The high price of depression: Family members' health conditions and health care costs

Impact of living with an adult with depressive symptoms among households in the United States

BACKGROUND

The effect of depressive symptoms on individuals has been widely studied but their impact on households remains less explored. This study assessed the humanistic and economic impact of living with an adult with depressive symptoms on adults without depressive symptoms among households in the United States (US).

METHODS

The Medical Expenditure Panel Survey (MEPS) Household Component database was used to identify adults without depressive symptoms living in households with ≥1 adult with depressive symptoms (depression household) and adults without depressive symptoms living in households without an adult with depressive symptoms (no-depression household). Weighted generalized linear models with clustered standard errors were used to compare total income (USD 2020), employment status, workdays missed, quality of life (QoL), and healthcare resource utilization (HRU) between cohorts.

RESULTS

Adults without depressive symptoms living in a depression household (n = 1699) earned $4720 less in total annual income (representing 11.3% lower than the average income of $41,634 in MEPS), were less likely to be employed, missed more workdays per year, and had lower QoL than adults without depressive symptoms living in a no-depression household (n = 15,286). Differences in total annual healthcare costs and for most types of HRU, except for increased outpatient mental health-related visits, were not significant.

LIMITATIONS

Data is subject to reporting bias, misclassification, and other inaccuracies. Causal inferences could not be established.

CONCLUSION

The economic and humanistic consequences of depressive symptoms may extend beyond the affected adults and impact other adult members of the household.

Effects of work-to-family enrichment on psychological distress and family satisfaction: A dyadic analysis in dual-earner parents

Resources that individuals acquire at work can have significant effects on their own well-being and family satisfaction, and on those of their closest family relations. Following the conservation of resources theory, this study examined the effects of work-to-family enrichment (WFE) on psychological distress (depression, anxiety, and stress) and family satisfaction (SWFaL) in different-gender dual-earner parents. The sample consisted of 473 couples - mother and father - from Temuco, Chile, who answered the Work-Family Interface scale, the Depression, Anxiety and Stress Scale, and the Satisfaction with Family Scale. The analysis was conducted using the Actor-Partner Interdependence Model (APIM). Results showed that WFE was positively associated with SWFaL for both mothers and fathers (actor effects), whereas higher WFE was linked to lower psychological distress only in fathers. For mothers and fathers, psychological distress was negatively associated with their own (actor effects) and the other parent's SWFAL (partner effects). The mediating role of psychological distress was found only for fathers' WFE and their SWFaL. These results indicate that resources from work can increase family satisfaction for both fathers and mothers in dual-earner couples with adolescent children. However, in these couples, fathers acquire affective resources (positive mood) that reduce their own psychological distress, while mothers acquire skills (managing time at home more efficiently) that they invest directly in the family domain.

Healthcare utilization costs of emerging adults with mood and anxiety disorders in an early intervention treatment program compared to a matched cohort

AIM

The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care.

METHODS

We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and non-users, by cost category and overall. We performed risk-adjusted comparison of overall costs using generalized estimating equations.

RESULTS

FEMAP users (n = 366) incurred significantly lower costs compared to non-users (n = 660), for inpatient services (-$784, 95% confidence interval [CI] -$1765, -$28), ambulatory care services (-$90, 95% CI -$175, -$14) and drug benefit claims (-$47, 95% CI -$115,-$4) and significantly higher physician services costs ($435, 95% CI $276, $581) over 1 year. The unadjusted difference in overall costs was not significant (-$853, 95% CI -$2048, $142). Following adjustment for age, sex and age at first mental health diagnosis, the difference of -$914 (95% CI (-$2747, $919)) was also not significant.

CONCLUSIONS

FEMAP was associated with significantly lower costs of inpatient and ambulatory care services, and higher costs of physician services, however we are unable to conclude that FEMAP is cost-saving overall.