Poor and depressed, the tip of the iceberg: the unmet needs of enrollees in an indigent health care plan.

Depression is a leading cause of disability [World Health Organization (WHO), 2001] with economic costs exceeding 63 billion dollars per year in the US [U.S. Department of Health and Human Services (DHHS), 1999]. The challenges of treating depression among the poor are compounded by broader social needs. This study examined the prevalence of depression and psychosocial needs among enrollees in an indigent health care plan. Results indicated clinical levels of depression were present in 28.6% of respondents (n=1,405). Depressed respondents were significantly more likely (p<0.001) to have co-occurring alcohol (OR=1.78; CI(95) =1.32-2.40), drug (OR=2.67; CI(95) =1.80-3.98), and health (OR=5.44; CI(95) = 4.12-7.19) problems compared to non-depressed respondents. Significantly more social needs were also associated with depression. Depressed respondents averaged 7.8 needs compared to 3.6 among non-depressed respondents. Needs included a significantly increased likelihood (p<0.001) of lacking sufficient food (OR=2.56; CI(95) =1.97-3.34), shelter (OR=3.67; CI(95) =2.23-6.05), or money (OR=3.18; CI(95) = 2.39-4.23) and having more legal (OR=2.95; CI(95) =2.22-3.92) and family (OR=3.00; CI(95) =2.32-3.86) problems. The high rates of co-occurring social needs among individuals with clinical depression underscores the need for comprehensive, coordinated care in order to improve their quality of life and also reduce high utilization of crisis management services.