Does the severity of mood and anxiety symptoms predict health care utilization?

BACKGROUND. Traditional diagnostic criteria for depression and anxiety fail to account for symptom severity. We previously evaluated a severity-based classification system of mood and anxiety symptoms. This study examines whe ther those severity groups are predictive of differences in health care uti lization. METHODS. We used a cohort design to compare the health care utilization of 1232 subjects classified into 4 groups according to symptom severity. Healt h care billing data were evaluated for each subject for a 15-month period a round the index visit. Multiple linear regression models were used to exami ne relative contributions of individual Variables to differences in health care utilization. Analysis of Variance procedures were used to compare char ges among the severity groups after adjusting for demographic and medical c omorbidity variables. RESULTS. After adjustment, significant differences in health care utilizati on between groups were seen in all bur 3 of the 15 months studied. Also, af ter adjustment, the presence of a mood or anxiety disorder influenced utili zation for only a 8-month period. At 9 to12 months, subjects in the high-se verity group showed a more than twofold difference in adjusted charges comp ared with the low-severity group ($225.36 vs $94.37). CONCLUSIONS. Our severity-based classification predicts statistically and c linically significant differences in health care utilization over most of a 15-month period. Differences in utilization persist even after adjustment for medical comorbidity and significant demographic covariates. Our work le nds additional evidence that beyond screening for the presence of mood and anxiety disorders, it is important to assess symptom severity in primary ca re patients, Further study directed toward developing effective methods of identifying patients with high levels of mood and anxiety symptom severity could result in significant cost savings.