Depression phenotypes in spinal cord injury and impact on post-injury healthcare utilization and cost: Analysis using a large claim database

Riley L Wilkinson; Roman V Isakov; Uzoma A Anele; Camilo Castillo; April Herrity; Mayur Sharma; Dengzhi Wang; Maxwell Boakye; Beatrice Ugiliweneza

doi:10.1080/10790268.2023.2223446

Depression phenotypes in spinal cord injury and impact on post-injury healthcare utilization and cost: Analysis using a large claim database

J Spinal Cord Med. 2023 Jul 11:1-16. doi: 10.1080/10790268.2023.2223446. Online ahead of print.

Authors

Riley L Wilkinson¹, Roman V Isakov¹, Uzoma A Anele², Camilo Castillo³, April Herrity^{3

4}, Mayur Sharma³, Dengzhi Wang^{3

4}, Maxwell Boakye^{3

4}, Beatrice Ugiliweneza^{3

4

5}

Affiliations

¹ University of Louisville School of Medicine, Louisville, KY, USA.
² Department of Urology, University of Louisville, Louisville, KY, USA.
³ Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.
⁴ Kentucky Spinal Cord Injury Research Center, University of Louisville, Lousville, KY, USA.
⁵ Department of Health Management and Systems Science, University of Louisville, Louisville, KY, USA.

PMID: 37432058
DOI: 10.1080/10790268.2023.2223446

Abstract

Context/objective: Depression is the most common psychological comorbidity associated with spinal cord injury (SCI) and affects healthcare utilization and costs. This study aimed to use an International Classification of Disease (ICD) and prescription drug-based depression phenotypes to classify people with SCI, and to evaluate the prevalence of those phenotypes, associated risk factors, and healthcare utilization.

Design: Retrospective Observational Study.

Setting: Marketscan Database (2000-2019).

Participants: Individuals with SCI were classified into six ICD-9/10, and prescription drugs defined phenotypes: Major Depressive Disorder (MDD), Other Depression (OthDep), Antidepressants for Other Psychiatric Conditions (PsychRx), Antidepressants for non-psychiatric condition (NoPsychRx), Other Non-depression Psychiatric conditions only (NonDepPsych), and No Depression (NoDep). Except for the latter, all the other groups were referred to as "depressed phenotypes". Data were screened for 24 months pre- and 24 months post-injury depression.

Interventions: None.

Outcome measures: Healthcare utilization and payments.

Results: There were 9,291 patients with SCI classified as follows: 16% MDD, 11% OthDep, 13% PsychRx, 13% NonPsychRx, 14% NonDepPsych, 33% NoDep. Compared with the NoDep group, the MDD group was younger (54 vs. 57 years old), predominantly female (55% vs. 42%), with Medicaid coverage (42% vs. 12%), had increased comorbidities (69% vs. 54%), had fewer traumatic injuries (51% vs. 54%) and had higher chronic 12-month pre-SCI opioid use (19% vs. 9%) (all P < 0.0001). Classification into a depressed phenotype before SCI was found to be significantly associated with depression phenotype post-SCI, as evidenced by those who experienced a negative change (37%) vs. a positive change (15%, P < 0.0001). Patients in the MDD cohort had higher healthcare utilization and associated payments at 12 and 24 months after SCI.

Conclusion: Increasing awareness of psychiatric history and MDD risk factors may improve identifying and managing higher-risk patients with SCI, ultimately optimizing their post-injury healthcare utilization and cost. This method of classifying depression phenotypes provides a simple and practical way to obtain this information by screening through pre-injury medical records.

Keywords: Depression; Depression phenotype; Healthcare cost; Healthcare utilization; Spinal cord injury.