The profiles of health care utilization among a non-depressed population and patients with depressive symptoms with and without clinical depression

Abstract

Objective: To examine health service (HS) utilization profiles among a non-depressive population and patients with depressive symptoms (DS) with and without clinical depression. Design, subjects and setting: The study population was based on primary care patients with DS scoring ≥10 in the 21-item Beck Depression Inventory (BDI) and who were at least 35 years old and had been referred to depression nurse case managers (n = 705). Their psychiatric diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (M.I.N.I.). Of these patients, 447 had clinical depression. The number of patients with DS without clinical depression was 258. The control group consisted of a random sample of 414 residents with a BDI score < 10. Use of HS (visits and phone calls to a doctor and a nurse) was based on patient records. Main outcome measures: Number of visits and calls to physicians and nurses. Results: Patients with DS regardless of their depression diagnosis used primary health care (PHC) services three times more than the controls (p < 0.001). In the secondary care, the differences were smaller but significant. Of the controls, 70% had 0-4 HS contacts per year whereas a majority of the patients having DS had more than 5 contacts per year. The number of contacts correlated with the BDI from a score of 0 to 10 but not as clearly in the higher scores. Conclusion: Depressive symptoms, both with or without clinical depression, are associated with increased HS use, especially in PHC. This study suggests that even mild depressive symptoms are associated with an increased use of HS. KEY POINTS We analyzed the health service (HS) use among primary health care patients screened for depression and non-depressive population. Screen positive patients without clinical depression used as much HS as those having clinical depression. Regardless of depression diagnosis, screen positive patients visited a GP and nurse three times more often than the control population. In the screen negative control population, milder depressive symptoms were correlated with the use of HS. Primary health care was responsible for most of the HS use among patients having depressive symptoms.

Keywords: Primary health care; depression; depressive symptoms; health services; public health.

Figure 1.

Crude numbers of health care contacts to primary health care and secondary care (per person years). GP: general practitioner. BDI: Beck Depression Inventory.

Figure 2.

All contacts (per person years) among the subjects with depressive symptoms with and without depression and among the controls. BDI: Beck Depression Inventory.

Figure 3.

Relationships of all contacts per person years as a function of the BDI score. The curves were derived from a 5-knot-restricted cubic splines Poisson regression model. The model was adjusted using a propensity score approach (MMWS, marginal mean weighting through stratification) (gender, age, years of education, BMI, smoking, alcohol use, leisure-time physical activity, and medication). The gray area represents 95% confidence intervals. BDI: Beck Depression Inventory.