HOS Highlights: Depressed Mood and Mental Health Among Elderly Medicare Managed Care Enrollees

Mental and physical health and functioning are intrinsically linked, and this relationship has distinct implications for the delivery of health care to elderly Medicare beneficiaries. Depressive symptoms are associated with an increased risk of physical decline, disability, and mortality (Covinsky et al., 1999; Oslin et al., 2000; and Penninx et al., 1998). The association between chronic illness and depression is well documented. Chronic conditions, such as myocardial infarction and stroke, are associated with a higher risk of depression (Whyte et al., 2004). Among patients with coronary artery disease, symptom burden and physical limitations are associated with a higher prevalence of depressive symptoms (Ruo et al., 2003). Among diabetics, instability of blood sugar levels is associated with fluctuations in mood and mental functioning. (Sommerfield, Deary, and Frier, 2004). Disability is also associated with an increased risk of depression. Thus, in order to optimize both physical and mental health outcomes, improved management of both physical and mental illness is essential. Although improved management of depression in clinical practice improves physical functioning (Callahan et al., 2005), the quality of care for depression in Medicare managed care has been shown to be suboptimal (Virnig et al., 2004). Furthermore, there are racial disparities in both the prevalence of depressive disorders and in the quality of depression care (Strothers et al., 2005). The quality of care for mental illness and depression has been found to be poorer for minority managed care enrollees than for White enrollees (Virnig et al., 2004). Additionally, the higher prevalence of depression among Hispanics and Black enrollees can be attributed to their higher burden of chronic illness and worse access to care (Dunlop et al., 2003). Using data from the Medicare Health Outcomes Survey (HOS), we profile the mental health status of Medicare beneficiaries enrolled in managed care by examining the association between two measures of mental health: depressed mood and the mental component summary (MCS) score of the RAND® 36-Item Health Survey (RAND® SF-361) and sociodemographic characteristics, comorbidity, and disability. The HOS is designed to assess the physical functioning and mental well-being of Medicare managed care beneficiaries. Beginning in 1998 and continuing annually, a Medicare HOS baseline cohort is created from a random sample of 1,000 members from Medicare Advantage (MA) plans in