Key Points
- To evaluate the prevalence, 9-month incidence, and persistence of depressive symptoms among older primary care patients and assess how depression patterns correlate with healthcare utilization and costs.
- Prospective cohort study of 1,711 patients aged 60 and older evaluated via the Center for Epidemiologic Studies Depression (CES-D) scale at baseline and 9 months (935 patients were also evaluated at 6 months).
- Outpatient healthcare utilization, emergency room visits, and charges were tracked via an electronic medical record system at an urban academic primary care clinic over 9 months.
- Depression prevalence (CES-D ≥ 16) was 17.1% at baseline and 18.8% at 9 months (9-month incidence 11.7%), with 47.6% (140/292) of baseline-depressed patients remaining depressed at 9 months.
- Patients exceeding the CES-D threshold at any time were more likely to report fair or poor health (69.8% vs 43.7%) and visit the emergency room (40.4% vs 29.4%).
- Depressed patients generated 38% more outpatient visits (7.7 vs 5.6) and 61% higher total outpatient charges ($1209 vs $751) compared to patients without depressive symptoms (all P < 0.01).
Depressive symptoms in elderly primary care patients are frequent, often persistent, and associated with significantly greater health services use and poorer perceived health.