Patients with major depression, minor depression, and depressive symptoms have greater functional impairment and consume greater health care resources than patients who are not depressed [13-29]. For example, in a comparison of patients with DSM-III-R anxiety or depressive disorders, subthreshold disorders, or no anxiety or depressive disorders, Simon et al  found that, after controlling for physician rating and disease severity, patients with anxiety or depression had statistically significantly higher 6-month health care expenditures relative to patients with no anxiety or depression (Figure 6.1).
Epidemiological studies have shown significant functional impairment in depressed patients as measured by lost productivity and absenteeism [20, 30, 31]. Studies have found that depressed patients in primary care generally have 2-4 disability days per month [32,33]. Health care costs are also positively correlated with symptom severity [10, 34]. Furthermore, since depression often co-occurs with other psychiatric and non-psychiatric illnesses, it is not surprising that the outcomes of those other illnesses are poorer and costs are higher when the depression is present [9, 35, 36].
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