Pain and Depression Among the Near Elderly

Key aims: 1) Describe social and functional outcomes for Americans with chronic pain, depressive disorders, and both types of health problems over time. Functioning will be assessed by limitations in activities of daily living and instrumental activities of daily living. Social outcomes include changes in earned income, wealth, disability, early retirement, and current work status.

2) Measure changes in insurance status following depression and pain conditions. We expect primarily moves from employer-sponsored private insurance to Medicaid, but there may be also an important group on disability. Of particular concern for this group is becoming uninsured and this is a very vulnerable age group for this adverse outcome.

3) Analyze how these health problems affect total medical utilization and out-of-pocket costs by initial insurance status and changes in insurance status and calculate the individual's financial burden in terms of ability to pay.

4) Study the time trend of wealth and savings by pain and depression status.

Methods: We will analyze data from an 8-year panel of respondents from the Health and Retirement Survey from 1992 through 2000.

Significance: Cross-sectional results from a recent national survey show that depression is a stronger predictor of pain conditions with unclear pathology than most common chronic health problems among otherwise similar individuals (Bao, Sturm, and Croghan, unpublished data point). Comorbid arthritis pain and depression is associated with the loss of life activities that individuals value particularly highly (Katz and Yelin, 2001).

Cross-sectional results also show a divergence in the availability of household wealth between individuals with and without a mental health problem over time (Gresenz and Sturm, 2000). In particular, older individuals with mental health conditions are at particular risk for having no savings, which is particularly problematic when these individuals transition into Medicare. With limited household wealth, these individuals are the group least likely to be able to afford supplemental insurance that covers medications and least likely to be able to afford the out-of-pocket costs for newer psychotropic medications. This study will assess how depression and pain among the near elderly affect long-term functional outcomes and how these outcomes are affected by initial insurance status.