Article

Overlap of anxiety and depression in a managed care population: Prevalence and association with resource utilization.

NDCHealth, Phoenix, AZ, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 09/2006; 67(8):1187-93. DOI: 10.4088/JCP.v67n0803
Source: PubMed

ABSTRACT To characterize the diagnosis of anxiety and depression within a large managed care population and to measure the impact of having both of these conditions on treatment patterns, health care utilization, and cost. Further, to compare the impact of having both conditions with having neither or either condition alone.
A retrospective, cross-sectional analysis of population-level anxiety-related and depression-related utilization over a 12-month study period was conducted. Data were from the PharMetrics Patient-Centric database, which is composed of medical and pharmaceutical claims for approximately 36 million patients from 61 health plans across the United States. Patients 18 years and older were included as cases in the analysis if they had a diagnosis of depression or anxiety during 2002. Four groups were identified based on the presence of anxiety and/or depression diagnosis: anxiety only, depression only, anxiety and depression, and controls. Controls were matched to the anxiety and depression cohort using a 4:1 ratio, based on patient age, gender, and similarity of health coverage. Cohorts were compared with respect to patient demographics, comorbid diagnoses, medication use, specialist care, utilization of health care services, and treatment costs, using both univariate and multivariate statistics.
Significant differences in comorbid diagnoses, medication use, health care utilization, and treatment costs existed between the study groups. Specifically, patients with both anxiety and depression tended to have more somatic complaints such as abdominal pain, malaise, or chest pain than patients with either condition alone or the control group. Antidepressant use was highest among the anxiety and depression cohort, while anxiolytic use was as prevalent in the anxiety and depression cohort as in the anxiety only cohort. Patients in the anxiety only, depression only, or anxiety plus depression groups had a higher number of anxiety- and/or depression-related visits as well as visits not related to depression or anxiety than the control group, with the anxiety and depression cohort incurring the highest utilization of medical services. Similarly, in terms of cost, the disease cohorts incurred significantly higher cost than their control counterparts, with the anxiety and depression cohort incurring higher cost than those with either condition alone, even after accounting for differences in patient characteristics.
Combination of anxiety and depression is fairly common in a managed care population as evidenced by diagnosis and treatment. The combination of both diagnoses appears to increase the complexity of these patients with respect to comorbid conditions as well as increases the economic cost to payers.

2 Followers
 · 
99 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Evidence suggests that individuals with autism spectrum disorders (ASD) often exhibit associated psychiatric symptoms, particularly related to depression. The current study investigated whether individual characteristics, specifically, severity of ASD symptoms, level of cognitive ability, and/or presence of other psychiatric disorders, are associated with occurrence of depressive symptoms in adults with ASD. Forty-six adults with ASD were administered a standardized psychiatric history interview. Twenty participants (43%) endorsed depressive symptoms. It was found that individuals with less social impairment, higher cognitive ability, and higher rates of other psychiatric symptoms, were more likely to report depressive symptoms. These characteristics may be vulnerability factors for the development of depression, and should be considered when screening and treating adults with ASD.
    Journal of Autism and Developmental Disorders 08/2008; 38(6):1011-8. DOI:10.1007/s10803-007-0477-y · 3.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Mental health and primary care delivery systems have evolved to operate differently. For example, attention to multiple medical issues, health maintenance, and structured diagnostic procedures are standard elements of primary care rarely incorporated into mental health care. A multidisciplinary treatment approach, group care, and case management are common features of mental health treatment settings only rarely used in primary care practices. Advances in treatments for mental health disorders and increased knowledge of the integral link between mental health and physical health encourage mental health disorder treatment in primary care settings, which reach the most patients. Effective integration of mental health care into primary care requires systematic and pragmatic change that builds on the strengths of both mental health and primary care.
    Primary Care Clinics in Office Practice 10/2007; 34(3):571-92, vii. DOI:10.1016/j.pop.2007.05.007 · 0.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Studies and treatments for the symptomatic menopausal woman have been reviewed elsewhere. The aim of this clinical review series is to examine the evidence for the diagnosis and treatment of the woman who presents with distressing symptoms that she attributes to menopause, whose actual etiology may be a psychiatric disorder, a pre- or co-existing problem such as sleep or cognitive problems, or a dynamic interaction among one of these and a symptomatic menopause. This series of articles will review new research on somatic symptoms of depression, the depression continuum and its impact on morbidity and functioning, treatment issues related to remission of depression, cognitive decline or impairment secondary to a mood disorder, sleep problems in women and their impact on well-being and functioning, and attention and working memory problems in women. These will all be reviewed in the context of the vulnerable female patient and her experience of increased or new distressing symptoms during her menopausal transition. Recommendations for the diagnosis and management of women with psychiatric comorbidity and a symptomatic menopause are discussed.
    Expert Review of Neurotherapeutics 12/2007; 7(11 Suppl):S3-6. DOI:10.1586/14737175.7.11s.S3 · 2.83 Impact Factor