Cited by 697Mental Health Treatment and AccessHealth Systems, Economic Evaluations, Quality of LifeAging, Health, and Disability

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Depressive Symptoms and the Cost of Health Services in HMO Patients Aged 65 Years and Older: A 4-Year Prospective Study

Unützer, Jürgen·1997·JAMA

DOI 10.1001/jama.1997.03540440052032

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Abstract

OBJECTIVE: To examine whether depressive symptoms in older adults contribute to increased cost of general medical services. DESIGN: A 4-year prospective cohort study. SETTING: Four primary care clinics of a large staff-model health maintenance organization (HMO) in Seattle, Wash. PATIENTS: A total of 5012 Medicare enrollees older than 65 years were invited to participate in the study; 2558 subjects (51%) were successfully enrolled. Non-participants were somewhat older and had a higher level of chronic medical illness. MAIN OUTCOME MEASURES: Depressive symptoms as measured by the Center for Epidemiological Studies Depression scale, which was administered as part of a mail survey at baseline, at 2 years, and at 4 years; and total cost of medical services from the perspective of the HMO. Data were obtained from the cost accounting system of the HMO. RESULTS: In this cohort of older adults, depressive symptoms were common, persistent, and associated with a significant increase in the cost of general medical services. This increase was seen for every component of health care costs and was not accounted for by an increase in specialty mental health care. The increase in health care costs remained significant after adjusting for differences in age, sex, and chronic medical illness. CONCLUSIONS: Depressive symptoms in older adults are associated with a significant increase in the cost of medical services, even after adjusting for the severity of chronic medical illness.

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Authors: Unützer, J.
Affiliations: University of Washington (US)
Corresponding author: Unützer, Jürgen
ORCID: Unützer, Jürgen
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 1997-05-28
Volume: 277
Issue: 20
Pages: 1618
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.1997.03540440052032
OpenAlex: W2153731374
Cited by: 697
References: 65
Citations by year: 2026: 4 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 9 · 2021: 11 · 2020: 17 · 2019: 14 · 2018: 15 · 2017: 8 · 2016: 17 · 2015: 22 · 2014: 12 · 2013: 37 · 2012: 29
FWCI: 61.67
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
Keywords: depressive symptoms, geriatric depression, health care costs, health maintenance organizations, Medicare enrollees, primary care, chronic disease, mental health service utilization, older adults
MeSH terms: Aged, Chronic Disease, Depression, Family Practice, Female, Health Maintenance Organizations, Health Services, Humans, Male, Mental Health Services, Prospective Studies, Regression Analysis, United States, Prevalence, Health Care Costs

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Depressive Symptoms and the Cost of Health Services in HMO Patients Aged 65 Years and Older: A 4-Year Prospective Study

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