Individuals who have been treated for depression reduce their use of non-routine medical services in the long term, although these individuals still use more outpatient medical services than do similar individuals in their communities, according to the results of a new 10-year analysis involving more than 600 people.
The study looked at the relationship between depression and non-routine outpatient medical utilization in adults who had been treated for depressive disorders, compared to a similar group of adults in the same communities who had not been treated. Non-routine medical utilization refers to the use of medical services beyond regularly scheduled physicals, preventive care, and disease monitoring. Study participants in the patient group had been treated for depression at a public hospital, a health maintenance organization, a university medical center, or a Veterans Affairs Medical Center.
Information was obtained from each study participant about depressive symptoms they experienced and their use of non-routine outpatient medical services in the year before entering the study, and again at one, four, and 10 years after entry into the study.
"The depressed patients had very different patterns of both depressive symptoms and medical utilization than the general population over the 10 years," said Rachel Kimerling, PhD, one of the authors of the study.
The patient group reported more non-routine physician visits than did the community group at all points over the 10 years, even when age, sex, marital status, and medical conditions were considered. Among both patients and the community group, more severe depressive symptoms were linked to greater medical utilization.
The community group's rate of non-routine medical service utilization was very low and remained stable at all follow-ups. The patients' rate was far higher and did not change until the four-year follow-up, when it declined significantly, and then remained unchanged at the 10-year mark. The study results are published in the current issue of the Annals of Behavioral Medicine.
As expected, the community group reported low levels of depressive symptoms that did not change significantly over time. In contrast, over the 10-year study period the patient group reported significant decreases in depressive symptoms, but not to the levels reported by the community group. This finding suggests that a large proportion of people seeking treatment for depression experience chronic problems with depression.
"Although treatment of mental health problems, such as depression, seems to be associated with a long term reduction in excess medical utilization, our study results suggest that treatment for psychological symptoms and disorders cannot be considered independently of other areas of medical care," said Kimerling. "We suggest that, as both medical and mental health care systems increasingly recognize the interconnections between physical and mental health, associations between mental health interventions and medical costs and utilization may become more apparent."
The research was conducted by scientists in the Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, with support from the U.S. Department of Veterans Affairs Health Services Research and Development Service and the National Institute of Mental Health. Dr. Kimerling is now at the University of California, San Francisco School of Medicine.
Annals of Behavioral Medicine is the official peer-reviewed publication of the Society of Behavioral Medicine. For information about the journal, contact Arthur Stone, PhD, 516-632-8833.
Posted by the Center for the Advancement of Health www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org (202) 387-2829.
Journal
Annals of Behavioral Medicine