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Báo cáo y học: " Depression diagnoses following the identification of bipolar disorder: costly incongruent diagnoses"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Depression diagnoses following the identification of bipolar disorder: costly incongruent diagnoses | Stensland et al. BMC Psychiatry 2010 10 39 http www.biomedcentral.com 1471-244X 10 39 BMC Psychiatry RESEARCH ARTICLE Open Access Depression diagnoses following the identification of bipolar disorder costly incongruent diagnoses Michael D Stensland1 Jennifer F Schultz2 and Jennifer R Frytak 3 Abstract Background Previous research has documented that the symptoms of bipolar disorder are often mistaken for unipolar depression prior to a patient s first bipolar diagnosis. The assumption has been that once a patient receives a bipolar diagnosis they will no longer be given a misdiagnosis of depression. The objectives of this study were 1 to assess the rate of subsequent unipolar depression diagnosis in individuals with a history of bipolar disorder and 2 to assess the increased cost associated with this potential misdiagnosis. Methods This study utilized a retrospective cohort design using administrative claims data from 2002 and 2003. Patient inclusion criteria for the study were 1 at least 2 bipolar diagnoses in 2002 2 continuous enrollment during 2002 and 2003 3 a pharmacy benefit and 4 age 18 to 64. Patients with at least 2 unipolar depression diagnoses in 2003 were categorized as having an incongruent diagnosis of unipolar depression. We used propensity scoring to control for selection bias. Utilization was evaluated using negative binomial models. We evaluated cost differences between patient cohorts using generalized linear models. Results Of the 7981 patients who met all inclusion criteria for the analysis 17.5 1400 had an incongruent depression diagnosis IDD . After controlling for background differences individuals who received an IDD had higher rates of inpatient and outpatient psychiatric utilization and cost on average an additional 1641 per year compared to individuals without an IDD. Conclusions A strikingly high proportion of bipolar patients are given the differential diagnosis of unipolar depression after being identified as having bipolar disorder. .