Minimally Adequate Treatment for Depression and Anxiety Associated With Mortality in Primary Care Older Adults

Factors associated with past-year medication use and psychotherapy in adults with suicidal ideation in France

BACKGROUND

The objective of the study is to assess the sociodemographic and clinical factors associated with past-year medication use and/or psychotherapy among adults with suicidal ideation in the past 12 months.

METHODS

Data were drawn from the 2017 Health Barometer survey, a large computer-assisted telephone survey on a representative sample of the general population aged 18 to 75 years living in metropolitan France (n = 25,319). Logistic and multinomial regression analyses were used to study past-year medication use and/or psychotherapy as a function of sociodemographic and clinical factors. Analyses were restricted to individuals reporting suicidal ideation in the past year (n = 1,148).

RESULTS

Overall, 43.6% of adults with suicidal ideation reported no treatment for a mental health reason in the past year; 36.6% reported using medication only, 4.8% psychotherapy only, and 15.0% both. Sociodemographic and clinical factors associated with increased probability of treatment varied as a function of the type of treatment received. Adjusting for key factors including clinical factors, older adults with suicidal ideation were more likely than younger adults to receive medication only.

CONCLUSIONS

The findings point to differential inequalities in access to medication and psychotherapy among adults with suicidal ideation in the general population of France.

Health care system and patient costs associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults

BACKGROUND

Depression and anxiety disorders in older adults are associated with a great burden. Research has shown that less than 50% of adults receive adequate treatment in primary care settings for these disorders. Rare are the studies however assessing adequate treatment in older adults and associated costs from the societal perspective. Given the episodic nature of common mental disorders, this study aims to assess the three-year costs from a restricted societal perspective (including health system and patient perspectives) associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults consulting in primary care.

METHODS

This primary care cohort study included 358 older adults aged 65 years and older with either a self-reported or physician diagnosis of depression or an anxiety disorder covered under Quebec's public drug plan. Receipt of minimally adequate treatment was assessed according to Canadian guidelines and relevant reports. Outpatient and inpatient service use, medication costs and physician billing fees were obtained from provincial administrative databases. Unit costs were calculated using provincial financial and activity reports and relevant literature. A propensity score was created to estimate the probability of receiving minimally adequate treatment and the inverse probability was used as a weight in analyses. Generalized linear models, with gamma distribution and log link, were conducted to assess the association between receipt of minimally adequate treatment and costs.

RESULTS

Overall, receipt of minimally adequate treatment was associated with increased three-year costs averaging $5752, $536, $6266 for the health system, patient and societal perspectives, respectively, compared to those not receiving minimally adequate treatment. From the health system perspective, participants receiving minimally adequate treatment had higher costs related to emergency department (ED) (difference: $457, p = 0.001) and outpatient visits (difference: $620, p < 0.001), inpatient stays (difference: $2564, p = 0.025), drug prescriptions (difference: $1243, p = 0.002) and physician fees (difference: $1224, p < 0.001). From the patient perspective, receipt of minimally adequate treatment was associated with higher costs related to loss of productivity related to ED (difference: $213, p < 0.001) and outpatient visits (difference: $89, p < 0.001).

CONCLUSIONS

Older adults receiving minimally adequate treatment for depression and anxiety disorders incurred higher societal costs reaching $2089 annually compared to older adults not receiving minimally adequate treatment. The main cost drivers were attributable to hospitalizations and prescription drug costs.