Depressive Symptoms and Total Healthcare Costs: Roles of Functional Limitations and Multimorbidity

John T. Schousboe, Tien N. Vo, Allyson M. Kats, Lisa Langsetmo, Susan J. Diem, Brent C. Taylor, Elsa S. Strotmeyer, Kristine E. Ensrud

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

OBJECTIVES: Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity. DESIGN: Prospective cohort study (Study of Osteoporotic Fractures [SOF]). SETTING: Four US sites. PARTICIPANTS: A total of 2508 community-dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data. MEASUREMENTS: At Y10, depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0-5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data. RESULTS: Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0-1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2-5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self-reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14-1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99-1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms). CONCLUSION: Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs. J Am Geriatr Soc 67:1596–1603, 2019.

Original languageEnglish (US)
Pages (from-to)1596-1603
Number of pages8
JournalJournal of the American Geriatrics Society
Volume67
Issue number8
DOIs
StatePublished - 2019

Bibliographical note

Funding Information:
Financial Disclosure: Ensrud has received grant support from the National Institutes of Health (and supporting agencies). The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provided support under the following grants: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576. This article is the result of work supported with resources and use of facilities of the Minneapolis Veterans Administration Health Care System. The contents do not represent the views of the US Department of Veterans Affairs or the US government. Conflict of Interest: The authors have no conflicts of interest to report. Author Contributions: Schousboe: study concept and design, data interpretation, preparation of manuscript, and critical review of manuscript. Vo: data analysis, data interpretation, and critical review of manuscript. Kats: data analysis, data interpretation, and critical review of manuscript. Langsetmo: data analysis, data interpretation, and critical review of manuscript. Diem: data analysis, data interpretation, and critical review of manuscript. Taylor: data analysis, data interpretation, and critical review of manuscript. Strotmeyer: data analysis, data interpretation, and critical review of manuscript. Ensrud: study concept and design, acquisition of study subjects and data, data interpretation, and critical review of manuscript. Sponsor's Role: The sponsors had no role in study concept or design, methods, subject recruitment, data collection, analysis, and preparation of the manuscript.

Funding Information:
Financial Disclosure: Ensrud has received grant support from the National Institutes of Health (and supporting agencies). The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provided support under the following grants: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576. This article is the result of work supported with resources and use of facilities of the Minneapolis Veterans Administration Health Care System. The contents do not represent the views of the US Department of Veterans Affairs or the US government.

Publisher Copyright:
© 2019 The American Geriatrics Society

Keywords

  • depressive symptoms
  • functional limitations
  • healthcare costs
  • multimorbidity

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