Effect of depression on health service utilisation in men: a prospective cohort study of Australian men aged 35 to 80 years.

Objectives: To examine the relationship between depression burden, health service utilisation and depression diagnosis in community-based men.
Design: Prospective cohort study.
Setting: Community-based.
Participants: Men aged 35-80 years at recruitment (2002-2005), randomly selected from the northern and western suburbs of Adelaide, Australia, without depression at baseline, who attended follow-up visits (2007-2010) (n=1464).
Primary and Secondary Outcome Measures: Depression symptoms were categorised into high burden (total score of ≥13 for the Beck Depression Inventory (BDI) or ≥10 for the Centre for Epidemiologic Studies Depression Scale (CES-D) or low burden (<13 for the BDI or <10 for the CES-D). Diagnosed depression was determined by patient-reported physician diagnosis. Frequent general practitioner (GP) visits were those occurring 5+ times over the preceding year. Use of national medical and prescription services (Medicare Benefit Schedule and Pharmaceutical Benefit Scheme; MBS and PBS) was assessed through data linkage.
Results: Frequent attendance and depression diagnosis was more common in men with a high than low burden of depression symptoms (45.9% vs 29.3%-18.7% vs 1.9%, p<0.001). Depression diagnoses were also more common in frequent GP attenders compared with low-average attenders (5.1% vs 2.2%, p<0.001). Among men with high burden of symptoms, there was no age-adjusted or multi-adjusted difference for likelihood of depression diagnosis between non-regular and frequent GP attenders. Annualised MBS and PBS expenditure was highest for men with undiagnosed depression.
Conclusions: Men with a high burden of depression symptoms have commensurate use of health services when compared with those with a low burden, but only half report a physician diagnosis of depression. Undiagnosed depression led to a higher usage of medical and prescription services.
Competing Interests: Competing interests: SM has received research funding from the National Health and Medical Research Council of Australia. RJA reports grants from National Health & Medical Research Council (Project Grant no. 627227), grants from ResMed Foundation during the conduct of the study; non-financial support from Embla Systems, Colorado, outside the submitted work. GAW reports grants from National Health & Medical Research Council (Project Grant no. 627227), grants from ResMed Foundation during the conduct of the study; non-financial support from Embla Systems, Colorado, personal fees from Eli Lilly, Bayer Schering, Sanofi, Novo Nordisk, AstraZeneca, INova and Elsevier outside the submitted work. IZ, AV and SA have no competing interests to declare.
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