The Impact of Depressive Symptoms on Healthcare Utilization and Charges for Adolescents with Type 1 Diabetes (T1D)
Clayton, Kyle Marcus
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BACKGROUND: Poorly managed chronic illness consumes a large share of health resources. Identifying modifiable variables for those at risk for poor management is essential to containing costs. Given the growing economic burden of diabetes (approximately $200 billion annually) and that type 1 diabetes (T1D) contributes a disproportionately large share to these costs, factors associated with higher costs in this population should be examined. The present study examines the impact of adolescent and maternal depressive symptoms on healthcare utilization and charges in adolescents with T1D. METHODS: This retrospective cohort study relied on archival data collected as part of a longitudinal study on treatment adherence among adolescents with diabetes in the Children’s Endocrinology Center at Children’s Medical Center of Dallas (CMCD). Two hundred and forty six adolescents with T1D (age range: 11-18 years;57% girls) and their mothers completed the Center for Epidemiological Studies Depression Scale (CES-D) at enrollment and 12 months later. Demographic and disease-related variables, including HbA1c, were also assessed.Healthcare utilization data and charges for diabetes-related care (i.e., endocrinology clinic visits, emergency room visits, hospitalizations, hospital inpatient days) for the period of 12 and 24 months following enrollment were provided by CMCD. Results: Both adolescent and maternal depressive symptoms predicted healthcare utilization/charges at 12 and 24 month follow-up, after controlling for demographic and disease-related variables. Adolescent depressive symptoms acted indirectly, by decreasing adherence behaviors. Maternal depressive symptoms predicted healthcare utilization and charges even after controlling for disease management (HbA1c) and adolescent depressive symptoms. Adolescents with high depressive symptoms incurred $5,293 more in healthcare charges over a two year period than those with low depressive symptoms. High maternal depressive symptoms resulted in total charges of $11,389 compared to an average of $3,504.25 when maternal depressive symptoms were low. Maternal depressive symptoms accounted for a portion of the variance in total healthcare charges comparable to HbA1c (5% and 7% respectively). Preliminary directional analyses suggested a path from maternal depressive symptoms to adolescent healthcare utilization, rather than the reverse. Conclusion: Both adolescent and maternal depressive symptoms impact healthcare utilization and charges for adolescents with T1D. Maternal depressive symptoms are even more important than adolescent depressive symptoms in predicting utilization of medical resources and higher costs in this population. Interventions aimed at identifying and treating depressive symptoms in youth with T1D and their mothers would not only enhance the quality of life of the individuals, they may also be economically advantageous for payers and providers. To the extent that reducing depressive symptoms would be cost-effective, addressing this issue represents additive value to optimizing the clinical care of patients and their families.