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A recent study of a large HMO shows that patients with persistent anxiety and depressed mood use more general medical care and have higher health care costs than those without such problems. Patients with depressed mood, persistent anxiety, and significant impairment in work, family, or social functioning have roughly twice the medical care costs of patients without these problems. These findings highlight the possible economic benefits of screening primary care patients for selected psychiatric symptoms, suggests William D. Spector, Ph.D., of the Agency for Healthcare Research and Quality.
Dr. Spector and his colleagues from Kaiser Permanente of Northern California and the University of California, San Francisco, examined the 1-year medical care costs of 10,377 adults enrolled in a California HMO. The HMO enrollees were initially interviewed by telephone about psychiatric symptoms and associated impairment in social, family, or work function. About one-fourth (24 percent) of the respondents reported having one or more of five psychiatric symptoms (depressed mood, brief anxiety, persistent anxiety, panic attacks, and trouble controlling violent behavior).
After controlling for age, sex, race, medical conditions, and smoking, the mean costs of general medical care were $1,948 for respondents who reported none of the psychiatric symptoms or impaired function, $3,006 for respondents with all five symptoms but no impaired function, and $3,906 for those with all five symptoms and pervasive functional impairment. Persistent anxiety and depressed mood had the greatest impact on general medical costs, increasing mean costs by almost 50 percent. Impaired function was associated with increased likelihood of hospital admission and emergency room use. Those impaired in work, family, and social functioning had a 50 percent increase in emergency care use and a 62 percent increase in hospital use over people who had no functional impairments.
See "Psychiatric symptoms, impaired function, and medical care costs in an HMO setting," by Enid M. Hunkeler, M.A., Dr. Spector, Bruce Fireman, M.S., and others, in the May-June 2003 General Hospital Psychiatry 25, pp. 178-184.
Reprints (AHRQ Publication No. 03-R050) are available from the AHRQ Publications Clearinghouse.
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