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Open Access Research article

Co-morbidity and health care utilisation five years prior to diagnosis for depression. A register-based study in a Swedish population

David Andersson1*, Henrik Magnusson1, John Carstensen2 and Lars Borgquist1

Author Affiliations

1 Department of Medical and Health Sciences, Family Medicine, Linköping University, SE 58183 Linköping, Sweden

2 Department of Medical and Health Sciences, Health and Society, Linköping University, Linköping, Sweden

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BMC Public Health 2011, 11:552  doi:10.1186/1471-2458-11-552

Published: 12 July 2011

Abstract

Background

Depressive disorders have been associated with a number of co-morbidities, and we hypothesized that patients with a depression diagnosis would be heavy users of health care services, not only when first evaluated for depression, but also for preceding years. The aim of this study was to investigate whether increased health care utilisation and co-morbidity could be seen during five years prior to an initial diagnosis of depression.

Methods

We used a longitudinal register-based study design. The setting comprised the general population in the county of Östergötland, south-east Sweden. All 2470 patients who were 20 years or older in 2006 and who received a new diagnosis of depression (F32 according to ICD-10) in 2006, were selected and followed back to the year 2001, five years before their depression diagnosis. A control group was randomly selected among those who were aged 20 years or over in 2006 and who had received no depression diagnosis during the period 2001-2006.

Results

Predictors of a depression diagnosis were a high number of physician visits, female gender, age below 60, age above 80 and a low socioeconomic status.

Patients who received a diagnosis of depression used twice the amount of health care (e.g. physician visits and hospital days) during the five year period prior to diagnosis compared to the control group. A particularly strong increase in health care utilisation was seen the last year before diagnosis. These findings were supported with a high level of co-morbidity as for example musculoskeletal disorders during the whole five-year period for patients with a depression diagnosis.

Conclusions

Predictors of a depression diagnosis were a high number of physician visits, female gender, age below 60, age above 80 and a low socioeconomic status. To find early signs of depression in the clinical setting and to use a preventive strategy to handle these patients is important.