Longitudinal study of depression and health services use among elderly primary care patients

Christopher Callahan, Siu Hui, N. A. Nienaber, B. S. Musick, W. M. Tierney

Research output: Contribution to journalArticle

258 Citations (Scopus)

Abstract

OBJECTIVE: To describe the prevalence and 9-month incidence of depressive symptoms among a cohort of elderly primary care patients and to determine whether different patterns of depression are associated with different patterns of health services use. DESIGN: Prospective study of depressive symptoms as measured by the Center for Epidemiologic Studies Depression (CES- D) scale and identification of patients' outpatient health services use through an electronic medical record system. SETTING: An academic primary care group practice at an urban ambulatory care clinic. PATIENTS/PARTICIPANTS: 1711 patients aged 60 and older who completed the CES- D at baseline and 9 months later; 935 of these patients also completed the CES-D at 6 months. MEASUREMENT AND MAIN RESULTS: The prevalence of significant symptoms of depression (CES-D ≥ 16) was 17.1% at baseline and 18.8% at 9 months; 26.8% of patients exceeded the threshold on the CES-D either at baseline or 9 months, and the 9-month incidence was 11.7%. Among the patients re-interviewed at both 6 and 9 months, the 6-month incidence was 12%, and the incidence between the 6- and 9-month assessments was 10%. Of the 292 patients with depression at baseline, 140 (47.6%) remained depressed at the 9-month follow-up. Baseline and 6-month CES-D score, in addition to perceived health at 6 months, explained 45% of the variance in the 9-month CES-D score. Patients above the threshold on the CES-D at any time were more likely to rate their health as fair or poor (69.8% vs 43.7%) and more likely to have an emergency room visit (40.4% vs 29.4%). These patients also had 38% more outpatient visits (7.7 vs 5.6) and 61% higher total outpatient charges ($1209 vs $751) than patients who never exceeded the CES-D threshold over the 9-month window (all P values < 0.01). CONCLUSIONS: Depressive symptoms were frequent and often persistent in this patient population. We identified patterns of oscillating severity of symptoms within individuals but relatively stable incidence and prevalence rates over a 9-month period. Patients who exceeded the threshold on the CES-D at any time during the study had significantly greater health services use and poorer perceived health.

Original languageEnglish
Pages (from-to)833-838
Number of pages6
JournalJournal of the American Geriatrics Society
Volume42
Issue number8
StatePublished - 1994

Fingerprint

Health Services
Longitudinal Studies
Primary Health Care
Depression
Incidence
Ambulatory Care
Epidemiologic Studies
Outpatients
Health Fairs
Group Practice
Electronic Health Records
Health
Hospital Emergency Service
Prospective Studies

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Longitudinal study of depression and health services use among elderly primary care patients. / Callahan, Christopher; Hui, Siu; Nienaber, N. A.; Musick, B. S.; Tierney, W. M.

In: Journal of the American Geriatrics Society, Vol. 42, No. 8, 1994, p. 833-838.

Research output: Contribution to journalArticle

@article{ede66b5561654d5dbb30a905fa79b4e2,
title = "Longitudinal study of depression and health services use among elderly primary care patients",
abstract = "OBJECTIVE: To describe the prevalence and 9-month incidence of depressive symptoms among a cohort of elderly primary care patients and to determine whether different patterns of depression are associated with different patterns of health services use. DESIGN: Prospective study of depressive symptoms as measured by the Center for Epidemiologic Studies Depression (CES- D) scale and identification of patients' outpatient health services use through an electronic medical record system. SETTING: An academic primary care group practice at an urban ambulatory care clinic. PATIENTS/PARTICIPANTS: 1711 patients aged 60 and older who completed the CES- D at baseline and 9 months later; 935 of these patients also completed the CES-D at 6 months. MEASUREMENT AND MAIN RESULTS: The prevalence of significant symptoms of depression (CES-D ≥ 16) was 17.1{\%} at baseline and 18.8{\%} at 9 months; 26.8{\%} of patients exceeded the threshold on the CES-D either at baseline or 9 months, and the 9-month incidence was 11.7{\%}. Among the patients re-interviewed at both 6 and 9 months, the 6-month incidence was 12{\%}, and the incidence between the 6- and 9-month assessments was 10{\%}. Of the 292 patients with depression at baseline, 140 (47.6{\%}) remained depressed at the 9-month follow-up. Baseline and 6-month CES-D score, in addition to perceived health at 6 months, explained 45{\%} of the variance in the 9-month CES-D score. Patients above the threshold on the CES-D at any time were more likely to rate their health as fair or poor (69.8{\%} vs 43.7{\%}) and more likely to have an emergency room visit (40.4{\%} vs 29.4{\%}). These patients also had 38{\%} more outpatient visits (7.7 vs 5.6) and 61{\%} higher total outpatient charges ($1209 vs $751) than patients who never exceeded the CES-D threshold over the 9-month window (all P values < 0.01). CONCLUSIONS: Depressive symptoms were frequent and often persistent in this patient population. We identified patterns of oscillating severity of symptoms within individuals but relatively stable incidence and prevalence rates over a 9-month period. Patients who exceeded the threshold on the CES-D at any time during the study had significantly greater health services use and poorer perceived health.",
author = "Christopher Callahan and Siu Hui and Nienaber, {N. A.} and Musick, {B. S.} and Tierney, {W. M.}",
year = "1994",
language = "English",
volume = "42",
pages = "833--838",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Longitudinal study of depression and health services use among elderly primary care patients

AU - Callahan, Christopher

AU - Hui, Siu

AU - Nienaber, N. A.

AU - Musick, B. S.

AU - Tierney, W. M.

PY - 1994

Y1 - 1994

N2 - OBJECTIVE: To describe the prevalence and 9-month incidence of depressive symptoms among a cohort of elderly primary care patients and to determine whether different patterns of depression are associated with different patterns of health services use. DESIGN: Prospective study of depressive symptoms as measured by the Center for Epidemiologic Studies Depression (CES- D) scale and identification of patients' outpatient health services use through an electronic medical record system. SETTING: An academic primary care group practice at an urban ambulatory care clinic. PATIENTS/PARTICIPANTS: 1711 patients aged 60 and older who completed the CES- D at baseline and 9 months later; 935 of these patients also completed the CES-D at 6 months. MEASUREMENT AND MAIN RESULTS: The prevalence of significant symptoms of depression (CES-D ≥ 16) was 17.1% at baseline and 18.8% at 9 months; 26.8% of patients exceeded the threshold on the CES-D either at baseline or 9 months, and the 9-month incidence was 11.7%. Among the patients re-interviewed at both 6 and 9 months, the 6-month incidence was 12%, and the incidence between the 6- and 9-month assessments was 10%. Of the 292 patients with depression at baseline, 140 (47.6%) remained depressed at the 9-month follow-up. Baseline and 6-month CES-D score, in addition to perceived health at 6 months, explained 45% of the variance in the 9-month CES-D score. Patients above the threshold on the CES-D at any time were more likely to rate their health as fair or poor (69.8% vs 43.7%) and more likely to have an emergency room visit (40.4% vs 29.4%). These patients also had 38% more outpatient visits (7.7 vs 5.6) and 61% higher total outpatient charges ($1209 vs $751) than patients who never exceeded the CES-D threshold over the 9-month window (all P values < 0.01). CONCLUSIONS: Depressive symptoms were frequent and often persistent in this patient population. We identified patterns of oscillating severity of symptoms within individuals but relatively stable incidence and prevalence rates over a 9-month period. Patients who exceeded the threshold on the CES-D at any time during the study had significantly greater health services use and poorer perceived health.

AB - OBJECTIVE: To describe the prevalence and 9-month incidence of depressive symptoms among a cohort of elderly primary care patients and to determine whether different patterns of depression are associated with different patterns of health services use. DESIGN: Prospective study of depressive symptoms as measured by the Center for Epidemiologic Studies Depression (CES- D) scale and identification of patients' outpatient health services use through an electronic medical record system. SETTING: An academic primary care group practice at an urban ambulatory care clinic. PATIENTS/PARTICIPANTS: 1711 patients aged 60 and older who completed the CES- D at baseline and 9 months later; 935 of these patients also completed the CES-D at 6 months. MEASUREMENT AND MAIN RESULTS: The prevalence of significant symptoms of depression (CES-D ≥ 16) was 17.1% at baseline and 18.8% at 9 months; 26.8% of patients exceeded the threshold on the CES-D either at baseline or 9 months, and the 9-month incidence was 11.7%. Among the patients re-interviewed at both 6 and 9 months, the 6-month incidence was 12%, and the incidence between the 6- and 9-month assessments was 10%. Of the 292 patients with depression at baseline, 140 (47.6%) remained depressed at the 9-month follow-up. Baseline and 6-month CES-D score, in addition to perceived health at 6 months, explained 45% of the variance in the 9-month CES-D score. Patients above the threshold on the CES-D at any time were more likely to rate their health as fair or poor (69.8% vs 43.7%) and more likely to have an emergency room visit (40.4% vs 29.4%). These patients also had 38% more outpatient visits (7.7 vs 5.6) and 61% higher total outpatient charges ($1209 vs $751) than patients who never exceeded the CES-D threshold over the 9-month window (all P values < 0.01). CONCLUSIONS: Depressive symptoms were frequent and often persistent in this patient population. We identified patterns of oscillating severity of symptoms within individuals but relatively stable incidence and prevalence rates over a 9-month period. Patients who exceeded the threshold on the CES-D at any time during the study had significantly greater health services use and poorer perceived health.

UR - http://www.scopus.com/inward/record.url?scp=0027969293&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027969293&partnerID=8YFLogxK

M3 - Article

C2 - 8046192

AN - SCOPUS:0027969293

VL - 42

SP - 833

EP - 838

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 8

ER -