The Excess Healthcare Costs Associated With Depression and Anxiety in Elderly Living in the Community

Objectives Relatively little is known about whether mental disorders other than depression remit versus persist in later life, especially within nationally representative samples. Our objectives were to examine the prevalence of persistent mood, anxiety, and substance disorders in older adults, and to explore a range of physical and mental health predictors of disorder chronicity. Methods This study utilized a three-year follow-up design using Waves 1 (2001/2002) and 2 (2004/2005) of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Participants included 1,994 adults 55+ who had a past-year mental disorder at Wave 1 and who completed Wave 2. The primary outcome was the prevalence of persistent mood, anxiety, and substance disorders at Wave 2. Potential predictors of persistence included sociodemographic variables, physical health (chronic health conditions and physical health-related quality of life), and mental health (childhood adversity, suicide attempts, mental health-related quality of life, comorbid mental disorders, personality disorders, and lifetime treatment seeking). Results With the exception of nicotine dependence, the prevalence of persistent mood, anxiety, and substance disorders ranged from 13% to 33%. Only younger age predicted substance disorder chronicity. Significant predictors of persistent mood and anxiety disorders included physical and mental health comorbidity, physical and mental health-related quality of life, suicide attempts, comorbid personality disorders, and treatment seeking. Conclusions At least two thirds of mental disorders in older adults were not persistent. Sociodemographic variables had little influence on chronicity, whereas a number of markers of mental disorder severity and complexity predicted persistent mood and anxiety disorders. The findings have important treatment and prevention implications.

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Persistent Versus Remitting Mood, Anxiety, and Substance Disorders in a National Sample of Older Adults

Mackenzie

El‐Gabalawy

Chou

et al. 2014

“…After all, depression is the single leading cause of non-fatal disease burden [1–3] and has substantial economic consequences [4–7]. …”

Section: Objectivementioning

confidence: 99%

Improving the Cost-Effectiveness of a Healthcare System for Depressive Disorders by Implementing Telemedicine: A Health Economic Modeling Study

Lokkerbol

Adema²,

Cuijpers³

et al. 2014

Objective Depressive disorders are important causes of disease burden and are associated with substantial economic costs. Therefore, it is important to design a health care system that can effectively manage depression at sustainable costs. This paper computes the benefit-to-costs ratio of the current Dutch health care system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. Methods A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compares a base-case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome is the benefit-to-cost ratio, also known as return-on-investment (ROI). Results In terms of ROI, a health care system with preventive telemedicine for depressive disorders offers better value for money than a health care system without internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base-case scenario to €1.76 ($2.09) in the alternative scenario where preventive telemedicine is offered. In a scenario where the costs of offering preventive telemedicine are balanced by cutting back on the expenditure for curative interventions, ROI increases to €1.77 ($2.10), while keeping the health care budget constant. Conclusion In order for a health care system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement.

“…9 Depressive syndromes in this age group are associated with a number of adverse outcomes, including functional impairment, 10 medical illnesses 11 and nonpsychiatric hospitalizations, 12 disability, 13 and increased health services utilization. 14,15 In older adults, depression has also proven to be difficult to treat, with a high rate of treatment refractoriness using first-line pharmacotherapies. 16 Meanwhile, several studies suggest bright-light therapy, a chronobiologic treatment designed to correct circadian rhythm disruption, may be an effective treatment for depression in older adults.…”

Section: Introductionmentioning

confidence: 99%

Depressive Symptoms and Circadian Activity Rhythm Disturbances in Community-Dwelling Older Women

Maglione

Ancoli‐Israel

Peters

et al. 2014

Objectives Aging is associated with changes in circadian rhythms. Current evidence supports a role for circadian rhythms in the pathophysiology of depression. However, little is known about the relationship between depressive symptoms and circadian activity rhythms in older adults. We examined this association in community-dwelling older women. Methods We performed a cross-sectional analysis of 3,020 women (mean age: 83.55 ± 3.79 years) enrolled in the Study of Osteoporotic Fractures. Depressive symptoms were assessed with the Geriatric Depression Scale categorizing participants as “normal” (0–2; referent group, N = 1,961), “some depressive symptoms” (3–5, N = 704), or “depressed” (≥6, N = 355). Circadian activity rhythm variables were measured using wrist actigraphy. Results In age-adjusted and Study of Osteoporotic Fractures site–adjusted models, greater levels of depressive symptoms were associated with decreased amplitude (height; df = 3,014, t = −11.31, p for linear trend <0.001), pseudo F-statistic (robustness; df =3,014, t =−8.07, p for linear trend <0.001), and mesor (mean modeled activity; df = 3014, t = −10.36, p for linear trend <0.001) of circadian activity rhythms. Greater levels of depressive symptoms were also associated with increased odds of being in the lowest quartile for amplitude (df =1, χ2 =9240, p for linear trend <0.001), pseudo F-statistic (df =1, χ2 =49.73, p for linear trend <0.001), and mesor (df =1, χ2 =81.12, p for linear trend <0.001). These associations remained significant in multivariate models. Post-hoc analyses comparing mean amplitude, mesor, and pseudo F-statistic values pair-wise between depression-level groups revealed significant differences between women with “some depressive symptoms” and the “normal” group. Conclusion These data suggest a graded association between greater levels of depressive symptoms and more desynchronization of circadian activity rhythms in community-dwelling older women. This association was observed even for women endorsing subthreshold levels of depressive symptoms.