Abstract
PurposeTo identify how severity of depression predicts future utilization of psychiatric care and antidepressants.MethodsData derived from a longitudinal population-based study in Stockholm, Sweden, include 10443 participants aged 20–64 years. Depression was assessed by Major Depression Inventory and divided into subsyndromal, mild, moderate and severe depression. Outcomes were the first time of hospitalization, specialized outpatient care and prescribed drugs obtained from national register records. The association between severity of depression and outcomes was tested by Cox regression analysis, after adjusting for gender, psychiatric treatment history and socio-environmental factors.ResultsThe cumulative incidences of hospitalizations, outpatient care and antidepressants were 4.0, 11.2, and 21.9% respectively. Compared to the non-depressed group, people with different severity of depression (subsyndromal, mild, moderate and severe depression) all had significantly higher risk of all three psychiatric services (all log-rank test P < 0.001). Use of psychiatric care and antidepressants increased by rising severity of depression. Although the associations between severity of depression and psychiatric services were significant, the dose relationship was not present in people with previous psychiatric history or after adjusting for gender and other factors.ConclusionsPeople with subsyndromal to severe depression all have increased future psychiatric service utilization compared to non-depressed people.
Highlights
The reported 12-month prevalence of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) major depressive episodes in 18 countries ranges from 2.2 to 10.4% [1]
No depression was present in 77.1% of the participants (n = 7943), 15.2% (n = 1562) had subsyndromal depression, 3.4% (n = 346) had mild depression, 1.9% (n = 196) had moderate depression and 2.5% (n = 257) had severe depression
The results showed that persons affected by subsyndromal to severe depression had higher risk of utilizing psychiatric care and antidepressants than non-depressed people
Summary
The reported 12-month prevalence of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) major depressive episodes in 18 countries ranges from 2.2 to 10.4% [1]. There is a consensus that major depressive episodes always need treatment but there are suggestions that people with persistent subthreshold depressive symptoms or mild to moderate depression should be treated [4]. While one study showed that health care utilization increased by severity of depressive disorder [7], another reported increased utilization of psychiatric care for moderate to severe depression but not for mild depression [8]. A third study found increased utilization of health care or use of antidepressants for major but not minor depression after controlling for other factors [9]. The current evidence is, inconclusive and there is a lack of studies that examine social and environmental factors together to predict psychiatric service utilization
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