Caring for Depression and Comorbid Pain: Evidence from HRS and HCC

Depression is a common and serious illness, which often occurs together with painful physical symptoms. Though depression and its social and economical impacts have been well documented in the past decades, the role of pain comorbidity is far less understood. Based on two recent national survey datasets, Health and Retirement Study, and Healthcare for Communities, this dissertation investigates the interaction of depression and pain and its impact on labor market, financial, insurance, disability, medication decision, and medication costs outcomes. Chapter 2 examined the relationship between depression and pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65, using wave 3 of Health and Retirement Survey. It found that depression and comorbid pain was associated with worse labor market, financial, insurance and disability outcomes compared to depression alone, and showed the adverse effects were attributed disproportionally to individuals with depression and comorbid pain versus "pure" depression. Chapter 3 examined the relationship between depression and pain, and medication behavior and medication costs outcomes in a nationally representative cross-section of Americans, using first wave of Healthcare for Communities survey. It found that depressed individuals with pain comorbidity were substantially less likely to take antidepressant medications compared to those with depression only, and pain comorbidity was associated with a heavier burden on total medication costs and prescription drug costs. Chapter 4 used Health and Retirement Survey to analyze the effect of depression and comorbid pain on the transition from employment to full retirement for male and female workers. It found that depression and comorbid pain predicted early retirement for female workers, but depression alone did not predict fully retirement for either female workers or male workers. This dissertation not only makes an important contribution to our understanding of depression and pain comorbidity in terms of its prevalence in the general population, and its effect on treatment and access to care, it will also inform health policy makers who want to reduce the burden of depression and pain, and has implications for health care providers and practitioners to improve the quality of care for depression and pain comorbidity.

Health care

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