Depression and Health Service Utilization in Physically Disabled Medicaid Fee-for-Service Enrollees Wieland, Lisa S. creator 2008 ic, 96 p. born digital Thesis (Ph.D.) -- Brown University (2009) Allen, Susan director Intrator, Orna reader Pirraglia, Paul reader Dickersin, Kay reader Brown University. Division of Biology and Medicine. Epidemiology sponsor theses Background: Although depression is prevalent among working-aged Medicaid enrollees with physical disabilities, the association of depression and health service utilization has not been examined in this population. The relationship between depression and validity of self-reported health service utilization has also not been well explored. Objectives: We tested the hypotheses that depression is associated with both increased non-mental health service utilization and with overreporting of prior health service utilization. Methods: We linked data from a 2001 telephone survey of 556 physically disabled working-age Medicaid enrollees to paid Medicaid claims for the 12 months preceding and following the survey. The association between a claims diagnosis of depression during the previous year or a survey report of depression, and non-mental health emergency department (ED) or hospital utilization was examined for the 12 months following the survey. Self-reports of ED visits, hospitalization and inpatient nights during the previous year were compared to paid claims for the 12 months preceding the survey. Agreement between self-reports and paid claims was compared for respondents who did and did not report recent depressed mood. Results: After adjustment for demographics and physical health, a depression diagnosis was associated with increased odds of a non-mental health ED visit (OR=2.28, 95% CI = 1.22, 4.26). There was no increase in the odds of hospitalization. Survey respondents reported more ED and hospital utilization than was contained in paid Medicaid claims. After adjustment for demographics and factors associated with reporting error, recent depressed mood increased overreports of ED visits by 37% and was associated with overreporting inpatient nights by 1-7 nights. Conclusion: In working-aged adults with disabilities, depression is associated with increased non-mental health ED use. However, recent depressed mood is associated with greater overreporting of previous ED and hospital utilization. Further research is needed to assess whether depression may be a modifiable factor in efforts to reduce non-mental health utilization in this population. In the meantime, self-reports of health service use should be used with caution when assessing the relationship between depression and health service utilization. Depression Health Services Physical Disability Depression, MentalMedical careMedicaid RPB 20091218 engEnglish10.7301/Z0J101KDIn CopyrightCollection is open for research.dissertations