Abstract
OBJECTIVE: To characterize the prevalence and predictors of diagnosed depression among persons with HIV on Medicaid and antidepressant treatment among those diagnosed, and to compare utilization and costs between depressed HIV-infected individuals treated with and without antidepressant medications.
DESIGN: Merged Medicaid and surveillance data were used to compare health services utilized by depressed individuals who were or were not treated with antidepressant medications, controlling for other characteristics.
SETTING AND PARTICIPANTS: The study population comprised Medicaid recipients in New Jersey who were diagnosed with HIV or AIDS by March 1996 and received Medicaid services between 1991 and 1996.
MEASUREMENTS AND MAIN RESULTS: Logistic regression and ordinary least squares regressions were employed. Women were more likely and African Americans were less likely to be diagnosed with depression. Women and drug users in treatment were more likely to receive antidepressant treatment. Depressed patients treated with antidepressants were more likely to receive antiretroviral treatment than those not treated with antidepressants. Monthly total expenditures were significantly lower for individuals diagnosed with depression and receiving antidepressant therapy than for those not treated with antidepressants. After controlling for socioeconomic and clinical characteristics, treatment with antidepressant medications was associated with a 24% reduction in monthly total health care costs.
CONCLUSIONS: Depressed HIV-infected patients treated with antidepressants were more likely than untreated subjects to receive appropriate care for their HIV disease. Antidepressant therapy for treatment of depression is associated with a significantly lower monthly cost of medical care services.
Article PDF
Similar content being viewed by others
References
Rabkin JG, Ferrando S, Jacobsberg L, Fishman B. Prevalence of axis I disorders in an AIDS cohort: a cross-sectional, controlled study. Compr Psychiatry. 1997;38:146–54.
Stober D, Schwartz J, McDaniel J, Abrams R. Depression and HIV disease: prevalence, correlates, and treatment. Psychiatr Ann. 1997;27:372–7.
Lesserman J, Ptitto J, Perkinds D, et al. Severe stress, depressive symptoms, and changes in lymphocyte subsets in human immunodeficiency virus-infected men. Arch Gen Psychiatry. 1997;54:279–85.
Zorilla E, McKay J, Luborsky L, Schmidt K. Relation of stressors and depressive symptoms to clinical progression of viral illness. Am J Psychiatry. 1996;153:626–35.
Leserman J, Jackson ED, Petitto JM, et al. Progression to AIDS: the effects of stress, depressive symptoms and social support. Psychosom Med. 1999;61:397–406.
Holmes W, Bix B, Meritz M, Turner J, Hutelmeyer C. Human immunodeficiency virus (HIV) infection and quality of life: the potential impact of axis I psychiatric disorders in a sample of 95 HIV seropositive men. Psychosom Med. 1997;59:187–92.
Patterson T, Shaw W, Semple S, et al. Relationship of psychosocial factors to HIV disease progression. Ann Behav Med. 1996;18:30–9.
Mayne T, Vittinghoff E, Chesney M, et al. Depressive affect and survival among gay and bisexual men infected with HIV. Arch Intern Med. 1996;156:2233–8.
Markowitz J, Rabkin J, Perry SW. Treating depression in HIV-positive patients. AIDS. 1994;8:403–12.
Rabkin J, Wagner G, Rabkin R. Effects of sertraline on mood and immune status in patients with major depression and HIV illness: an open trial. J Clin Psychiatry. 1994;55:433–9.
Rabkin J, Rabkin R, Wagner G. Effects of fluoxetine on mood and immune status in depressed patients with HIV illness. J Clin Psychiatry. 1994;55:92–7.
Hintz S, Kuck J, Peterkin J, Volk D, Zisook S. Depression in the context of human immunodeficiency virus infection: implications for treatment. J Clin Psychiatry. 1990;51:497–501.
Fernandez F, Levy J. Psychopharmacotherapy of psychiatric syndromes in asymptomatic and symptomatic HIV infection. Psychiatr Med. 1991;9:377–94.
Elliott A, Uldall K, Bergam K, Russo J, Claypoole K, Roy-Byrne P. Randomized, placebo-controlled trial of paroxetine versus imipramine in depressed HIV-positive outpatients. Am J Psychiatry. 1998;155:367–72.
Vali F, Walkup J. Combined medical and psychological symptoms: impact on disability and health care utilization of patients with arthritis. Med Care. 1998;36:1073–84.
Unutzer J, Patrick D, Simon G, et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. JAMA. 1997;277(20):1618–23.
Manning W Jr The effects of psychological distress and psychological well-being on use of medical services. Med Care. 1992;30:541–53.
Von Korff M, Ormel J, Katon W, Lin E. Disability and depression among high utilizers of health care: a longitudinal analysis. Arch Gen Psychiatry. 1992;49:91–100.
Frank RG, Busch SH, Berndt ER. Measuring prices and quantities of treatment for depression. Am Econ Rev. 1998;88:106–11.
Katzelnick D, Kobak K, Greist J, Jefferson J, Henk H. Effect of primary care treatment of depression on service use by patients with high medical expenditures. Psychiatr Serv. 1997;48:59–64.
McCombs JS, Nichol MB, Stimmel GL, Sclar DA, Beasley CM, Gross LS. The cost of antidepressant drug therapy failure: a study of antidepressant drug use in a Medicaid population. J Clin Psychiatry. 1990;51 (suppl 6):60–9.
Thompson D, Buesching D, Gregor KJ, Oster G. Patterns of antidepressant use and their relation to costs of care. Am J Manag Care. 1996;2:1239–46.
Olfson M, Sing M, Schlesinger H. Mental health/medical care cost offsets: opportunities for managed care. Health Aff. 1999;18:79–90.
Katon W, von Korff M, Lin E, et al. A randomized trial of psychiatric consultation with distressed high utilizers. Gen Hosp Psychiatry. 1992;14:86–98.
Melif CA, Croghan TW, Hanna MP. Access to treatment for depression in a Medicaid population. J Health Care Poor Underserved. 1999;10:201–15.
Conviser R, Gamliel S, Honberg L. Health-based payment for HIV/AIDS in Medicaid managed care programs. Health Care Financ Rev. 1998;19:63–82.
Crystal S, Sambamoorthi U, Merzel C. The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts. Health Serv Res. 1995;30:593–614.
Markson LE, McKee L, Mauskopf J, Houchens R, Fanning TR, Turner BJ. Patterns of Medicaid expenditures after AIDS diagnosis. Health Care Financ Rev. 1994;15:43–59.
Halvorsen R, Palmquist R. The interpretation of dummy variables in semilogarithmic equations. Am Econ Rev. 1980;70:474–5.
Kessler R, McGonagle K, Swartz M, Blazer D, Nelson C. Sex and depression in the National Comorbidity Survey, I: lifetime prevalence, chronicity and recurrence. J Affect Disord. 1993;29:85–96.
Miller N, Klamen D, Hoffmann N, Flaherty J. Prevalence of depression and alcohol and other drug deprendence in addictions treatment populations. J Psychoactive Drugs. 1996;28:111–24.
Ziedonis D, Rayford B, Bryant K, Rounsaville B. Psychiatric comorbidity in white and African-American cocaine addicts seeking substance abuse treatment. Hosp Community Psychiatry. 1994;45:43–9.
Leo R, Sherry C, Jones A. Referral patterns and recognition of depression among African American and Caucasian patients. Gen Hosp Psychiatry. 1998;20:175–82.
Sussman L, Robins L, Earls F. Treatment seeking for depression by black and white Americans. Soc Sci Med. 1987;24:187–96.
Gallo JJ, Marino S, Ford D, Anthony J. Filters on the pathway to mental health care, II: sociodemographic factors. Psychol Med. 1995;25:1149–60.
Padgett DK, Patrick C, Burns B, Schlesinger H. Ethnicity and the use of outpatient mental health services in a national insured population. Am J Public Health. 1994;84:222–6.
Pincus HA, Tanielan TL, Marcus SC, et al. Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA. 1998;279:526–31.
Wagner GJ, Rabkin JG, Rabkin R. A comparative analysis of standard and alternative antidepressants in the treatment of human immunodeficiency virus patients. Comp Psychiatry. 1996;37:402–8.
Wagner GJ, Rabkin JG, Rabkin R. Dextroamphetamine as a treatment for depression and low energy in AIDS patients: a pilot study. J Psychosom Res. 1997;42:407–11.
Markowitz JC, Klerman GL, Clougherty KF, et al. Individual psychotherapies for depressed HIV-positive patients. Am J Psychiatry. 1995;152:1504–9.
Markowitz JC, Kocsis JH, Fishman B, et al. Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Arch Gen Psychiatry. 1998;55:452–7.
Cazzullo CL, Bessone E, Bertrando P, et al. Treatment of depression in HIV-infected patients. J Psychiatry Neurosci. 1998;23:293–7.
Ferrando SJ, Goldman JD, Charness WE. Selective serotonin reuptake inhibitor treatment of depression in symptomatic HIV infection and AIDS: improvements in affective and somatic symptoms. Gen Hosp Psychiatry. 1997;19:89–97.
Smith SR, Kirking DM. Access and use of medications in HIV disease. Health Serv Res. 1999;34:123–44.
Sirey JA, Meyers BS, Bruce ML, et al. Predictors of antidepressant prescription and early use among depressed outpatients. Am J Psychiatry. 1999;156:690–6.
Stein M, Piette J, Mor V, et al. Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons. J Gen Intern Med. 1991;6:35–40.
Rawson N, Malcolm E, D’Arcy C. Reliability of the recording of schizophrenia and depressive disorder in the Saskatchewan health care datafiles. Soc Psychiatry Psychiatr Epidemiol. 1997;32:191–9.
Kashner T. Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. Med Care. 1998;36:1324–36.
Walkup J, Boyer C, Kellerman S. Using Medicaid claims for research, clinical decision making, and policy: how reliable can they be? Admin Mental Health. 2000;27:129–39.
Rost K, Smith R, Matthews DB, Guise B. The deliberate misdiagnosis of major depression in primary care. Arch Fam Med. 1994;3:333–7.
Fairfield KM, Libman H, Davis RB, et al. Delays in protease inhibitor use in clinical practice. J Gen Intern Med. 1999;14:395–401.
Author information
Authors and Affiliations
Corresponding author
Additional information
This research was supported by a grant from the National Institute on Drug Abuse, R01-DA11362-01. The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations.
Rights and permissions
About this article
Cite this article
Sambamoorthi, U., Walkup, J., Olfson, M. et al. Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression. J GEN INTERN MED 15, 311–320 (2000). https://doi.org/10.1046/j.1525-1497.2000.06219.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2000.06219.x