HEALTH-CARE COSTS ASSOCIATED WITH DEPRESSIVE AND ANXIETY DISORDERS INPRIMARY-CARE

Objective: The authors examined the overall health care costs associat ed with depression and anxiety among primary care patients. Method: Of 2,110 consecutive primary care patients in a health maintenance organ ization, 1,962 were screened with the 12-item General Health Questionn aire. A stratified random sample of 615 patients were selected for fur ther diagnostic assessment; 373 of these patients completed the Compos ite International Diagnostic Interview at baseline and 328 were reasse ssed 12 months later. Computerized cost records were used to calculate total health care costs for the 6-month period surrounding the baseli ne assessment and a similar period surrounding the follow-up assessmen t. Cost accounting data were available for 327 patients at baseline an d for 206 patients at both assessments. Results: Primary care patients with DSM-III-R anxiety or depressive disorders at baseline had marked ly higher baseline costs ($2,390) than patients with subthreshold diso rders ($1,098) and those with no anxiety or depressive disorder ($1,39 7). Large cost differences persisted after adjustment for medical morb idity. Cost differences reflected higher utilization of general medica l services rather than higher mental health treatment costs. Although most patients with baseline anxiety or depressive disorders showed sig nificant improvement, longitudinal analyses did not show any clear rel ationship between change in psychiatric diagnosis and change in health care cost. Conclusions: Among primary care patients, anxiety and depr essive disorders are associated with markedly higher health care costs even after adjustment for medical comorbidity. In this small sample, improvement in depression over 1 year was not clearly associated with decreases in cost.