Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs
Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs
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DOI：
10.1176/appi.ps.60.3.344
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发表时间：
2009-03-01
影响因子：
3.8
通讯作者：
Hayward, Chris
中科院分区：
文献类型：
--
作者：
Arnow, Bruce A.;Blasey, Christine M.;Hayward, Chris
目的：尽管有证据表明抑郁症患者比非抑郁症患者使用更多的医疗服务，但很少有研究考察抑郁症患者的特定亚群是否比其他人利用更高的医疗服务。这项研究将患有严重抑郁症和致残慢性疼痛的患者(参照组)的普通医疗护理费用与其他五组患者的费用进行了比较：患有抑郁症和非致残性慢性疼痛的患者，仅有严重抑郁障碍的患者，没有抑郁症的患者有致残慢性疼痛的患者，患有慢性疼痛但不致残的抑郁症患者，以及既没有疼痛也没有抑郁的患者。将仅有严重抑郁障碍组的费用与三组没有抑郁的组的费用进行比较。方法：一份评估严重抑郁障碍、慢性疼痛和疼痛相关残疾的问卷被邮寄给去初级保健诊所就诊的随机抽样的Kaiser Permanente患者。共有5,808名患者回答(参与率为54%)。两年的费用是从Kaiser Permanente的费用管理信息系统中获得的。分析针对四种主要慢性疾病中的任何一种进行了调整。结果：参照组患者的总费用显著高于其他五个亚组的费用。回归分析表明，疼痛严重程度和抑郁严重程度的连续测量与成本增加相关，但没有观察到抑郁和疼痛对总成本有统计学意义的交互作用。结论：重度抑郁障碍并伴有慢性疼痛的患者的医疗服务费用高于其他组的抑郁症患者和非抑郁症患者。然而，研究结果表明，同时患有疼痛和抑郁的成本增加是累加的，而不是乘法的。(精神科服务60：344-350,2009)
Objective: Although evidence suggests that patients with depression use more medical services than those without depression, few studies have examined whether specific subgroups of patients with depression have higher utilization than others. The study compared costs for general medical care with and without psychiatric care for patients with major depression and disabling chronic pain (reference group) with costs for five other groups: those with depression and nondisabling chronic pain, those with major depressive disorder alone, those with no depression who had disabling chronic pain, those with depression who had chronic pain that was not disabling, and those who had neither pain nor depression. Costs for the group with major depressive disorder alone were compared to costs for the three groups without depression. Methods: A questionnaire assessing major depressive disorder, chronic pain, and pain-related disability was mailed to a random sample of Kaiser Permanente patients who visited a primary care clinic. A total of 5,808 patients responded (54% participation rate). Costs for a two-year period were obtained from Kaiser Permanente's Cost Management Information System. Analyses were adjusted for presence of any of four major chronic medical illnesses. Results: Total costs for patients in the reference group were significantly higher than costs for the other five subgroups. Regression analyses indicated that continuous measures of severity of pain and severity of depression were associated with increased costs, but no statistically significant interaction of depression and pain on total cost was observed. Conclusions: Patients with major depressive disorder and comorbid disabling chronic pain had higher medical service costs than other groups of patients with and without depression. However, findings suggest that the increases in cost from having both pain and depression are additive and not multiplicative. (Psychiatric Services 60: 344-350, 2009)