Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun;31(6):615-22.
doi: 10.1007/s11606-016-3650-1. Epub 2016 Mar 11.

Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011

Leonard E Egede  1   2   3 , Rebekah J Walker  4   5 , Kinfe Bishu  4   6 , Clara E Dismuke  4   5
Affiliations

Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011

Leonard E Egede et al. J Gen Intern Med. 2016 Jun.

Abstract

Objective: To investigate differences in healthcare cost trends over 8 years in adults with diabetes and one of four categories of comorbid depression: no depression, unrecognized depression, asymptomatic depression, or symptomatic depression.

Research design and methods: Data from the 2004-2011 Medical Expenditure Panel Survey (MEPS) was used to create nationally representative estimates. The dependent variable was total healthcare expenditures for the calendar year, including office-based, hospital outpatient, emergency room, inpatient hospital, prescription, dental, and home health care expenditures. The 2004-2011 direct medical costs were adjusted to a common 2014 dollar value. The primary independent variable was four mutually exclusive depression categories created from ICD-9-CM codes and the PHQ-2 depression screening tool. Healthcare expenditures were estimated using a two-part model and were adjusted for age, sex, race, marital status, education, health insurance, metropolitan statistical area status, region, income level, and comorbidities.

Results: Based on a national sample of adults with diabetes (unweighted sample of 15,548, weighted sample of 17,465,579), 10.2 % had unrecognized depression, 13.6 % had asymptomatic depression, and 8.9 % had symptomatic depression. In the pooled sample, after adjusting for covariates, the incremental cost of unrecognized depression was $2872 (95 % CI 1660-4084), asymptomatic depression increased by $3347 (95 % CI 2568-4386), and symptomatic depression increased by $5170 (CI 95 % 3610-6731) compared to patients with no depression.

Conclusions: Adjusted analyses showed that expenditures were $2000-3000 higher for unrecognized and asymptomatic depression than no depression, and $5000 higher for symptomatic depression. Higher medical expenditures persisted over time, with only symptomatic depression showing a sustained decrease over time.

PubMed Disclaimer

Conflict of interest statement

Funding Source

This study was supported by grant no. K24DK093699 from The National Institute of Diabetes and Digestive and Kidney Diseases (PI: Leonard Egede).

Conflict of Interest

The authors report no potential conflicts of interest relevant to this article.

Disclaimer

The views expressed in this article are solely those of the authors and do not necessarily reflect the views of the National Institutes of Health (NIH), the Veterans Health Administration (VHA), or Health Services Research and Development (HSR&D).

Figures

Figure 1
Figure 1
Medical expenditure by depression and diabetes categories, 2004–2011.
Figure 2
Figure 2
Annual mean expenditures by depression categories, 2004–2011.
See this image and copyright information in PMC

Comment in

  • Costs of Coexisting Depression and Diabetes.
    Bogner HR, McClintock HF. Bogner HR, et al. J Gen Intern Med. 2016 Jun;31(6):594-5. doi: 10.1007/s11606-016-3675-5. J Gen Intern Med. 2016. PMID: 27008651 Free PMC article. No abstract available.

References

    1. Egede LE, Ellis C. Diabetes and depression: global perspectives. Diabetes Res Clin Pract. 2010;87(3):302–312. doi: 10.1016/j.diabres.2010.01.024. - DOI - PubMed
    1. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069–1078. doi: 10.2337/diacare.24.6.1069. - DOI - PubMed
    1. Li C, Ford ES, Zhao G, Ahjuwalia IB, Pearson WS, Mokdad AH. Prevalence and correlates of undiagnosed depression among US adults with diabetes: the Behavioral Risk Factor Surveillance System. Diabetes Res Clin Pract. 2009;83:268–279. doi: 10.1016/j.diabres.2008.11.006. - DOI - PubMed
    1. Ali S, Stone M, Skinner TC, Robertso N, Davies M, Khunti K. The association between depression and health-related quality of life in people with type 2 diabetes: a systematic literature review. Diabetes Metab Res Rev. 2010;26(2):75–89. doi: 10.1002/dmrr.1065. - DOI - PubMed
    1. Dismuke CE, Egede LE. Association between major depression, depressive symptoms and personal income in US adults with diabetes. Gen Hosp Psychiatry. 2010;32(5):484–491. doi: 10.1016/j.genhosppsych.2010.06.004. - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources