TITLE:
Population-based study of health service deficits in US adults with depression: Does chronic disease co-morbidity and/or rural residency make a difference?
AUTHORS:
Andrine Lemieux, Daniel M. Saman, M. Nawal Lutfiyya
KEYWORDS:
Health Service Deficits for Depression and Other Co-Morbidities; BRFSS Surveillance Data
JOURNAL NAME:
Health,
Vol.5 No.4,
April
24,
2013
ABSTRACT: Introduction: Rural residents are at higher risk
for a depressive disorder than their non-rural counterparts. Recent research
has indicated that co-morbidities are also associated with depression. Health
service deficits (HSDs) is an analytic concept that facilitates the examination
of how a population uses health services relevant to their condition. A HSD
is present when, over the preceding 12 months, an individual has had no health
insurance, no specified health care provider, deferred medical care due to cost,
or did not have a routine medical exam. Research has shown a high prevalence
of HSDs in populations with individual chronic conditions. No study that we
know of has examined if there is an association between the constellation of
chronic conditions of depression and the co-morbidities of asthma, arthritis,
and diabetes, with HSDs. Methods: 2011 Behavioral Risk Factor Surveillance
Survey (BRFSS) data were analyzed to identify important dimensions of the
epidemiology of depression by ascertaining whether there were differences in
the prevalence of health service deficits in rural versus non-rural adults
with depression and at least one additional chronic disease (arthritis, asthma,
or diabetes). Data analyses entailed both bivariate and multivariate techniques.
All analyses were performed on weighted data. Results: Logistic regression
analysis performed using the presence of at least one HSD as the dependent variable
yielded that for US adults with lifetime depression those who were African
American, Hispanic and other/multiracial in comparison to Caucasian had
higher odds of having at least one health service deficit. Low socioeconomic
status (SES) and middle SES in comparison to high SES were also risk factors
for US adults with lifetime depression having at least one HSD. Rural residency
in comparison to non-rural residency also emerged as an independent risk
factor (for US adults with lifetime depression having at least one HSD. Chronic
disease, however, emerged as protective against US adults with lifetime
depression having at least one health service deficit. Conclusions: This study
demonstrated that race/ethnicity, SES, and rural residency are important
predictors of health service deficits for individuals with a lifetime diagnosis
of depression while having one or more chronic conditions for these same individuals was protective.