# Healthcare utilization and expenditures among adults with type 2 diabetes mellitus and comorbid psychological distress

## TL;DR

This study finds that psychological distress in adults with type 2 diabetes in rural China is linked to increased healthcare use and costs.

## Contribution

This is the first study to evaluate the association between psychological health and healthcare expenditures in rural Chinese adults with T2DM.

## Key findings

- Higher diabetes distress scores are associated with increased outpatient visits, inpatient use, and outpatient costs.
- Depressive symptoms are linked to higher outpatient visits, inpatient use, and total medical expenditures.
- Psychological screening and care interventions are suggested to reduce healthcare burdens in this population.

## Abstract

Depressive symptoms and diabetes distress are associated with adverse outcomes in adults with type 2 diabetes mellitus (T2DM). However, no prior studies evaluated the association between healthcare expenditures, utilization, and psychological health in adults with T2DM in rural areas of China. The aim of this study was to explore the association between psychological health—specifically depressive symptoms and diabetes distress—and healthcare utilization and expenditures in this population.

This cross-sectional study was conducted in 15 rural health clinics in Jiangsu Province, China, and involved 843 adults with T2DM. Psychological health was assessed using the 17-item Diabetes Distress Scale (DDS-17) and the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Healthcare utilization and expenditures were evaluated with negative binomial, logistic, and ordinary least squares (OLS) regression models.

Of 843 participants, a total of 32.62% of the sample were comorbid with distress, depression, or both. Each 1-point increase in diabetes distress score was associated with a 44% increase in the expected number of annual outpatient visits (IRR = 1.44, P<0.05), a 52% increase in the odds of inpatient service utilization (OR = 1.52, P <0.05), and a 43.3% increase in outpatient costs (eβ-1 = 0.433, P<0.05). For each point increase in depressive symptom score, the expected number of annual outpatient visits increased by 4% (IRR = 1.04, P<0.01), the odds of inpatient service utilization increased by 4% (OR = 1.04, P <0.01), and total medical expenditures increased by 2% (eβ-1 = 0.02, P<0.05).

Our study observed that Diabetes distress is associated with higher outpatient costs, while diabetes with depressive symptoms is associated with higher total medical expenditures. These findings suggest that psychological screening and care interventions for adults with diabetes may be essential.