Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. e829-e836 (doi:10.1542/peds.2006-2399)
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ARTICLE

Association Between Parental Depression and Children's Health Care Use

Marion R. Sills, MD, MPHa, Susan Shetterly, MSPHb, Stanley Xu, PhDb, David Magid, MD, MPHb and Allison Kempe, MD, MPHa,c

a Department of Pediatrics
c Primary Care Research Unit, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
b Clinical Research Unit, Kaiser Permanente, Denver, Colorado

OBJECTIVE. The objective of this study was to determine the association between parental depression and pediatric health care use patterns.

METHODS. We selected all children who were 0 to 17 years of age, enrolled in Kaiser Permanente of Colorado during the study period July 1997 to December 2002, and linked to at least 1 parent/subscriber who was enrolled for at least 6 months during that period. Unexposed children were selected from a pool of children whose parents did not have a depression diagnosis. Outcome measures were derived from the child's payment files and electronic medical charts and included 5 categories of use: well-child-care visits, sick visits to primary care departments, specialty clinic visits, emergency department visits, and inpatient visits. We compared the rate of use per enrollment month for these 5 categories between exposed and unexposed children within each of the 5 age strata.

RESULTS. Our study population had 24391 exposed and 45274 age-matched, unexposed children. For the outcome of well-child-care visits, teenagers showed decreased rates of visits among exposed children. The rate of specialty department visits was higher in exposed children in the 4 oldest age groups. The rates of both emergency department visits and sick visits to primary care departments were higher for exposed children across all 5 age categories. The rate of inpatient visits was higher among exposed children in 2 of the 5 age groups.

CONCLUSIONS. Overall, having at least 1 depressed parent is associated with greater rate of emergency department and sick visits across all age groups, greater use of inpatient and specialty services in some age groups, and a lower rate of well-child-care visits among 13- to 17-year-olds. This pattern of increased use of expensive resources and decreased use of preventive services represents one of the hidden costs of adult depression.

Key Words: health services research • health care provider/services • depression • parental influence • maternal mental health

Abbreviations: WCC—well-child care • ED—emergency department • HMO—health maintenance organization • KPCO—Kaiser Permanente of Colorado • ICD-9—International Classification of Diseases, Ninth Revision • RxRisk—risk score

Accepted Oct 20, 2006.




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