Overlap of Anxiety and Depression in a Managed Care Population: Prevalence and Association With Resource Utilization

ArticleinThe Journal of Clinical Psychiatry 67(8):1187-93 · September 2006with14 Reads
DOI: 10.4088/JCP.v67n0803 · Source: PubMed
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.
    • "The negative effects of GAD on health-related quality of life are among the greatest of the serious mental disorders, particularly when compared with those described in major depression, a disorder known to have a high incapacitating potential and to be health-resource consuming [1-3,23-25]. Aspects involving subjective perceptions of health improve when patients have undergone the right treatment, as is shown in controlled clinical studies [26]. "
    [Show abstract] [Hide abstract] ABSTRACT: We assessed the impact of generalised anxiety disorder (GAD) on disability and health-related quality of life in outpatients treated in psychiatric clinics via a secondary analysis conducted in 799 patients from a cross-sectional study of prevalence of GAD in psychiatric clinics. Patients were allocated into two groups: follow-up (15.7%) and newly diagnosed patients (84.3%), and were administered the Hamilton Anxiety Scale (HAM-A), Clinical Global Impressions Scale (CGI), Sheehan Disability Scale (SDS), and 36-item short form structured quality of life questionnaire (SF-36) scales. The newly diagnosed group showed higher significant intensity of anxiety (56.9% vs 43.0% (HAM-A >24)), psychiatrist's CGI Severity (CGI-S) scores (4.2 vs 3.7), and perceived stress according to SDS (5.7 vs 5.2). They also showed lower scores in mental health-related quality of life: 25.4 vs 30.8. Statistical differences by gender were not observed. GAD was shown to have a significant impact on patient quality of life and disability, with a substantial portion having persistent, out of control symptoms despite treatment. These results suggest that there is still room for improvement in the medical management of patients with GAD treated in psychiatric clinics.
    Full-text · Article · Mar 2011
    • "d other feel - ings related to depression ( Tantam 2000 ) . This study found that individuals with ASD who endorse depressive symptoms are also significantly more likely to have symptoms related to general anxiety and obsessive – compulsive disorder ( OCD ) . Depression , anxiety , and OCD are highly co - morbid in the general population as well ( McLaughlin et al . 2006 ; Overbeek et al . 2002 ; Pollack 2005 ; Tukel et al . 2002 ) . The presence of anxiety and rit - uals or compulsions may exacerbate difficulties in adults with ASD and further impair functioning . In their review of case reports in the literature , Stewart et al . ( 2006 ) sug - gested that for individuals with ASD , symptoms of OCD , "
    [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.
    Full-text · Article · Aug 2008
  • [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.
    Full-text · Article · Oct 2007
Show more