Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004–2011
Open accessAbstract
Objective To investigate differences in healthcare cost trends over 8 years in adults with diabetes and one of four categories of comorbid depression: no depression, unrecognized depression, asymptomatic depression, or symptomatic depression.Research design and methods Data from the 2004-2011 Medical Expenditure Panel Survey (MEPS) was used to create nationally representative estimates. The dependent variable was total healthcare expenditures for the calendar year, including office-based, hospital outpatient, emergency room, inpatient hospital, prescription, dental, and home health care expenditures. The 2004-2011 direct medical costs were adjusted to a common 2014 dollar value. The primary independent variable was four mutually exclusive depression categories created from ICD-9-CM codes and the PHQ-2 depression screening tool. Healthcare expenditures were estimated using a two-part model and were adjusted for age, sex, race, marital status, education, health insurance, metropolitan statistical area status, region, income level, and comorbidities.Results Based on a national sample of adults with diabetes (unweighted sample of 15,548, weighted sample of 17,465,579), 10.2 % had unrecognized depression, 13.6 % had asymptomatic depression, and 8.9 % had symptomatic depression. In the pooled sample, after adjusting for covariates, the incremental cost of unrecognized depression was $2872 (95 % CI 1660-4084), asymptomatic depression increased by $3347 (95 % CI 2568-4386), and symptomatic depression increased by $5170 (CI 95 % 3610-6731) compared to patients with no depression.Conclusions Adjusted analyses showed that expenditures were $2000-3000 higher for unrecognized and asymptomatic depression than no depression, and $5000 higher for symptomatic depression. Higher medical expenditures persisted over time, with only symptomatic depression showing a sustained decrease over time.
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Comorbid MDD in people with type 2 diabetes is associated with increased health care costs.
“Comorbid MDD in people with type 2 diabetes is associated with poorer adherence to diabetes treatment52 and self-care activities (e.g., exercise, healthy eating)53,54, increased health care costs22,54, reduced glycemic control55,56, and increased hospital admissions and complications57-60.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [22]
The Conclusions report higher medical expenditures among adults with diabetes and comorbid depression. However, the study does not isolate people with type 2 diabetes or establish that its depression categories represent diagnosed major depressive disorder (Depression section). (LLM, conf=0.88)
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Prescription Medication Expenditures for Patients With Diabetes in the United States: 2012–2021
Li, S., Pan, S., Xiao, N., Jiang, S., Liu, G. G., & Lyu, B. (2025) · Journal of Diabetes · doi:10.1111/1753-0407.70106
Fardousi, N., Negara, S. N. S., Subronto, Y. W., Mashuri, Y. A., Cheng, Q., Wulandari, L. P. L., Putra, I. W. C. S. D., Wahyuningtias, S. D., Probandari, A. N., Thabrany, H., et al. (2025) · Health Policy and Planning · doi:10.1093/heapol/czaf058
Additional file 4 of Costs of multimorbidity: a systematic review and meta-analyses
Tran, P. B., Kazibwe, J., Nikolaidis, G. F., Linnosmaa, I., Rijken, M., & van Olmen, J. (2022) · Figshare · doi:10.6084/m9.figshare.20336987
Additional file 1 of Costs of multimorbidity: a systematic review and meta-analyses
Tran, P. B., Kazibwe, J., Nikolaidis, G. F., Linnosmaa, I., Rijken, M., & van Olmen, J. (2022) · Figshare · doi:10.6084/m9.figshare.20336978
Additional file 2 of Costs of multimorbidity: a systematic review and meta-analyses
Tran, P. B., Kazibwe, J., Nikolaidis, G. F., Linnosmaa, I., Rijken, M., & van Olmen, J. (2022) · Figshare · doi:10.6084/m9.figshare.20336981
Ruhm, C. J. (2026) · Psychological Medicine · doi:10.1017/s0033291726106072
- Authors
- Egede, L. E., Walker, R. J., Bishu, K., & Dismuke, C. E.
- Affiliations
- Medical University of South Carolina (US)
- Corresponding author
- Egede, Leonard E.
- Venue
- Journal of General Internal Medicine
- Published
- 2016-03-11
- Volume
- 31
- Issue
- 6
- Pages
- 615-622
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4870425
- OpenAlex
- W2340346104
- Cited by
- 70
- References
- 35
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 9 · 2021: 11 · 2020: 6 · 2019: 5 · 2018: 12 · 2017: 6 · 2016: 3
- FWCI
- 13.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- depression, diabetes mellitus, health care costs, comorbidities, cost trends, ICD-9-CM codes, Medical Expenditure Panel Survey
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Depression, Depressive Disorder, Diabetes Mellitus, Health Expenditures, Humans, Middle Aged, Psychiatric Status Rating Scales, United States, Health Care Costs
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