Thomas Grobe

Prevalence of depression diagnosis and prescription of antidepressants in East and West Germany: an analysis of health insurance data

AimThis study aimed to analyse depression-related factors. The prevalence of depression has been shown in prior surveys to vary between East and West Germany. Do these differences also appear in health insurance data?MethodThe outpatient data of a large German statutory health insurance company were analysed for regional differences in (a) the prevalence of depression diagnosis, (b) prescription rates of antidepressants and (c) risk factors of being diagnosed with depression or prescribed antidepressants. Diagnosis rates of depression in outpatient care (ICD-10 diagnosis F32/33) were analysed for the first quarter of 2004, and prescription rates of antidepressants were analysed for the first half of 2004. Odds ratios were calculated for the likelihood of being diagnosed with depression and of being prescribed antidepressants whilst considering socio-demographic and regional variables.ResultsThe prevalence of depression diagnosis is up to 41% lower in East Germany than the expected mean rate and 30% above the expected mean rate in Berlin. Regional distribution rates of antidepressant prescriptions largely follow the same pattern as rates for depression diagnosis, with the exception of Berlin where prescription rates are 10% below the expected mean rate. Unemployed persons in West Germany have a higher chance of being diagnosed with depression and of being prescribed antidepressants than those unemployed in East Germany.DiscussionResults correspond greatly to findings of epidemiologic surveys. However, the lower rate of depression diagnosis and prescription rates in East Germany might also be due to fewer mental health professionals practising there and possible differences in reporting style of emotional symptoms. This might contribute to the differences in diagnosis and prescription prevalence but cannot be solely responsible for this phenomenon. Probable causes of the different depression prevalence rates in East and West Germany will be discussed in this analysis. More research into factors impacting on regional differences in the prevalence of depression is needed.

Who is treated, and how, for depression? An analysis of statutory health insurance data in Germany

BackgroundStudies on the treatment of depression using epidemiological survey methods suggest a high level of under-treatment. Little is known about the characteristics of those people receiving treatment and indeed what kind of treatment they are likely to receive.MethodAnalysis of the data of a statutory health insurance company in Germany.ResultsIn middle-aged groups, about 50% of those diagnosed as being depressed in outpatient care are prescribed antidepressants and/or psychotherapy in the course of a year. There is more pharmacologic treatment provided in rural areas and more psychotherapy in cities, suggesting that treatment is dependent upon service availability rather than evidence-based treatment decisions. Treatment rates are considerably lower in the very young and the very old and show gender bias. Young females receive less pharmacologic treatment than young males, and elderly men are, in general, treated less than women, suggesting under-treatment at least for these groups.ConclusionsThe low treatment rates following the diagnosis of depression in the young and the old require attention, in particular with respect to gender aspect.

Who is diagnosed as suffering from depression in the German statutory health care system? An analysis of health insurance data

BackgroundDepressive disease is becoming increasingly relevant in industrialised countries. For public health policy and planning it is important to know about the epidemiology of this disease as well as the extent to which this epidemiology impacts on health service provision.MethodAnalysis of data from a major German statutory health insurance company: Longitudinal micro-level claims data containing information about diagnoses obtained from inpatient and outpatient sources as well as information collected from prescriptions issued for antidepressants. Data was analysed with regard to the differences in drug utilisation and the risk of being diagnosed with depression according to age, sex, marital status and area of residence.ResultsResults correspond significantly with the findings of population surveys on depression epidemiology. They also confirm the finding of a lower prevalence of depression in East Germany compared to West Germany. However, the claims data revealed an unexpectedly high prevalence of depression diagnosis in older age groups.ConclusionStatutory health insurance data seems to be a reliable source of epidemiological information that is both easily accessible and longitudinally available, and thus provides important information that is needed for health policy and service planning.With regard to service provision it should be considered that depression in old age is a greater problem than is suggested by most epidemiological surveys.

Veränderungen der Lebensqualität nach Organtransplantationen

138 patients with end-stage kidney disease and 118 patients with end-stage liver disease were included in an observational cohort study regarding their quality of life. Instruments used were the Nottingham Health Profile (NHP), a scale for Activities of Daily Life (ADL), a Symptom Check List (SCL-90-R), and the Center of Epidemiology and Statistics Depression Scale (CES-D), all for self rating, as well as the indices of Spitzer and Karnofsky for foreign rating of life quality. Apart from the early postoperative period in both groups there was significant and persistent improvement in quality of life already three months after transplantation. In some dimensions, patients after kidney transplantation presented even lower trouble scores than a population sample. In addition, semistructured interviews showed clearly the need for psychotherapeutic support to guarantee the success for specific cases. The present investigation demonstrates, that systematic registration of the patients perception of illness and treatment is possible even in extreme situations and leads to a differentiated evaluation of medical procedures. Thereby the study also contributes to the development of modern evaluation research according to the spirit of evidence based medicine.

1.5 years after: no substantial differences in health-related quality of life by type of coronary revascularisation among German health insurance beneficiaries

Aims: To explore the level of health-related quality of life (HRQL) in usual patients after surgical and percutaneous approaches to coronary revascularisation. Methods: We surveyed all beneficiaries of a large German health insurance, who underwent coronary revascularisation in the year 2005, were younger than 75 years of age, and survived until the time the survey took place (on average 1.5 year after the index-procedure) (n=2.810). We used German validated versions of the Short-Form 36 (SF-36) and the Seattle Angina Questionnaire (SAQ). The eight SF-36 subscales and the five SAQ-subscales are scored from 0 to 100, higher values representing better health. We compared the age- and sex-standardized SF-36-scores with the German reference population and calculated risk-adjusted scores for the SAQ- and SF-36scales (generalized equation modeling). Results: After one reminder answers from 1657 patients were available for analysis. Among the responders 462 patients had coronary artery bypass grafting, 99 patients underwent a percutaneous transluminal coronary angioplasty only, 769 patients had at least one bare metal stent implanted, and 327 patients were treated with drug-eluting stent(s). 1.5 years after the index-procedure, health-related quality of life of the study sample was five to ten points below the German reference population in seven of the eight SF-36 subscales regardless of the type of revascularisation. SF-36- and SAQ-scores by type of revascularisation differed only two to six points. Among others, a history of depression, physical comorbidity, younger age, self-reported complications, and coronary re-interventions lead to lower levels of health-related quality of life. Conclusion: Health-related quality of life in usual patients 1.5 years after coronary revascularisation is still (or again?) limited. There appear no substantial differences by type of revascularisation.