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ORIGINAL ARTICLES |
From the University of Washington (M.D.S., J.R.), Seattle, Washington; Center for Health Studies, Group Health Cooperative of Puget Sound (A.Z.L., J.H.), Seattle, Washington; and Mid-America Heart Institute, University of Missouri (J.A.S.), Kansas City, Missouri.
Address reprint requests to: Mark D. Sullivan, MD, PhD, Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA 98195. Email: sullimar{at}u.washington.edu
OBJECTIVE: Depression has been reported to increase cardiac event rates and functional impairment in patients with coronary disease. This article describes the impact of depression on subsequent healthcare utilization for such patients.
METHODS: One hundred ninety-eight health maintenance organization patients with stable coronary disease were interviewed after elective angiography using a structured psychiatric diagnostic scale. Cardiac events, hospitalizations, procedures, and costs were monitored for the next 5 years through automated data. Subjects were classified at the time of angiography by modified DSM-IV criteria into those with major, minor, and no depression.
RESULTS: In univariate analyses, the no depression group (N = 136) was most likely to receive coronary artery bypass grafting (CABG) (61% vs. 36% in the major depression group vs. 27% in the minor depression group, p = .001), and the major depression group (N = 25) was most likely to receive percutaneous transluminal coronary angioplasty (PTCA) (44% vs. 14% in the minor depression group vs. 24% in the no depression group). The minor depression group (N = 37) was least likely to be hospitalized for cardiac reasons during follow-up (54% vs. 80% in the major depression group vs. 80% in the no depression group, p = .005). Five-year rates of myocardial infarction and death did not differ significantly between groups. Proportional hazard models showed that those in the depression groups differed in time from catheterization to CABG (
2(2) = 11.9, p = .003) and time to PCTA (2(2) = 7.74, p = .02) after controlling for relevant covariates. Median regression showed that patients with no depression had higher costs during the first year but tended to have lower costs in years 2 through 5 than patients with minor or major depression.
CONCLUSIONS: Depression status at angiography is associated with the need for revascularization and total healthcare costs for the following year.
Key Words: depression, • revascularization, • coronary disease, • costs, • utilization, • myocardial infarction.
Abbreviations: CABG = coronary artery bypass grafting;; CAD = coronary artery disease;; DIS = National Institute of Mental Health Diagnostic Interview Schedule for DSM-III-R;; GHC = Group Health Cooperative of Puget Sound;; HAM-D = Hamilton Depression Rating Scale;; HMO = health maintenance organization;; PTCA = percutaneous transluminal coronary angioplasty.
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