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Depression in people with diabetes is associated with increased health care use and higher expenditures

About 3 percent of men and 5 to 9 percent of women in the United States suffer from depression. People who have diabetes are twice as likely as those who do not to suffer from clinical depression. When depression occurs in people with diabetes, it usually is associated with poor metabolic control, poor diet and adherence to treatment, and negative effects on quality of life.

A recent study found that people with diabetes who suffered from depression were more likely than those who were not depressed to report poor physical health (68 vs. 45 percent) and poor mental health (31 vs. 13 percent), use more outpatient care (12 vs. 7 visits), and fill more prescriptions (42 vs. 21). The study was supported in part by the Agency for Healthcare Research and Quality (HS11418 and HS10871) and led by Leonard E. Egede, M.D., M.S., of the Medical University of South Carolina.

Total health care expenditures for individuals with diabetes and depression were 4.5 times higher than for individuals without depression ($247 million vs. $55 million). The increased health care use and costs for people with both diabetes and depression remained even after adjusting for differences in age, sex, race/ethnicity, health insurance, and coexisting illnesses.

People with diabetes who also had depression were more likely than those without depression to be female, unmarried, and younger than 65 years of age. These groups, as well as people with diabetes who report poor physical or mental health, may benefit from screening for depression. This screening should be part of a plan of care that includes aggressive treatment and appropriate followup, suggests Dr. Egede. The researchers compared data on health care use and expenditures for 825 adults with diabetes and 20,688 adults without diabetes using data from the 1996 Medical Expenditure Panel Survey (MEPS).

More details are in "Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes," by Dr. Egede, Deyi Zheng, M.B., Ph.D., and Kit Simpson, Dr.P.H., in the March 2002 Diabetes Care 25(3), pp. 464-470.

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