Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures.
Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures.
复制标题
DOI：
10.1016/j.acap.2015.08.013
复制
发表时间：
2016-01
影响因子：
3.1
通讯作者：
Richardson LP
中科院分区：
文献类型：
--
作者：
Wright DR;Katon WJ;Ludman E;McCauley E;Oliver M;Lindenbaum J;Richardson LP
美国预防服务工作组建议对青少年进行抑郁症筛查。我们试图从支付者的角度评估青少年人群中阳性抑郁筛查对医疗保健利用率和费用的影响。我们使用2项和9项患者健康问卷(PHQ)对登记在大型综合护理系统中的13-17岁青少年进行了抑郁症筛查。医疗保健利用和费用数据从行政记录中获得。使用卡方、Wilcoxon秩和和t检验来检验基于筛查状态的青少年之间结果的统计学差异。在完成抑郁症筛查的4,010名青少年中，3,707名(92.4%)筛查为阴性(PHQ-2和10)，186名(3.9%)轻度抑郁症筛查为阳性(PHQ-9=10-14)，95名(2.4%)筛查为中度至重度抑郁症(PHQ-9≥15)。在筛查后的12个月中，筛查阳性的青少年比筛查阴性的青少年更有可能接受任何急诊科就诊或住院治疗，并且对门诊医疗(平均(SD)=8.3(1.5)比3.5(5.1))和精神健康(3.8(9.3)比0.7(3.5))就诊的利用率显著更高。屏幕阳性青少年的平均总医疗费用(5,083美元(10,489美元))是屏幕阴性青少年(2,357美元(7,621美元))的两倍多。青少年抑郁症状，即使是轻微的，也与医疗保健利用率和成本的增加有关。在增加的费用中，只有一小部分可归因于精神卫生保健。实施抑郁症筛查和循证心理健康服务可能有助于更好地控制筛查阳性青少年的医疗费用。
Screening adolescents for depression is recommended by the U.S. Preventive Services Task Force. We sought to evaluate the impact of positive depression screens in an adolescent population on healthcare utilization and costs from a payer perspective. We conducted depression screening among 13-17 year olds adolescents enrolled in a large integrated care system using the 2- and 9-item Patient Health Questionnaires (PHQ). Healthcare utilization and cost data were obtained from administrative records. Chi-square, Wilcoxon rank-sum, and t-tests were used to test for statistical differences in outcomes between adolescents based on screening status. Of the 4,010 adolescents who completed depression screening, 3,707 (92.4%) screened negative (PHQ-2 < 2 or PHQ-9 < 10), 186 (3.9%) screened positive for mild depression (PHQ-9 = 10-14), and 95 (2.4%) screened positive for moderate-to-severe depression (PHQ-9 ≥ 15). In the 12-months after screening, screen-positive adolescents were more likely than screen-negative adolescents to receive any emergency department visit or inpatient hospitalization, and had significantly higher utilization of outpatient medical (mean (SD) = 8.3 (1.5) vs. 3.5 (5.1)) and mental health (3.8 (9.3) vs. 0.7 (3.5)) visits. Mean total healthcare system costs for screen-positive adolescents ($5,083 ($10,489)) were more than twice as high as those of screen-negative adolescents ($2,357 ($7,621)). Adolescent depressive symptoms, even when mild, are associated with increased healthcare utilization and costs. Only a minority of the increased costs is attributable to mental health care. Implementing depression screening and evidence-based mental health services may help to better control healthcare costs among screen-positive adolescents.