Major Depressive Disorder, Somatic Pain, and Health Care Costs in an Urban Primary Care Practice

Objective: To evaluate the extent to which painseverity contributes to the increased medical care costsassociated with depression in primary care.

Method: A systematic sample of primary carepatients (N = 1028) from an urban practice were assessed betweenApril 1, 2002, and January 16, 2003, with the DSM-IV Primary CareEvaluation of Mental Disorders Patient Health Questionnaire, theSheehan Disability Scale, a medical illness checklist, and theMedical Outcomes Study 12-Item Short Form Health Survey, whichincludes a measure of pain interference with daily activities.Medical charges for inpatient, outpatient, and emergencydepartment services were assessed for the 6-month periodspreceding and following the index medical visit. Patients withand without major depressive disorder (MDD) were first comparedwith respect to clinical characteristics and median medicalcharges. Mean predicted medical care charges were then comparedamong 4 patient groups: (1) No MDD/Low Pain Interference, (2) NoMDD/High Pain Interference, (3) MDD/Low Pain Interference, and(4) MDD/High Pain Interference.

Results: As compared to patients without MDD(N = 821), those with MDD (N = 207) had significantly higherpredicted mean medical care charges ($19,838 vs. $6268; t = 3.3,p = .001) after controlling for age and gender and weresignificantly more likely to report at least moderatepain-related interference in daily activities (MDD: 69.1% vs. noMDD: 38.6%; chi² = 61.3, df = 1, p < .0001). Meanpredicted medical care charges of patients with MDD and at leastmoderate pain-related interference were on average 2.33 times(95% CI = 1.34 to 4.05) as high as those for patients with MDD andlittle or no pain-related interference. Among patients with atleast moderate pain-related interference, MDD was associated withsignificantly greater mean predicted charges (mean = $28,598/yearwith MDD vs. $11,031/year without MDD). However, among patientswith lower levels of pain-related interference, MDD was notassociated with greater mean predicted medical charges(mean = $2306/year with MDD vs. $3560/year without MDD).

Conclusion: In this urban primary care practice,major depressive disorder is associated with increased healthcare costs, but only among patients with moderate to extremepain-related interference in daily activities.