Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3084 — The Long-Term Course of Depression: Comparing VA and Non-VA Patients

Author List:
Cronkite RC (Center for Health Care Evaluation)
Robinson RL (Eli Lilly)
Swindle RW (Eli Lilly)
Turrubiartes P (Center for Health Care Evaluation)
Moos RH (Center for Health Care Evaluation)

Objectives:
Little is known about the implications of the long-term course of unipolar depression on health services utilization and work productivity. We sought to: (1) compare VA and non-VA patients on the likelihood of experiencing a course of remission, partial remission, or non-remission of unipolar depression, and (2) characterize the pattern of utilization of health care services and work productivity for the three subgroups of patients and a matched community control group.

Methods:
A cohort of 424 patients treated for unipolar depression at VA and non-VA facilities and 424 matched controls completed mail and telephone surveys at baseline and four follow-ups, with 80% of surviving respondents participating over 23 years. VA and non-VA patients were categorized as having a course of remission, partial remission, or nonremission.

Results:
VA and non-VA patients did not differ significantly on the likelihood of experiencing a course of remission (34% vs 31%). However, VA patients were significantly more likely to experience a course of nonremission (40% vs 22%). Over most follow-ups, VA and non-VA patients who had a course of remission were similar to matched community controls on the number of medical symptoms, medications, outpatient doctor visits, and work history (employment and inability to work due to health problems). Nonremitted patients reported the highest levels of medical symptoms, medication use, and doctor visits, and the lowest work productivity. There were no differences between VA and non-VA patients on these indices within patient subgroups.

Implications:
For both VA and non-VA patients, a course of remission is associated with an overall normalization of health, use of health services, and work productivity. The burden of a course of nonremission is reflected by higher health services utilization and lower employment levels, and is somewhat greater for VA than for non-VA patients.

Impacts:
The findings underscore the value of maintaining long-term remission from depression and the comparability of VA and non-VA patients in achieving remission, which may lead to cost savings due to a return to health care utilization and work productivity levels that are similar to those of community controls. The higher rate of nonremission for VA patients suggests a need to improve VA treatment for depression.