Effect of depression on health service utilisation in men: a prospective cohort study of Australian men aged 35 to 80 years
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Date
2021
Authors
Martin, S.
Zajac, I.
Vincent, A.
Adams, R.J.
Appleton, S.
Wittert, G.A.
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BMJ Open, 2021; 11(3):e044893-1-e044893-10
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Sean Martin, Ian Zajac, Andrew Vincent, Robert J Adams, Sarah Appleton, Gary A Wittert
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Abstract
OBJECTIVES: To examine the relationship between depression burden, health service utilisation and depression diagnosis in community-based men. DESIGN: Prospective cohort study. SETTING: Community-based. PARTICIPANTS: Men aged 35-80 years at recruitment (2002-2005), randomly selected from the northern and western suburbs of Adelaide, Australia, without depression at baseline, who attended follow-up visits (2007-2010) (n=1464). PRIMARY AND SECONDARY OUTCOME MEASURES: Depression symptoms were categorised into high burden (total score of ≥13 for the Beck Depression Inventory (BDI) or ≥10 for the Centre for Epidemiologic Studies Depression Scale (CES-D) or low burden (<13 for the BDI or <10 for the CES-D). Diagnosed depression was determined by patient-reported physician diagnosis. Frequent general practitioner (GP) visits were those occurring 5+ times over the preceding year. Use of national medical and prescription services (Medicare Benefit Schedule and Pharmaceutical Benefit Scheme; MBS and PBS) was assessed through data linkage. RESULTS: Frequent attendance and depression diagnosis was more common in men with a high than low burden of depression symptoms (45.9% vs 29.3%-18.7% vs 1.9%, p<0.001). Depression diagnoses were also more common in frequent GP attenders compared with low-average attenders (5.1% vs 2.2%, p<0.001). Among men with high burden of symptoms, there was no age-adjusted or multi-adjusted difference for likelihood of depression diagnosis between non-regular and frequent GP attenders. Annualised MBS and PBS expenditure was highest for men with undiagnosed depression. CONCLUSIONS: Men with a high burden of depression symptoms have commensurate use of health services when compared with those with a low burden, but only half report a physician diagnosis of depression. Undiagnosed depression led to a higher usage of medical and prescription services.
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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.