Recovery From Depression Predicts Lower Health Services Costs
J Clin Psychiatry 2006;67(8):1226-1231
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To examine the association between
outcome of acute-phase depression treatment and subsequent health
Method: Data from 9 longitudinal studies of
patients starting depression treatment were used to examine the
relationship between outcome of acute-phase treatment and health
services costs over the subsequent 6 months. All studies were 2-
to 4-year studies conducted between the years 1991 and 2004.
Assessment of diagnosis was done using the Inventory of
Depressive Symptoms or the Structured Clinical Interview for
DSM-IV. Clinical outcomes were assessed by structured telephone
interviews using the Hamilton Rating Scale for Depression or a
20-item depression scale extracted from the Hopkins Symptom
Checklist. Costs were assessed using health plan accounting
Results: Of 1814 patients entering treatment and
meeting criteria for major depressive episode, 29% had persistent
major depression 3 to 4 months later, 37% were improved but did
not meet criteria for remission, and 34% achieved remission of
depression. Those with persistent depression had higher baseline
depression scores and higher health services costs before
beginning treatment. After adjustment for baseline differences,
mean health services costs over the 6 months following
acute-phase treatment were $2012 (95% CI = $1832 to $2210) for
those achieving remission, $2571 (95% CI = $2350 to $2812) for
those improved but not remitted, and $3094 (95% CI = $2802 to
$3416) for those with persistent major depression. Average costs
for depression treatment (antidepressant prescriptions,
outpatient visits, and mental health inpatient care) ranged from
$429 in the full remission group to $585 in the persistent
Conclusions: Among patients treated for
depression in community practice, only one third reached full
remission after acute-phase treatment. Compared with persistent
depression, remission is associated with significantly lower
subsequent utilization and costs across the full range of mental
health and general medical services.