Abstract Introduction
The number of individuals with multiple chronic conditions in the UK is rising. Depression is a poor prognostic factor for many chronic physical conditions but is generally treated separately. An evidence and needs-based approach to integration of mental and physical health services is necessary. An epidemiological needs assessment of comorbid depression in a small English City was undertaken to inform the implementation of an Integrated Care System, using linked primary and secondary-care data.
Methods
Prevalence of comorbid depression, and general practice (GP) and Accident and Emergency (A&E) attendances by diagnosis were extracted from a novel primary-secondary care linked dataset. Descriptive statistics were calculated, and negative binomial regression models developed to estimate the effect of depression on service-use for different combinations of chronic conditions.
Results
Prevalence of depression was highest among those with asthma (19.7%, 95% CI 17.4-22.2) and Chronic Obstructive Pulmonary Disease (COPD) (16.2%, 95% CI 15.0-17.5). People with depression had 42% (95% CI 1.26-1.59) higher adjusted rates of A&E attendance and 20% (95% CI 1.15-1.25) higher adjusted rates of GP attendance compared to people without depression in the sample sub-population. When asthma or hypertension and depression were co-present, their interaction added significantly to GP and A&E attendance.
Conclusion
Patients with chronic physical conditions with depression used services more than those without depression, suggesting they have greater healthcare needs. Depression-related needs are likely to be high for patients with asthma and COPD; they should be particularly well-supported with their depression, possibly through an integrated depression and respiratory service. External funding details N/a