Top

BMC Psychiatry

Published in:

Open Access 01-12-2016 | Research article

Depression treatment decreases healthcare expenditures among working age patients with comorbid conditions and type 2 diabetes mellitus along with newly-diagnosed depression

Authors: Rituparna Bhattacharya, Chan Shen, Amy B. Wachholtz, Nilanjana Dwibedi, Usha Sambamoorthi

Published in: BMC Psychiatry | Issue 1/2016

Abstract

Background

There are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions.

Methods

We used multi-state Medicaid data (2000–2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions.

Results

Total healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition.

Conclusions

Among adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits.

Available only for authorised users

Amsterdam JD, Shults J, Rutherford N, Schwartz S. Safety and efficacy of s-citalopram in patients with co-morbid major depression and diabetes mellitus. Neuropsychobiology. 2006;54(4):208–14.CrossRefPubMed

Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.CrossRefPubMed

Atlantis E, Fahey P, Foster J. Collaborative care for comorbid depression and diabetes: a systematic review and meta-analysis. BMJ Open. 2014;4(4):e004706.CrossRefPubMedPubMedCentral

Blom MB, Jonker K, Dusseldorp E, Spinhoven P, Hoencamp E, Haffmans J, van Dyck R. Combination treatment for acute depression is superior only when psychotherapy is added to medication. Psychother Psychosom. 2007;76(5):289–97.CrossRefPubMed

Chen PC, Chan YT, Chen HF, Ko MC, Li CY. Population-based cohort analyses of the bidirectional relationship between type 2 diabetes and depression. Diabetes Care. 2013;36(2):376–82.CrossRefPubMedPubMedCentral

Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med. 2000;160(21):3278–85.CrossRefPubMed

Clarke JL, Meiris DC. Building bridges: integrative solutions for managing complex comorbid conditions. Am J Med Qual. 2007;22(2 Suppl):5S–16.CrossRefPubMed

Cuijpers P, Dekker J, Hollon SD, Andersson G. Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis. J Clin Psychiatry. 2009;70(9):1219–29.CrossRefPubMed

Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds 3rd CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56–67.CrossRefPubMedPubMedCentral

10.

de Jonghe F, Hendricksen M, van Aalst G, Kool S, Peen V, Van R, van den Eijnden E, Dekker J. Psychotherapy alone and combined with pharmacotherapy in the treatment of depression. Br J Psychiatry. 2004;185:37–45.CrossRefPubMed

11.

Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25(3):464–70.CrossRefPubMed

12.

Finkelstein EA, Bray JW, Chen H, Larson MJ, Miller K, Tompkins C, Keme A, Manderscheid R. Prevalence and costs of major depression among elderly claimants with diabetes. Diabetes Care. 2003;26(2):415–20.CrossRefPubMed

13.

Georgiades A, Zucker N, Friedman KE, Mosunic CJ, Applegate K, Lane JD, Feinglos MN, Surwit RS. Changes in depressive symptoms and glycemic control in diabetes mellitus. Psychosom Med. 2007;69(3):235–41.CrossRefPubMed

14.

Grenard JL, Munjas BA, Adams JL, Suttorp M, Maglione M, McGlynn EA, Gellad WF. Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med. 2011;26(10):1175–82.CrossRefPubMedPubMedCentral

15.

Gulseren L, Gulseren S, Hekimsoy Z, Mete L. Comparison of fluoxetine and paroxetine in type II diabetes mellitus patients. Arch Med Res. 2005;36(2):159–65.CrossRefPubMed

16.

Harpaz-Rotem I, Libby D, Rosenheck RA. Psychotherapy use in a privately insured population of patients diagnosed with a mental disorder. Soc Psychiatry Psychiatr Epidemiol. 2012;47(11):1837–44.CrossRefPubMed

17.

Hollon SD, DeRubeis RJ, Fawcett J, Amsterdam JD, Shelton RC, Zajecka J, Young PR, Gallop R. Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71(10):1157–64.CrossRefPubMedPubMedCentral

18.

Katon W, Cantrell CR, Sokol MC, Chiao E, Gdovin JM. Impact of antidepressant drug adherence on comorbid medication use and resource utilization. Arch Intern Med. 2005;165(21):2497–503.CrossRefPubMed

19.

Katon W, Unutzer J, Fan MY, Williams Jr JW, Schoenbaum M, Lin EH, Hunkeler EM. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care. 2006;29(2):265–70.CrossRefPubMed

20.

Katon W, Von Korff M, Lin E, Lipscomb P, Russo J, Wagner E, Polk E. Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry. 1990;12(6):355–62.CrossRefPubMed

21.

Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci. 2011;13(1):7–23.PubMed

22.

Katon WJ, Russo JE, Von Korff M, Lin EH, Ludman E, Ciechanowski PS. Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes. Diabetes Care. 2008;31(6):1155–9.CrossRefPubMed

23.

Le TK, Able SL, Lage MJ. Resource use among patients with diabetes, diabetic neuropathy, or diabetes with depression. Cost Eff Resour Alloc. 2006;4:18.CrossRefPubMedPubMedCentral

24.

Lustman PJ, Clouse RE, Nix BD, Freedland KE, Rubin EH, McGill JB, Williams MM, Gelenberg AJ, Ciechanowski PS, Hirsch IB. Sertraline for prevention of depression recurrence in diabetes mellitus: a randomized, double-blind, placebo-controlled trial. Arch Gen Psychiatry. 2006;63(5):521–9.CrossRefPubMed

25.

Lustman PJ, Freedland KE, Griffith LS, Clouse RE. Fluoxetine for depression in diabetes: a randomized double-blind placebo-controlled trial. Diabetes Care. 2000;23(5):618–23.CrossRefPubMed

26.

Lustman PJ, Griffith LS, Clouse RE, Freedland KE, Eisen SA, Rubin EH, Carney RM, McGill JB. Effects of nortriptyline on depression and glycemic control in diabetes: results of a double-blind, placebo-controlled trial. Psychosom Med. 1997;59(3):241–50.CrossRefPubMed

27.

Lustman PJ, Griffith LS, Freedland KE, Kissel SS, Clouse RE. Cognitive behavior therapy for depression in type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1998;129(8):613–21.CrossRefPubMed

28.

Lustman PJ, Williams MM, Sayuk GS, Nix BD, Clouse RE. Factors influencing glycemic control in type 2 diabetes during acute- and maintenance-phase treatment of major depressive disorder with bupropion. Diabetes Care. 2007;30(3):459–66.CrossRefPubMed

29.

Naessens JM, Stroebel RJ, Finnie DM, Shah ND, Wagie AE, Litchy WJ, Killinger PJ, O’Byrne TJ, Wood DL, Nesse RE. Effect of multiple chronic conditions among working-age adults. Am J Manag Care. 2011;17(2):118–22.PubMed

30.

Nichols L, Barton PL, Glazner J, McCollum M. Diabetes, minor depression and health care utilization and expenditures: a retrospective database study. Cost Eff Resour Alloc. 2007;5:4.CrossRefPubMedPubMedCentral

31.

Nierenberg AA, Petersen TJ, Alpert JE. Prevention of relapse and recurrence in depression: the role of long-term pharmacotherapy and psychotherapy. J Clin Psychiatry. 2003;64(Suppl 15):13–7.PubMed

32.

Paile-Hyvarinen M, Wahlbeck K, Eriksson JG. Quality of life and metabolic status in mildly depressed women with type 2 diabetes treated with paroxetine: a single-blind randomised placebo controlled trial. BMC Fam Pract. 2003;4:7.CrossRefPubMedPubMedCentral

33.

Paile-Hyvarinen M, Wahlbeck K, Eriksson JG. Quality of life and metabolic status in mildly depressed patients with type 2 diabetes treated with paroxetine: a double-blind randomised placebo controlled 6-month trial. BMC Fam Pract. 2007;8:34.CrossRefPubMedPubMedCentral

34.

Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29(3):725–31.CrossRefPubMed

35.

Prince JD, Akincigil A, Hoover DR, Walkup JT, Bilder S, Crystal S. Substance abuse and hospitalization for mood disorder among Medicaid beneficiaries. Am J Public Health. 2009;99(1):160–7.CrossRefPubMedPubMedCentral

36.

Sambamoorthi U, Olfson M, Wei W, Crystal S. Diabetes and depression care among medicaid beneficiaries. J Health Care Poor Underserved. 2006;17(1):141–61.CrossRefPubMed

37.

Sambamoorthi U, Shen C, Findley P, Frayne S, Banerjea R. Depression treatment patterns among women veterans with cardiovascular conditions or diabetes. World Psychiatry. 2010;9(3):177–82.CrossRefPubMedPubMedCentral

38.

Simon GE. Psychiatric disorder and functional somatic symptoms as predictors of health care use. Psychiatr Med. 1992;10(3):49–59.PubMed

39.

Simon GE, Katon WJ, Lin EH, Rutter C, Manning WG, Von Korff M, Ciechanowski P, Ludman EJ, Young BA. Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry. 2007;64(1):65–72.CrossRefPubMed

40.

Simon GE, Khandker RK, Ichikawa L, Operskalski BH. Recovery from depression predicts lower health services costs. J Clin Psychiatry. 2006;67(8):1226–31.CrossRefPubMed

41.

Simson U, Nawarotzky U, Friese G, Porck W, Schottenfeld-Naor Y, Hahn S, Scherbaum WA, Kruse J. Psychotherapy intervention to reduce depressive symptoms in patients with diabetic foot syndrome. Diabet Med. 2008;25(2):206–12.CrossRefPubMed

42.

Stein BD, Sorbero MJ, Dalton E, Ayers AM, Farmer C, Kogan JN, Goswami U. Predictors of adequate depression treatment among Medicaid-enrolled youth. Soc Psychiatry Psychiatr Epidemiol. 2013;48(5):757–65.CrossRefPubMed

43.

Taylor AW, Price K, Gill TK, Adams R, Pilkington R, Carrangis N, Shi Z, Wilson D. Multimorbidity - not just an older person’s issue. Results from an Australian biomedical study. BMC Public Health. 2010;10:718.CrossRefPubMedPubMedCentral

44.

Teh CF, Sorbero MJ, Mihalyo MJ, Kogan JN, Schuster J, Reynolds 3rd CF, Stein BD. Predictors of adequate depression treatment among Medicaid-enrolled adults. Health Serv Res. 2010;45(1):302–15.CrossRefPubMedPubMedCentral

45.

Thase ME. Achieving remission and managing relapse in depression. J Clin Psychiatry. 2003;64(Suppl 18):3–7.

46.

Tiwari A, Rajan M, Miller D, Pogach L, Olfson M, Sambamoorthi U. Guideline-consistent antidepressant treatment patterns among veterans with diabetes and major depressive disorder. Psychiatr Serv. 2008;59(10):1139–47.CrossRefPubMed

47.

To A, Oetter H, Lam RW. Treatment of depression in primary care-Part 1: Principles of acute treatment. B C Med J. 2002;44(9):473–8.

48.

U.S. Department of Health and Human Services. 2011. http://ahrf.hrsa.gov/.

49.

Wei W, Sambamoorthi U, Crystal S, Findley PA. Mental illness, traumatic brain injury, and medicaid expenditures. Arch Phys Med Rehabil. 2005;86(5): 905–11.CrossRefPubMedPubMedCentral

Title: Depression treatment decreases healthcare expenditures among working age patients with comorbid conditions and type 2 diabetes mellitus along with newly-diagnosed depression
Authors: Rituparna Bhattacharya
Chan Shen
Amy B. Wachholtz
Nilanjana Dwibedi
Usha Sambamoorthi
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-016-0964-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Depression treatment decreases healthcare expenditures among working age patients with comorbid conditions and type 2 diabetes mellitus along with newly-diagnosed depression

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Determinants of dropout in a community-based mental health crisis centre

Accuracy of reported service use in a cohort of people who are chronically homeless and seriously mentally ill

Increased risk of benign paroxysmal positional vertigo in patients with anxiety disorders: a nationwide population-based retrospective cohort study

Recognition of mental disorders among a multiracial population in Southeast Asia

Borderline personality disorder and violence in the UK population: categorical and dimensional trait assessment

Positive mental health in outpatients: comparison within diagnostic groups