Health-related quality of life outcomes, economic burden, and associated costs among diagnosed and undiagnosed depression patients in Japan

Figures & data

Table 1 Demographics and health characteristics among respondents with diagnosed and undiagnosed depression and control groups

Parameters		Bivariate comparisons – unweighted						Bivariate comparisons – weighted
		Diagnosed depression, n=2,843		Undiagnosed depression, n=6,561	Control, n=74,100		P-value	Diagnosed depression, n=2,843	Undiagnosed depression, n=2,717	Control, n=2,801	P-value
Age (years) (mean ± SD)			40.52±12.21	38.99±13.56		48.56±15.58	<0.001	40.52±0.23	40.33±0.16	40.69±0.07	0.002
Sex	Male (%)		1,494 (52.6)	2,894 (44.1)		37,881 (51.1)	<0.001	1,494 (52.6)	1,415 (52.1)	1,463 (52.2)	0.894
Currently employed	Not currently employed (%)		1,094 (38.5)	2,498 (38.1)		29,346 (39.6)	0.029	1,094 (38.5)	1,021 (37.6)	1,069 (38.2)	0.651
	Employed (%)		1,749 (61.5)	4,063 (61.9)		44,754 (60.4)		1,749 (61.5)	1,696 (62.4)	1,732 (61.8)
University education	Less than university education (%)		1,408 (49.5)	3,750 (57.2)		38,094 (51.4)	<0.001	1,408 (49.5)	1,364 (50.2)	1,405 (50.2)	0.742
	University education or higher (%)		1,435 (50.5)	2,811 (42.8)		36,006 (48.6)		1,435 (50.5)	1,353 (49.8)	1,396 (49.8)
Annual household income	<¥3 million (%)		777 (27.3)	1,805 (27.5)		12,695 (17.1)	<0.001	777 (27.3)	741 (27.3)	767 (27.4)	0.999
	¥3 million to <¥5 million (%)		667 (23.5)	1,629 (24.8)		19,079 (25.7)		667 (23.5)	653 (24.0)	656 (23.4)
	¥5 million to <¥8 million (%)		660 (23.2)	1,376 (21.0)		18,830 (25.4)		660 (23.2)	630 (23.2)	651 (23.2)
	≥¥8 million (%)		462 (16.3)	939 (14.3)		15,593 (21.0)		462 (16.3)	433 (15.9)	453 (16.2)
	Decline to answer (%)		277 (9.7)	812 (12.4)		7,903 (10.7)		277 (9.7)	260 (9.6)	273 (9.8)
Type of insurance	National health insurance (%)		1,248 (43.9)	2,953 (45.0)		33,102 (44.7)	<0.001	1,248 (43.9)	1,198 (44.1)	1,225 (43.7)	0.955
	Social Insurance (%)		1,346 (47.3)	2,977 (45.4)		36,750 (49.6)		1,346 (47.3)	1,302 (47.9)	1,335 (47.6)
	Late-stage elderly insurance (%)		4 (0.1)	25 (0.4)		978 (1.3)		4 (0.1)	3 (0.1)	5 (0.2)
	Others (%)		113 (4.0)	126 (1.9)		1,094 (1.5)		113 (4.0)	93 (3.4)	108 (3.9)
	None of the above (%)		132 (4.6)	480 (7.3)		2,176 (2.9)		132 (4.6)	121 (4.4)	129 (4.6)
BMI category	Underweight (%)		328 (11.5)	1,049 (16.0)		7,813 (10.5)	<0.001	328 (11.5)	322 (11.9)	325 (11.6)	0.987
	Acceptable risk (%)		1,183 (41.6)	3,096 (47.2)		38,122 (51.4)		1,183 (41.6)	1,147 (42.2)	1,166 (41.6)
	Increased risk (%)		783 (27.5)	1,472 (22.4)		20,240 (27.3)		783 (27.5)	743 (27.3)	765 (27.3)
	High risk (%)		419 (14.7)	531 (8.1)		4,790 (6.5)		419 (14.7)	383 (14.1)	414 (14.8)
	Decline to provide weight (%)		130 (4.6)	413 (6.3)		3,135 (4.2)		130 (4.6)	122 (4.5)	131 (4.7)
Alcohol use	Do not drink (%)		915 (32.2)	2,275 (34.7)		22,270 (30.1)	<0.001	915 (32.2)	874 (32.2)	903 (32.2)	0.996
	Drink alcohol (%)		1,928 (67.8)	4,286 (65.3)		51,830 (69.9)		1,928 (67.8)	1,843 (67.8)	1,898 (67.8)
Smoking behavior	Never smoked (%)		1,435 (50.5)	3,791 (57.8)		41,490 (56.0)	<0.001	1,435 (50.5)	1,373 (50.5)	1,422 (50.8)	0.984
	Former smoker (%)		550 (19.3)	1,237 (18.9)		18,048 (24.4)		550 (19.3)	534 (19.7)	547 (19.5)
	Current smoker (%)		858 (30.2)	1,533 (23.4)		14,562 (19.7)		858 (30.2)	810 (29.8)	832 (29.7)
Exercise behavior	No exercise in past month (%)		1,738 (61.1)	4,364 (66.5)		42,119 (56.8)	<0.001	1,738 (61.1)	1,678 (61.7)	1,720 (61.4)	0.822
	One or more days of exercise in past month (%)		1,105 (38.9)	2,197 (33.5)		31,981 (43.2)		1,105 (38.9)	1,039 (38.3)	1,082 (38.6)
CCI (mean ± SD)			0.40±2.05	0.17±0.58		0.13±0.44	<0.001	0.40±0.04	0.25±0.02	0.25±0.01	<0.001

Abbreviations: BMI, body mass index; CCI, Charlson comorbidity index.

Table 2 Effect of diagnosed and undiagnosed depression on HRQoL, work productivity loss, activity impairment, health care resource utilization, and costs

Parameters	Outcomes stratified – unadjusted				Outcomes stratified – adjusted
	Diagnosed depression n=2,843	Undiagnosed depression n=6,561	Control n=74,100	P-value	Diagnosed depression n=2,843	Undiagnosed depression n=2,717	Control n=2,801	P-value
MCS (mean ± SD)	32.5±12.3	33.9±9.5	49.6±8.0	<0.001	32.5±0.2	33.8±0.1	47.9±0.1	<0.001
PCS (mean ± SD)	49.7±7.9	50.5±8.1	53.7±5.9	<0.001	49.7±0.2	50.2±0.1	53.5±0.1	<0.001
Health state utility score (mean ± SD)	0.61±0.11	0.62±0.10	0.77±0.11	<0.001	0.61±0.00	0.62±0.00	0.76±0.00	<0.001
Absenteeism (mean ± SD [count])a	14.1±27.9 (1,621)	7.1±18.8 (3,709)	2.3±11.0 (41,735)	<0.001	14.1±0.7 (1,621)	7.1±0.4 (1,554)	2.7±0.1 (1,608)	<0.001
Presenteeism (mean ± SD [count])a	42.7±28.5 (1,596)	38.5±26.7 (3,824)	17.7±22.7 (42,763)	<0.001	42.7±0.7 (1,596)	39.1±0.5 (1,607)	19.4±0.2 (1,655)	<0.001
Overall work productivity impairment (mean ± SD [count])a	48.8±31.5 (1,621)	41.0±28.7 (3,709)	19.0±24.3 (41,735)	<0.001	48.8±0.8 (1,621)	42.3±0.5 (1,554)	20.9±0.2 (1,608)	<0.001
Activity impairment (mean ± SD)	49.1±29.0	43.0±27.7	19.2±23.4	<0.001	49.1±0.5	43.8±0.4	21.5±0.2	<0.001
Health care provider visits in past 6 months (mean ± SD)	13.5±16.8	5.3±9.3	4.1±7.2	<0.001	13.5±0.3	6.0±0.2	3.8±0.1	<0.001
Hospitalizations in the past 6 months (mean ± SD)	1.6±9.5	0.9±6.7	0.4±3.8	<0.001	1.6±0.2	1.1±0.1	0.5±0.0	<0.001
ER visits in the past 6 months (mean ± SD)	0.42±2.7	0.21±1.8	0.08±0.9	<0.001	0.42±0.05	0.24±0.03	0.14±0.04	<0.001
APP indirect costs (¥) (mean ± SD [count])a	2,271,496± 1,602,981 (1,621)	1,812,940± 1,368,645 (3,709)	860,484± 1,154,932 (41,735)	<0.001	2,271,496± 39,814 (1,621)	1,985,834± 29,340 (1,554)	972,291± 9,442 (1,608)	<0.001
APP direct costs (¥) (mean ± SD)	2,087,418±10,744,165	1,135,445±7,626,531	560,232±4,278,669	<0.001	2,087,418±201,504	1,329,674±156,223	602,978±41,085	<0.001
APP physician costs (¥) (mean ± SD)	223,426±278,099	88,199±152,767	68,434±119,095	<0.001	223,426±5,216	98,936±2,667	62,930±1,549	<0.001
APP hospital costs (¥) (mean ± SD)	99,346±576,940	55,910±409,496	26,298±229,764	<0.001	99,346±10,820	65,733±8,390	28,733±2,143	<0.001
APP ER costs (¥) (mean ± SD)	26,090±168,790	12,909±113,993	5,277±53,965	<0.001	26,090±3,166	14,681±1,673	8,493±2,688	<0.001

Note:

a Number of patients.

Abbreviations: APP, annual per-patient; ER, emergency room; HRQoL, health-related quality of life; MCS, Mental Component Summary; PCS, Physical Component Summary.

Table 3 Effect of diagnosed and undiagnosed depression on HRQoL, work productivity loss, activity impairment, health care resource utilization, and costs, relative to controls, after further adjustment for age and CCI

Dependent variables	Depression	Adjusted mean ± SE (95% CI)	P-value
MCS	Control	48.6±0.1 (48.5–48.7)	<0.001
	Diagnosed depression	33.2±0.1 (33.1–33.4)	<0.001
	Undiagnosed depression	34.5±0.1 (34.4–34.6)	–
PCS	Control	52.8±0.1 (52.7–52.9)	<0.001
	Diagnosed depression	49.2±0.1 (49.1–49.3)	<0.001
	Undiagnosed depression	49.5±0.1 (49.4–49.6)	–
Health state utility score	Control	0.76±0.00 (0.76–0.77)	<0.001
	Diagnosed depression	0.61±0.00 (0.61–0.62)	0.010
	Undiagnosed depression	0.62±0.00 (0.61–0.62)	–
Absenteeism	Control	2.5±0.1 (2.4–2.6)	<0.001
	Diagnosed depression	13.1±0.4 (12.5–13.8)	<0.001
	Undiagnosed depression	6.6±0.28 (6.3–6.9)	–
Presenteeism	Control	18.8±0.1 (18.6–19.1)	<0.001
	Diagnosed depression	41.4±0.3 (40.8–42.0)	<0.001
	Undiagnosed depression	38.1±0.3 (37.5–38.6)	–
Overall work productivity impairment	Control	20.2±0.2 (19.9–20.5)	<0.001
	Diagnosed depression	47.2±0.4 (46.5–47.9)	<0.001
	Undiagnosed depression	41.1±0.3 (40.5–41.7)	–
Activity impairment	Control	21.1±0.1 (20.9–21.3)	<0.001
	Diagnosed depression	48.4±0.3 (47.9–48.9)	<0.001
	Undiagnosed depression	43.3±0.2 (42.9–43.8)	–
ER visits in the past 6 months	Control	0.08±0.00 (0.08–0.09)	<0.001
	Diagnosed depression	0.31±0.02 (0.28–0.35)	<0.001
	Undiagnosed depression	0.22±0.01 (0.20–0.24)	–
Hospitalizations in the past 6 months	Control	0.4±0.0 (0.4–0.4)	<0.001
	Diagnosed depression	1.6±0.1 (1.5–1.8)	<0.001
	Undiagnosed depression	1.0±0.1 (0.9–1.1)	–
Health care provider visits in past 6 months	Control	3.7±0.0 (3.6–3.7)	<0.001
	Diagnosed depression	14.0±0.2 (13.7–14.3)	<0.001
	Undiagnosed depression	6.1±0.1 (5.9–6.2)	–
APP indirect costs (¥)	Control	1,010,952±7,692 (995,988–1,026,141)	<0.001
	Diagnosed depression	2,362,715±17,942 (2,327,809–2,398,143)	<0.001
	Undiagnosed depression	2,059,261±15,773 (2,028,577–2,090,410)	–
APP direct costs (¥)	Control	499,813±21,410 (459,564–543,587)	<0.001
	Diagnosed depression	2,050,538±85,762 (1,889,152–2,225,710)	<0.001
	Undiagnosed depression	1,225,569±51,035 (1,129,516–1,329,790)	–
APP hospital costs (¥)	Control	23,398±1,175 (21,204–25,819)	<0.001
	Diagnosed depression	96,919±4,882 (87,808–106,976)	<0.001
	Undiagnosed depression	58,454±2,949 (52,951–64,528)	–
APP ER costs (¥)	Control	5,255±198 (4,880–5,658)	<0.001
	Diagnosed depression	19,279±905 (17,585–21,136)	<0.001
	Undiagnosed depression	13,663±609 (12,520–14,911)	–
APP physician costs (¥)	Control	60,447±431 (59,608–61,298)	<0.001
	Diagnosed depression	231,873±1,964 (228,055–235,755)	<0.001
	Undiagnosed depression	100,252±885 (98,533–102,000)	–

Abbreviations: APP, annual per-patient; ER, emergency room; HRQoL, health-related quality of life; MCS, Mental Component Summary; PCS, Physical Component Summary; SE, standard error.