Prevalence of depression and utilization of health care in single and multiple morbidity: a population-based cohort study

Background. This study aimed to determine whether depression in patients with long-term conditions is associated with the number of morbidities or the type of co-morbidity.

Method. A cohort study of 299 912 participants aged 30-100 years. The prevalence of depression, rates of health-care utilization and costs were evaluated in relation to diagnoses of diabetes mellitus (DM), coronary heart disease (CHD), stroke and colorectal cancer.

Results. The age-standardized prevalence of depression was 7% in men and 14% in women with no morbidity. The frequency of depression increased in single morbidities including DM (men 13%, women 22%), CHD (men 15%, women 24 %), stroke (men 14%, women 26%) or colorectal cancer (men 10%, women 21%). Participants with concurrent diabetes, CHD and stroke had a very high prevalence of depression (men 23%, women 49%). The relative rate of depression for one morbidity was 1.63 [95% confidence interval (CI) 1.59-1.66], two morbidities 1.96 (95% CI 1.89-2.03) and three morbidities 2.35 (95% CI 2.03-2.59). Compared to those with no morbidity, depression was associated with higher rates of health-care utilization and increased costs at any level of morbidity. In women aged 55 to 64 years without morbidity, the mean annual health-care cost was 513 pound without depression and pound 1074 with depression; when three morbidities were present, the cost was 1495 pound without depression and 2878 pound with depression.

Conclusions. Depression prevalence and health-care costs are more strongly associated with the number of morbidities than the nature of the co-morbid diagnosis.