• Haijun Tian, Rebecca L Robinson, and Roland Sturm.
• Pardee RAND Graduate School, Santa Monica, CA 90407-2138, USA. tian@rand.org
• J Ment Health Policy Econ. 2005 Dec 1; 8 (4): 219-28.

BackgroundThe economic burden of depression has been documented, but the role of comorbid conditions is unclear. Depression and comorbid pain are particularly common, are associated with worse clinical outcomes and require different care than "pure'' depression. Does this comorbidity account for a large share of the adverse social outcomes attributed to depression?Aims Of StudyWe analyzed the relationship between depression and comorbid pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65.MethodsCross-sectional data were used from Wave 3 of the Health and Retirement Survey, a nationally representative sample of individuals aged 55-65 surveyed in 1996. Multivariate regression analyses, controlling for socio-demographics and chronic health conditions, estimated the associations between depression and pain, and economic outcomes. Outcomes included: employment and retirement status, household income, total medical expenditures, government health insurance, social security, limitations in activities of daily living (ADLs), and health limitations affecting work. Primary explanatory variables included the presence of severe pain, mild/moderate pain, or absence of pain, with or without depression.ResultsCompared to depression alone, depression and comorbid pain was associated with worse labor market (non-employment, retirement), financial (total medical expenditures), insurance (government insurance, social security) and disability outcomes (limitations in ADLs, health limitations affecting work), after covariate adjustment (p Implications For Health Care Provision And UseThe depressed with comorbid pain appear to experience greater burden through increased costs and worse functioning and may require different management than those with depression alone. The depressed with comorbid pain may benefit from treatment practices and guidelines that address the duality of these conditions throughout the process of care. IMPLICATION FOR HEALTH POLICIES: The depressed with comorbid pain were more likely to receive government support than depression alone. Given the central role of employer-sponsored health insurance in the U.S., they may have worse access to health care because they leave employment or retire earlier. With the evolving state of Medicare, broad formulary access to mental health treatments might be considered.Implications For Further ResearchFurther research should focus on causality of depression and comorbid pain on economic outcomes. Depression research should consider the heterogeneity of this disorder in outcomes assessment.

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