ABSTRACT
Psychiatric disorders are associated with significant morbidity, disability, and cost. The estimated 1990 cost of depression in the United States was $44 billion, with only $12.4 billion spent on actual treatment; the remaining cost was attributed to inadequate treatment, lowered job productivity, lost income from missed work days, and suicide (Franco, 1995). A study of health maintenance organization (HMO) primary care patients found that those with DSM-III-R anxiety or depressive disorders had 91% higher medical utilization costs at baseline assessment than patients without these disorders, and that these cost differences persisted after adjustment for medical morbidity (Simon, Von Korff, & Barlow, 1995). Other research has demonstrated that patients with anxiety or depressive disorders reported "reduced functioning levels within ranges that would be expected for patients with chronic physical diseases, such as diabetes and congestive heart failure" (Fifer et al., 1994, p. 740).
