A new study examining claims data and Veterans Health Administration records finds that the burden and costs of treatment-resistant depression among veterans is greater than previously understood.

The new research also found that the economic burdens and health care utilization rates of people diagnosed with treatment-resistant depression (TRD) are far greater as well.

Treatment-resistant depression is a term used to describe clinical depression that has not responded to treatment by two or more antidepressant medications. Nearly one-third of people diagnosed with major depressive disorder, as it is clinically known, will experience this form of the condition — nearly 5 million Americans every year.

Previous research has found that military veterans face depression rates that can be three times greater than the rates found within the general population.

The U.S. veterans study analyzed claims data from the Veterans Health Administration over a four-year period, from April 2014 to March 2018. Treatment-resistant depression (TRD) costs and utilization of healthcare resources were examined in 10,449 people with TRD against people without TRD, and with veterans who had depression without TRD.

The researchers found that the healthcare resource utilization and costs were 1.5 times greater in the TRD group than those with non-TRD depression.

These costs were four times higher compared to people with no depression diagnosis.

U.S. veterans with TRD were 1.7 times more likely to have inpatient visits than those with non-TRD depression, and five times more likely than those without depression.

A second analysis of a commercial claims database found that the economic burden of TRD increases based on the severity of the condition. According to the researchers, this analysis of 6,411 people with TRD used a claims-based algorithm to identify adults with TRD from a major health insurance provider’s database of privately insured employees and dependents from January 2010 to March 2015.

Among people with TRD, 7.1 percent were identified as having a mild form of the condition, 33.6 percent as moderate, and 22.7 percent as severe.

Healthcare resource utilization and costs of moderate and severe matched patient groups were compared to those of the mild control patient group using statistical models adjusted for baseline characteristics. Treatment patterns were compared using statistical tests.

This greater prevalence of depression among military service members is also seen in active duty soldiers. People in the military have a five times higher prevalence compared to civilians, according to the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

Depression and TRD are both treatable mental health concerns, although TRD is more difficult and time-consuming to treat. TRD can be under-diagnosed in all populations, because patients often under-report the effectiveness of their current treatment.

Both studies were limited by potential miscoding of diagnoses, possible inaccuracies in the claims database, under-reported claims, and the potential for results to not reflect characteristics of the general, non-military population.

“The more we learn about treatment-resistant depression, the more we realize how significant the unmet need is for people living with this debilitating illness,” said Holly Szukis, M.P.H., health economics and outcomes research specialist at Janssen Pharmaceuticals.

“This is an urgent public health crisis that demands a better understanding,” she noted.

The research was presented at the annual Psych Congress 2018 conference in Orlando, Florida, at the end of October.

Source: Janssen Pharmaceuticals, Inc.