Do symptoms of depression alter older adults' perceptions of health care access?

While depression is well-known risk factor for non-adherence to recommended medical care, mechanisms for this relationship are unknown. The purpose of this study was to assess one possible pathway linking depression to poor adherence; specifically, the link between depressive symptoms and perceived barriers in access to care.

Data were drawn from the 2004 wave of the Wisconsin Longitudinal Study (WLS), a longitudinal study of 5,465 men and women who graduated from Wisconsin high schools in 1957 (ages 63-67 years, 54% female). Depressive symptoms were categorized using scores on the Center for Epidemiologic Studies Depression Scale (CES-D) (≥16=high, <16=low). Fifteen items from the Group Health Association of America Consumer Satisfaction Survey (CSS) access subscale were selected to assess respondent's satisfaction with the (1) convenience of provider's location, (2) hours of operation, (3) office wait time, (4) availability of information by phone, (5) arrangements for making appointments by phone, (6) length of time waiting between making an appointment and the day of the appointment, (7) adequacy of time with the provider, (8) with out-of-pocket costs (9) services available for getting prescriptions filled, (10) access to mental health, (11) specialty, (12) routine care, (13) emergency care, (14) hospitals, and (15) overall quality of care. Responses to CSS items of poor/fair were categorized as a perceived access barrier. Selection of control variables was guided by the Andersen behavioral model (i.e., predisposing, enabling, medical need). Bivariate logistic regression models were estimated to determine total effects of depressive symptoms on each barrier, and then were adjusted for predisposing, enabling, and need factors.

The percentage of respondents perceiving an access barrier ranged from 3% for perceived access to hospitals to 31% for dissatisfaction with out-of-pocket costs. Unadjusted results revealed that those with high depressive symptoms were more likely to perceive all 15 barriers; odds ratios ranged from 1.49 (p<.001) for out-of-pocket costs to 2.53 for access to “routine” care (p<.001). With the exception of perceived barriers to prescription services and specialists, these disparities persisted in adjusted models.

These results suggest that older adults with high depressive symptoms -- a group with great potential need for healthcare services -- may perceive greater barriers in accessing a wide range health services. Perceived barriers in access may, therefore, be an important mediator linking depression to poor adherence. These findings could inform interventions to facilitate health-promoting adherence behaviors in person with poor mental health.