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Direct costs associated with depressive symptoms in late life: a 4.5-year prospective study

  • Melanie Luppa (a1), Hans-Helmut König (a2), Dirk Heider (a1) (a2), Hanna Leicht (a2), Tom Motzek (a1), Georg Schomerus (a3) and Steffi G. Riedel-Heller (a1)...


Background: Depression in old age is common. Only few studies examined the association of depressive symptoms and direct costs in the elderly in a cross-sectional way. This study aims to investigate prospectively health service use and direct costs over a course of 4.5 years considering also different courses of depressive symptomatology.

Methods: 305 primary care patients aged 75+ were assessed face-to-face regarding depressive symptoms (Geriatric Depression Scale), and service use and costs at baseline and 4.5 years later. Resource utilization was monetarily valued using 2004/2005 prices. The association of baseline factors and direct costs after 4.5 years was analyzed by multivariate linear regression.

Results: Mean annual direct costs of depressed individuals at baseline and follow-up were almost one-third higher than of non-depressed, and highest for individuals with chronic depressive symptoms. Most relevant cost drivers were costs for inpatient care, pharmaceuticals, and home care. Costs for home care increased at most in individuals with chronic depressive symptoms. Baseline variables that were associated with direct costs after 4.5 years were number of medications as a measure of comorbidity, age, gender, and depressive symptoms.

Conclusions: Presence and persistence of depressive symptoms in old age seems to be associated with future direct costs even after adjustment for comorbidity. The findings deign a look to the potential economic consequences of depressive symptoms in the elderly for the healthcare system in the future.


Corresponding author

Correspondence should be addressed to: Melanie Luppa, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straße 55, D-04103 Leipzig, Germany. Phone: +49-341-9724534; Fax: +49-341-9715409. Email:


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Allgaier, A. K., Kramer, D., Mergl, R., Fejtkova, S. and Hegerl, U. (2011). Validity of the geriatric depression scale in nursing home residents: comparison of GDS-15, GDS-8, and GDS-4. Psychiatrische Praxis, 38, 280286.
Barrett, B., Byford, S. and Knapp, M. (2005). Evidence of cost-effective treatments for depression: a systematic review. Journal of Affective Disorders, 84, 113.
Blazer, D. G. (2003). Depression in late life: review and commentary. Journals of Gerontology, Series A: Biological and Medical Sciences, 58, 249265.
Callahan, C. M. (2001). Quality improvement research on late life depression in primary care. Medical Care, 39, 772784.
Cole, M. G., Bellavance, F. and Mansour, A. (1999). Prognosis of depression in elderly community and primary care populations: a systematic review and meta-analysis. American Journal of Psychiatry, 156, 11821189.
Donohue, J. M. and Pincus, H. A. (2007). Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics, 25, 724.
Efron, B. and Tibshirani, R. (1986). Bootstrap methods for standard error, confidence interval, and other measures of statistical accuracy. Statistical Science, 1, 5477.
Farley, J. F., Harley, C. R. and Devine, J. W. (2006). A comparison of comorbidity measurements to predict healthcare expenditures. American Journal of Managed Care, 12, 110119.
Federal Statistical Office (2011). Pflegestatistik 2009: Pflege im Rahmen der Pflegeversicherung – Deutschlandergebnisse. Wiesbaden: Statistisches Bundesamt.
Fiske, A., Wetherell, J. L. and Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363389.
Gardarsdottir, H., Heerdink, E. R., van Dijk, L. and Egberts, A. C. G. (2007). Indications for antidepressant drug prescribing in general practices in the Netherlands. Journal of Affective Disorders, 98, 109115.
Gauggel, S. and Birkner, B. (1999). Validity and reliability of a German version of the Geriatric Depression Scale (GDS). Zeitschrift fuer Klinische Psychologie-Forschung und Praxis, 28, 1827.
Harris, T., Cook, D. G., Victor, C., DeWilde, S. and Beighton, C. (2006). Onset and persistence of depression in older people: results from a 2-year community follow-up study. Age Ageing, 35, 2532.
Johnston, K., Buxton, M. J., Jones, D. R. and Fitzpatrick, R. (1999). Assessing the costs of healthcare technologies in clinical trials. Health Technology Assessment, 3, 176.
Katon, W. J., Lin, E., Russo, J. and Unutzer, J. (2003). Increased medical costs of a population-based sample of depressed elderly patients. Archives of General Psychiatry, 60, 897903.
Kirmayer, L. J. (2001). Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. Journal of Clinical Psychiatry, 62, 2228.
König, H.-H., Luppa, M. and Riedel-Heller, S. (2010). Die Kosten von Depression und die Wirtschaftlichkeit ihrer Behandlung. Psychiatrische Praxis, 37, 213215.
Levinson, C. M. and Druss, B. G. (2005). Health beliefs and depression in a group of elderly high utilizers of medical services. General Hospital Psychiatry, 27, 9799.
Licht-Strunk, E., van der Windt, D. A., van Marwijk, H. W., de Haan, M. and Beekman, A. T. (2007). The prognosis of depression in older patients in general practice and the community: a systematic review. Family Practice, 24, 168180.
Linden, M., Horgas, A. L., Gilberg, R. and Steinhagen-Thiessen, E. (1997). Predicting health care utilization in the very old. Journal of Aging and Health, 9, 327.
Livingston, G., Manela, M. and Katona, C. (1997). Cost of community care for older people. British Journal of Psychiatry, 171, 5659.
Luber, M. al. (2001). Depression and service utilization in elderly primary care patients. American Journal of Geriatric Psychiatry, 9, 169176.
Luppa, M., Heinrich, S., Angermeyer, M. C., König, H.-H. and Riedel-Heller, S. G. (2007). Cost-of-illness studies of depression: a systematic review. Journal of Affective Disorders, 98, 2943.
Luppa, al. (2008). Direct costs associated with depression in old age in Germany. Journal of Affective Disorders, 105, 195204.
Luppa, al. (2012a). Age- and gender-specific prevalence of depression in latest-life: systematic review and meta-analysis. Journal of Affective Disorders, 136, 212221.
Luppa, M., Sikorski, C., Motzek, T., Konnopka, A., König, H.-H. and Riedel-Heller, S. (2012b). Health service utilization and costs of depressive symptoms in late life: a systematic review. Current Pharmaceutical Design, Epub Jun 6.
Raitano, M. (2006). The impact of death-related costs on health-care expenditures: a survey. European Network of Economic Policy Research Institutes Research Report No. 17. Available at:
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165173.
Unutzer, al. (1997). Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: a 4-year prospective study. JAMA, 277, 16181623.
Wang, P. S., Simon, G. and Kessler, R. C. (2003). The economic burden of depression and the cost-effectiveness of treatment. International Journal of Methods in Psychiatric Research, 12, 2233.
Waxman, H. M., McCreary, G., Weinrit, R. M. and Carner, E. A. (1985). A comparison of somatic complaints among depressed and non-depressed older persons. Gerontologist, 25, 501507.


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Direct costs associated with depressive symptoms in late life: a 4.5-year prospective study

  • Melanie Luppa (a1), Hans-Helmut König (a2), Dirk Heider (a1) (a2), Hanna Leicht (a2), Tom Motzek (a1), Georg Schomerus (a3) and Steffi G. Riedel-Heller (a1)...


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