Health services utilization by depressive patients identified by the MINI questionnaire in a primary care setting

Objectives. To identify patients with depression, in primary care clinics in Israel, using the MINI (Mini-International Neuropsychiatric Interview) as a screening tool and to evaluate the health services utilization and costs of the patients identified. Design. Phone interviews (between 1997 and 2000) and health services utilization data extracted from computerized databases. Setting. Three primary care clinics belonging to Clalit Health Services (HMO). Participants. A random sample of 2755 patients, aged 21-65. Main outcome measures. MINI score results, utilization data. Results. The study included interviews with 2507 patients. The screening questionnaire identified 5.9% with major depression, 1.6% with minor depression and 14.3% with depressive symptoms. Higher rates of depression were found among women, immigrants, secular or traditional religious Jews, and the unemployed. Those identified with major depression had higher health services utilization and costs. Logistic regression analysis showed that depression was related to older age, female gender, fewer years of education and among seculars. Depressed patients had significantly more somatic comorbidity. Conclusions. Health services utilization and costs of people identified as depressed by the screening tool were higher. Depressive patients had higher comorbidity, which might be partially responsible for the higher cost.