What is the clinical evidence from this study?

Study design: Cohort. Population: Depressive symptoms (n=973). Intervention: Depressive symptoms vs. No depressive symptoms. Primary outcome: Subsequent physician visits (RR 1.34, 95% CI 1.05-1.70).

What does this research mean for the field?

There is a reciprocal relationship between depressive symptoms and health service utilization in older adults, where baseline depression increases subsequent physician visits, and frequent physician visits or hospitalizations strongly predict subsequent depression. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 16, 2009Open Access

Depressive symptoms, physician visits and hospitalization among community-dwelling older adults

Key Result

Baseline depressive symptoms were associated with increased subsequent physician visits (RR 1.34; 95% CI 1.05-1.70), while frequent visits and hospitalization strongly predicted subsequent depression.

Study Design

Type

Cohort (n=973)

Structured PICO

Is there a reciprocal relationship between depressive symptoms and health service use (physician visits and hospitalization) among community-dwelling older adults?

Population

973 community-dwelling older adults in the Singapore Longitudinal Aging Studies (SLAS)

Intervention

Baseline depressive symptoms (15-item Geriatric Depression Scale score ≥5) or high health service use (≥5 physician visits or hospitalization)

Comparator

No baseline depressive symptoms or lower health service use (<5 physician visits, no hospitalization)

Outcome

Subsequent physician visits and hospitalization over one year, and depressive symptoms at one year

Depressive symptoms and health service use have a reciprocal relationship in older adults, suggesting post-hospitalization interventions to treat depression may optimize healthcare utilization.

Main Result

Effect estimate: RR 1.34 (95% CI 1.05-1.70)

Abstract

BACKGROUND: The relationship between depressive symptoms and health service use among older people is not well understood. In this study we examined the two-way relationships between depressive symptoms and hospitalization and/or physician visits by older adults. METHODS: In a one-year follow-up study of 973 community-dwelling older adults in the Singapore Longitudinal Aging Studies (SLAS), depressive symptoms (15-item Geriatric Depression Scale score > or =5) were assessed at baseline and one year later. Information on self-reported physician visits and hospitalization were collected bimonthly over one year. RESULTS: When demographic characteristics, medical comorbidities, functional status and other covariates were controlled for, baseline depressive symptoms were associated with increased episodes of subsequent physician visits during the one-year follow-up (RR,1.34; 95% CI, 1.05-1.70), but not with subsequent hospitalization(s) during the same period. Conversely, participants with five or more physician visits (versus less than 5) over one year were more likely to be depressed at one year (OR, 10.2; 95% CI, 3.36-31.1); hospitalization during this period was also significantly associated with depressive symptoms at one year (OR = 6.43, 95% CI, 2.48-16.6). CONCLUSION: Depressive symptoms and health service use have reciprocal relationships. Health service use for non-mental illnesses may be optimized by efforts at post-hospitalization interventions to recognize and treat depression in older persons.