Overlap of Anxiety and Depression in a Managed Care Population: Prevalence and Association With Resource Utilization
J Clin Psychiatry 2006;67(8):1187-1193
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: 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.
Method: 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 Phar Metrics 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.
Results: 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
Conclusions: 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.