wide excess costs for psychological distress ($441 million) were more than twice that for MDD ($210 million) as there was a greater number of people with psychological distress than depression. We found substantial healthcare costs associated with psychological distress and depression, suggesting that psychological distress and MDD have a high cost burden and there may be public health intervention opportunities to relieve distress. Further research examining how individuals with these conditions use the healthcare system may provide insight into the allocation of limited healthcare resources while maintaining high quality care.
我们研究的目的是估算以人群为基础的心理困扰或抑郁症患者样本所产生的直接医疗费用。我们使用了2002年加拿大心理健康与幸福社区健康调查，根据凯斯勒6项量表将个体归类为有心理困扰，根据《精神疾病诊断与统计手册》第四版标准将个体归类为重度抑郁症（MDD），并设立了一个没有MDD或心理困扰的参与者对照组。通过将个体与卫生行政数据库关联并追踪至2013年3月31日，估算出以2013年美元计的费用。我们的样本包括9965名个体，其中分别有651名和409名有心理困扰和MDD。尽管与对照组（2629美元，95%置信区间：2312美元，2945美元）相比，心理困扰者（3364美元，95%置信区间：2791美元，3937美元）和MDD患者（3210美元，95%置信区间：2413美元，4008美元）经年龄和性别调整后的人均费用同样较高，但心理困扰在全人群中的额外费用（4.41亿美元）是MDD（2.1亿美元）的两倍多，因为有心理困扰的人数比抑郁症患者更多。我们发现与心理困扰和抑郁症相关的医疗费用相当可观，这表明心理困扰和MDD有很高的成本负担，可能存在缓解困扰的公共卫生干预机会。进一步研究这些疾病患者如何利用医疗系统，可能会为在维持高质量护理的同时分配有限的医疗资源提供见解。
