Healthcare and preventive services utilization of elderly Europeans with depressive symptoms.
TL;DR: Share data suggest that patients with depressive symptoms are frequent users of healthcare but not preventive services, and low screening rates may reflect missed screening opportunities rather than a lack of screening opportunities.
About: This article is published in Journal of Affective Disorders.The article was published on 2008-01-01 and is currently open access. It has received 57 citations till now. The article focuses on the topics: Breast cancer screening.
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TL;DR: There is strong evidence to suggest that the quality of preventive and screening services received by patients with mental illness is often lower, but occasionally superior to that received by individuals who have no comparable mental disorder.
108 citations
Cites background from "Healthcare and preventive services ..."
...Eight studies showed no effect of mental illness on mammography [33,35,36,38,45–47,50]....
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...This trend was despite a significantly higher use of services in the depressed group [33]....
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...In the large European interview and survey study [33], the group screening positive for a depressive disorder had higher rates of colonoscopy or sigmoidoscopy (16....
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...Neutral association In a large European interview and survey study, the group with high Euro-D scores, suggesting the presence of a depressive disorder, had a trend towards higher flu vaccination, but this was not significant [33]....
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...[33] conducted an interview and questionnaire survey of over 50 years old in 10 European countries (n=15,380); those who scored N3 on the Euro-D were less likely to have a mammogram in the last 2 years, but the adjusted odds ratio was no longer significant (OR 1....
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TL;DR: Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress, clearly extend into preventive population screening.
Abstract: Background
There is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening.
Aims
To conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health.
Method
Major electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety.
Results
We identified 24 publications reporting breast cancer screening practices in women with mental illness ( n = 715 705). An additional 5 studies investigating screening for those with distress ( n = 21 491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66-0.77), mood disorders (OR = 0.83, 95% CI 0.76-0.90) and particularly SMI (OR = 0.54, 95% CI 0.45-0.65). No disparity was evident among women with distress alone.
Conclusions
Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.
100 citations
Cites background from "Healthcare and preventive services ..."
...…et al (2008) 58 (Canada) Green & Pope (2000) 49 Druss et al (2008) 48 (primary care) Masterton et al (2010) 54 (moderate) Pirraglia et al (2004) 52 Peytremann-Bridevaux et al (2008) 51 Carney & Jones (2006) 42 (any low severity) Carney & Jones (2006) 42 (mood disorder low severity) Werneke et al…...
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TL;DR: Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.
Abstract: Objectives To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (≥55 years) in primary care.
Design Longitudinal cohort study, with three years’ follow-up.
Setting 32 general practices in West Friesland, the Netherlands.
Participants 234 patients aged 55 years or more with a prevalent major depressive disorder.
Main outcome measures Depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Asberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariable analyses were used to identify variables predicting prognosis.
Results The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but not in those who had recovered.
Conclusion Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.
88 citations
TL;DR: Analysis of research literature regarding health service use and costs of depressive symptoms in late life showed homogeneously that depressive elderly individuals have an increased service use compared to non-depressive, and a one-third increase of outpatient, inpatient, and total healthcare cost of depressive individuals.
Abstract: Objective: The objective of the study is to systematically analyze and summarize research literature regarding health service use and costs of depressive symptoms in late life. Design: Relevant articles were identified by systematically searching the databases MEDLINE, Web of Science, PSYNDEXplus, PsycINFO, and Cochrane Library. Keywords were ‘depression’ or ‘depressive*’, and ‘cost’ or ‘economic burden’ or ‘utilization’ or ‘use’ and ‘old age’ or ‘elderly’. Studies based on representative samples of elderly individuals aged 55 years and older were included. Results: 55 studies were found, 34 studies determined health service utilization, 10 studies reported costs, and 11 studies reported both. Studies of health service utilization and costs showed homogeneously that depressive elderly individuals have an increased service use compared to non-depressive, and a one-third increase of outpatient, inpatient, and total healthcare costs of depressive individuals. The majority of studies reported antidepressant (AD) use between 20 and 45% by depressive individuals. Mean annual costs for AD ranged from 108 to 305 US$ PPP (purchasing power parities). Increased service use and costs are only to a small proportion related to depression treatment. Conclusions: Depressive symptoms in late life lead to a high economic burden for nations which is not explained by costs for depressive symptom treatment. Strategies for improvement of diagnostic validity and treatment success of depressive symptoms in late life may have an effect on economic burden for societies.
86 citations
TL;DR: Forgone care should be reduced even if it is not justified by an 'objective' need for health care, as it could be an independent stressor in its own right, and as patient satisfaction is a strong predictor of compliance.
Abstract: Studies on the association between access to health care and household income have rarely included an assessment of 'forgone care', but this indicator could add to our understanding of the inverse care law. We hypothesize that reporting forgone care is more prevalent in low income groups. The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non-institutionalized population aged 50 years or older. Data are included from France, Germany, Greece, Italy and Sweden. The dependent variable is assessed by the following question: During the last twelve months, did you forgo any types of care because of the costs you would have to pay, or because this care was not available or not easily accessible? The main independent variable is household income, adjusted for household size and split into quintiles, calculating the quintile limits for each country separately. Information on age, sex, self assessed health and chronic disease is included as well. Logistic regression models were used for the multivariate analyses. The overall level of forgone care differs considerably between the five countries (e.g. about 10 percent in Greece and 6 percent in Sweden). Low income groups report forgone care more often than high income groups. This association can also be found in analyses restricted to the subsample of persons with chronic disease. Associations between forgone care and income are particularly strong in Germany and Greece. Taking the example of Germany, forgone care in the lowest income quintile is 1.98 times (95% CI: 1.08–3.63) as high as in the highest income quintile. Forgone care should be reduced even if it is not justified by an 'objective' need for health care, as it could be an independent stressor in its own right, and as patient satisfaction is a strong predictor of compliance. These efforts should focus on population groups with particularly high prevalence of forgone care, for example on patients with poor self assessed health, on women, and on low income groups. The inter-country differences point to the need to specify different policy recommendations for different countries.
86 citations
Cites background or methods from "Healthcare and preventive services ..."
...Methods The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the noninstitutionalized population aged 50 years or older from 11 European countries plus Israel [16-23]....
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...Shmueli A, Achdut L, Sabag-Endeweld M: Financing the package of services during the first decade of the national health insurance law in Israel: trends and issues....
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...Methods The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non- institutionalized population aged 50 years or older from 11 European countries plus Israel [16-23]....
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...2004), and they are well accepted in the public health community [18-23]....
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References
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King's College London1, Maastricht University2, VU University Amsterdam3, University of Turku4, Trinity College, Dublin5, Ludwig Maximilian University of Munich6, French Institute of Health and Medical Research7, Free University of Berlin8, VU University Medical Center9, University of Zaragoza10, University of Gothenburg11, University of Brescia12, University of Liverpool13
TL;DR: The association between physical health and depressive symptoms in later life is consistent across western Europe and the association of depressive symptoms with functional disability was stronger than with chronic physical conditions.
Abstract: Background Associations between physical health and depression are consistent across cultures among adults up to 65 years of age. In later life, the impact of physical health on depression is much more substantial and may depend on sociocultural factors.
Aims To examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe.
Method Fourteen community-based studies on depression in later life in nine western European countries contributed to a total study sample of 22 570 respondents aged 65 years and older. Measures were harmonised for depressive symptoms (EURO-D scale), functional limitations and chronic physical conditions.
Results In the majority of the participating samples, the association of depressive symptoms with functional disability was stronger than with chronic physical conditions. Associations were slightly more pronounced in the UK and Ireland.
Conclusions The association between physical health and depressive symptoms in later life is consistent across western Europe.
161 citations
TL;DR: The article reviews the comorbidity of IBS in psychiatric patients and discusses implications for treatment.
Abstract: Irritable bowel syndrome (IBS), a functional gastrointestinal disorder, is present in 10% to 20% of the U.S. adult population. The syndrome is best defined as chronic abdominal discomfort with changes in stool frequency, consistency, and passage, with associated symptoms such as abdominal bloating or presence of mucus in stools. Several studies have shown that up to 70% to 90% of patients with IBS who seek treatment have psychiatric comorbidity, most notably mood and anxiety disorders. Recent studies have shown a high prevalence of IBS in psychiatric patients who seek treatment, with a prevalence of 19% in schizophrenia, 29% in major depression, and 46% in panic disorder among other disorders. Our article reviews the comorbidity of IBS in psychiatric patients and discusses implications for treatment.
141 citations
"Healthcare and preventive services ..." refers background in this paper
...The increased report of colorectal cancer screening might also be a consequence of the more frequent report of gastrointestinal symptoms (Garakani et al., 2003), and subsequent diagnostic endoscopies, for individuals with depressive symptoms....
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TL;DR: The presence of a high depressive symptom burden is a modest independent risk factor for lack of subsequent mammography and Pap smear testing, and ensuring that depressed patients receive regular cancer screening services is important.
Abstract: Background: Depression has been associated with lower cancer screening rates in some studies. We examined whether a higher depressive symptom burden presented a barrier to subsequent mammography an...
91 citations
"Healthcare and preventive services ..." refers result in this paper
...…of an association between depressive symptoms and preventive services are not consistent with previously published studies (Mangtani et al., 2005; Pirraglia et al., 2004; Werneke et al., 2006), and do not confirm the negative impact of depressive symptoms on receipt of preventive services…...
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...The findings of an association between depressive symptoms and preventive services are not consistent with previously published studies (Mangtani et al., 2005; Pirraglia et al., 2004; Werneke et al., 2006), and do not confirm the negative impact of depressive symptoms on receipt of preventive services (breast cancer screening and influenza immunization)....
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...Little research has been published regarding the receipt of preventive services by individuals presenting depressive symptoms, and the results of such research are discordant (Horvitz-Lennon et al., 2006, Lasser et al., 2003, Mangtani et al., 2005, Pirraglia et al., 2004; Werneke et al., 2006)....
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TL;DR: It is unclear whether depressive symptoms in older adults are associated with an increased risk for hospitalization, but the likelihood of hospitalization is higher in those with a history of depression.
Abstract: OBJECTIVE: To determine whether depressive symptoms in older adults are associated with an increased risk for hospitalization.
DESIGN: A 6 month cohort study.
SETTING: Five counties in the northern Piedmont of North Carolina from the Duke University site of the Established Populations for Epidemiological Studies of the Elderly project.
PARTICIPANTS: The sample included 3486 community-dwelling adults, aged 65 and older.
MEASUREMENTS: Crude risk ratios for the effect of depressive symptoms on 6 month risk for hospitalization were calculated, followed by a multivariable analysis controlling for demographics and health status.
RESULTS: Three hundred participants were hospitalized during the 6 month follow-up period. The crude risk ratio for the effect of depressive symptoms on hospitalization was 1.95 (95% CI = 1.47–2.58). Subgroup analysis showed significant positive risk ratios for men aged 65 to 74 and ≥75, and women aged 65 to 74. After a multivariable analysis, however, these associations remained significant only among men ≥75 (RR = 3.43; 95% CI = 1.33–8.86).
CONCLUSIONS: Depressive symptoms were independently associated with a more than threefold increased risk for hospitalization among men aged ≥75. This result reflects differences in the effects of depressive symptoms across age and gender groups, and emphasizes that symptoms of depression influence overall health and medical utilization among, at the very least, the oldest subset of men.
74 citations
"Healthcare and preventive services ..." refers background in this paper
...Depressive symptoms are a major public health problem because of their high prevalence, their detrimental effect on health (Braam et al., 2005) and their association with relatively frequent use of medical services (Bijl and Ravelli, 2000; Huang et al., 2000)....
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..., 2005) and their association with relatively frequent use of medical services (Bijl and Ravelli, 2000; Huang et al., 2000)....
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TL;DR: In a population-based sample of Nova Scotian adults, depressive symptoms predicted greater medical care utilization, independent of a number of medical severity measures.
Abstract: Background. Several examinations have detected a relation between depressive symptoms and medical utilization. However, selection biases have been involved in most previous examinations. We sought to test the association between depressive symptoms and prospective, increased medical care utilization, in a population-based Canadian sample, while controlling for utilization due to medical illness and controlling for selection bias.Methods. Data from the Nova Scotia Health Survey 1995, an age- and sex-stratified random sampling of 3227 Nova Scotian adults, included the Center for Epidemiological Studies-Depression scale and items assessing chronic medical conditions and current limitations in daily activities resulting from medical illness. We linked survey data with medical care utilization measures for the year following the survey, including out-patient visits, reimbursement for out-patient services, hospitalizations, and hospitalization days.Results. After controlling for age, sex, count of medical diagnoses and current medical severity, those with a greater level of depressive symptoms were at greater risk of having increased medical care utilization in the following year. These results remained after removing mental health care utilization costs.Conclusions. In a population-based sample, depressive symptoms predicted greater medical care utilization, independent of a number of medical severity measures. Whether depressive symptoms are a risk marker or a causal risk factor for increased medical utilization remains to be explored.
68 citations
"Healthcare and preventive services ..." refers result in this paper
...…population-based studies from several countries (Beekman et al., 1997; Fischer et al., 2002; Himelhoch et al., 2004; McCracken et al., 2006; Rowan et al., 2002), our results reveal an association between depressive symptoms and general healthcare use, which was not fully explained by…...
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