Depression diagnoses following the identification of bipolar disorder: costly incongruent diagnoses
| Autor: | Jennifer Feenstra Schultz, Jennifer R. Frytak, Michael D Stensland |
|---|---|
| Jazyk: | angličtina |
| Předmět: |
Adult
Male medicine.medical_specialty Pediatrics Bipolar Disorder lcsh:RC435-571 media_common.quotation_subject Drug Costs Medication Adherence Diagnosis Differential Recurrence lcsh:Psychiatry Research article Outcome Assessment Health Care mental disorders medicine Humans Bipolar disorder Medical diagnosis Diagnostic Errors Psychiatry Depression (differential diagnoses) media_common Selection bias Depressive Disorder Retrospective cohort study Health Care Costs medicine.disease Mental health Antidepressive Agents Psychiatry and Mental health Health Care Surveys Propensity score matching Female Differential diagnosis Psychology |
| Zdroj: | BMC Psychiatry BMC Psychiatry, Vol 10, Iss 1, p 39 (2010) |
| ISSN: | 1471-244X |
| DOI: | 10.1186/1471-244x-10-39 |
| Popis: | Background Previous research has documented that the symptoms of bipolar disorder are often mistaken for unipolar depression prior to a patient's first bipolar diagnosis. The assumption has been that once a patient receives a bipolar diagnosis they will no longer be given a misdiagnosis of depression. The objectives of this study were 1) to assess the rate of subsequent unipolar depression diagnosis in individuals with a history of bipolar disorder and 2) to assess the increased cost associated with this potential misdiagnosis. Methods This study utilized a retrospective cohort design using administrative claims data from 2002 and 2003. Patient inclusion criteria for the study were 1) at least 2 bipolar diagnoses in 2002, 2) continuous enrollment during 2002 and 2003, 3) a pharmacy benefit, and 4) age 18 to 64. Patients with at least 2 unipolar depression diagnoses in 2003 were categorized as having an incongruent diagnosis of unipolar depression. We used propensity scoring to control for selection bias. Utilization was evaluated using negative binomial models. We evaluated cost differences between patient cohorts using generalized linear models. Results Of the 7981 patients who met all inclusion criteria for the analysis, 17.5% (1400) had an incongruent depression diagnosis (IDD). After controlling for background differences, individuals who received an IDD had higher rates of inpatient and outpatient psychiatric utilization and cost, on average, an additional $1641 per year compared to individuals without an IDD. Conclusions A strikingly high proportion of bipolar patients are given the differential diagnosis of unipolar depression after being identified as having bipolar disorder. Individuals with an IDD had increased acute psychiatric care services, suggesting higher levels of relapses, and were at risk for inappropriate treatment, as antidepressant therapy without a concomitant mood-stabilizing medication is contraindicated in bipolar disorder. Further prospective research is needed to validate the findings from this retrospective administrative claims-based analysis. |
| Databáze: | OpenAIRE |
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