Major Depressive Disorder, Somatic Pain, and Health Care Costs in an Urban Primary Care Practice
J Clin Psychiatry 2006;67:1232-1239
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To evaluate the extent to which pain
severity contributes to the increased medical care costs
associated with depression in primary care.
Method: A systematic sample of primary care
patients (N = 1028) from an urban practice were assessed between
April 1, 2002, and January 16, 2003, with the DSM-IV Primary Care
Evaluation of Mental Disorders Patient Health Questionnaire, the
Sheehan Disability Scale, a medical illness checklist, and the
Medical Outcomes Study 12-Item Short Form Health Survey, which
includes a measure of pain interference with daily activities.
Medical charges for inpatient, outpatient, and emergency
department services were assessed for the 6-month periods
preceding and following the index medical visit. Patients with
and without major depressive disorder (MDD) were first compared
with respect to clinical characteristics and median medical
charges. Mean predicted medical care charges were then compared
among 4 patient groups: (1) No MDD/Low Pain Interference, (2) No
MDD/High Pain Interference, (3) MDD/Low Pain Interference, and
(4) MDD/High Pain Interference.
Results: As compared to patients without MDD
(N = 821), those with MDD (N = 207) had significantly higher
predicted mean medical care charges ($19,838 vs. $6268; t = 3.3,
p = .001) after controlling for age and gender and were
significantly more likely to report at least moderate
pain-related interference in daily activities (MDD: 69.1% vs. no
MDD: 38.6%; chi2 = 61.3, df = 1, p < .0001). Mean
predicted medical care charges of patients with MDD and at least
moderate pain-related interference were on average 2.33 times
(95% CI = 1.34 to 4.05) as high as those for patients with MDD and
little or no pain-related interference. Among patients with at
least moderate pain-related interference, MDD was associated with
significantly greater mean predicted charges (mean = $28,598/year
with MDD vs. $11,031/year without MDD). However, among patients
with lower levels of pain-related interference, MDD was not
associated with greater mean predicted medical charges
(mean = $2306/year with MDD vs. $3560/year without MDD).
Conclusion: In this urban primary care practice,
major depressive disorder is associated with increased health
care costs, but only among patients with moderate to extreme
pain-related interference in daily activities.