OBJECTIVES: This study estimated the humanistic and economic burden associated with co-morbid depression and anxiety among adults with diabetes and hypertension.

METHODS: A retrospective cross-sectional study was conducted among adults (>= 18 years) with diabetes and hypertension. Respondents were classified into four groups: 1) depression and anxiety (N=309), depression only (N=561), anxiety only (N=366), and no depression and no anxiety (N=3,324) using data from the Medical Expenditure Panel Survey for the years 2013 and 2015. The humanistic outcomes were: health-related quality of life (HRQoL) measures obtained from the SF-12-V2. Economic outcomes were: total annual healthcare expenditures, third party spending, out-of-pocket (OOP) spending and proportion of income spent out-of-pocket. Counter-factual recycled prediction method was used to assess the incremental burden associated with comorbid depression and anxiety.

RESULTS : Nationally, 1.57 million (7.7%) adults with diabetes and hypertension reported having comorbid depression and anxiety and incurred $45.3 billion in total healthcare expenditures. The per-capita total expenditures for those with comorbid depression and anxiety was nearly 250% higher ($28,832 vs $11,543) compared to those without depression and without anxiety. They also experienced high OOP burden (AOR=1.57; 95% CI=1.08, 2.27). The relationship between comorbid depression and anxiety and HRQoL measures were insignificant after adjustment.

CONCLUSIONS: Management of diabetes and hypertension needs to account for comorbid depression and anxiety.