Health care utilization and its costs for depressed veterans with and without comorbid PTSD symptoms

Domin Chan, Allen D Cheadle, Gayle Reiber, Jürgen Unützer, Edmund F Chaney
Psychiatric Services: a Journal of the American Psychiatric Association 2009, 60 (12): 1612-7

OBJECTIVE: This study examined health care utilization and costs of care among Veterans Affairs (VA) patients with depression and with or without symptoms of comorbid posttraumatic stress disorder (PTSD).

METHODS: Cross-sectional comparisons of health care utilization and costs were conducted with VA administrative data for a sample of veterans from a randomized trial of collaborative care depression treatment in ten VA primary care clinics across five states. Patients with depression or dysthymia were included in the study, and those who were acutely suicidal or had probable bipolar disorder were excluded. The sample of 606 patients was mainly male, white, and aged 55 or older. Health care utilization, costs, and medication data from VA administrative databases were analyzed over 12 months.

RESULTS: Patients with depression and PTSD (screen score > or =3) were more emotionally distressed, had more frequent mental health specialty visits (6.91 versus 1.68, p<.001), more total outpatient visits (26.16 versus 19.94, p<.001), and correspondingly higher outpatient mental health care costs over the previous 12 months compared with depressed patients without PTSD. Antidepressants were prescribed to a higher proportion of depressed patients with PTSD (61% versus 40%).

CONCLUSIONS: Patients with PTSD and depression had greater utilization of specialty mental health treatments and antidepressant medications and higher mental health care costs in the previous 12 months than depressed patients without PTSD. As military personnel return from Iraq, both VA and non-VA health care providers need to plan for an increase in outpatient mental health services and costs, particularly among depressed veterans who also have PTSD.

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