Psychiatric–Medical Comorbidity The Psychiatric–Medical Comorbidity section will focus on the prevalence and impact of psychiatric disorders in patients with chronic medical illness as well as the prevalence and impact of medical disorders in patients with chronic psychiatric illness. Associations of depression diagnosis and antidepressant treatment with mortality among young and disabled Medicare beneficiaries with COPD ☆ , ☆☆ Jingjing Qian, Ph.D. a, ⁎, Linda Simoni-Wastila, Ph.D. b , Gail B. Rattinger, Pharm.D., Ph.D. c , Susan Lehmann, M.D. d , Patricia Langenberg, Ph.D. e , Ilene H. Zuckerman, Pharm.D., Ph.D. b , Michael Terrin, M.D., M.P.H. e a Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849-5506, USA b Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA c Pharmacy Practice Division, Fairleigh Dickinson University School of Pharmacy, Florham Park, NJ, USA d Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA e Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA abstract article info Article history: Received 22 January 2013 Revised 28 May 2013 Accepted 12 June 2013 Keywords: Depression Antidepressant treatment Mortality Disabled Medicare beneficiaries COPD Objective: Depression is prevalent in chronic obstructive pulmonary disease (COPD) patients and a risk factor for COPD exacerbation and death. The objective of this study was to determine the associations of depression diagnosis and antidepressant treatment with mortality among Social Security Disability Insurance (SSDI)- eligible (age b 65 years who had permanent physical or mental disabilities) Medicare beneficiaries with COPD. Method: This retrospective cohort study used a 5% random sample of SSDI-eligible Medicare beneficiaries with COPD in stand-alone Part D plans during 2006–2008 (n= 17,320). COPD and depression diagnoses were assessed during 2006. Evidence of antidepressant treatment was measured in 2006–2008. All-cause mortality was measured in 2007–2008. Cox proportional hazards models were used to examine the associations of depression diagnosis with mortality and, among depressed beneficiaries, antidepressant treatment (time dependent) with mortality after controlling for covariates. Results: More than one third (37.3%) of SSDI-eligible beneficiaries with COPD had a baseline depression diagnosis; of those, 86.8% had evidence of antidepressant treatment. Baseline depression diagnosis was an independent risk factor for 2-year mortality [hazard ratio (HR)=1.21; 99% confidence interval (CI)=1.07– 1.37]. Among depressed beneficiaries, receiving antidepressant treatment was associated with significantly lower mortality (HR=0.55; 99% CI=0.44–0.68). Conclusion: Proactive antidepressant treatment should be considered as an intervention to reduce mortality for this young and disabled Medicare population. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Chronic obstructive pulmonary disease (COPD) is a condition with high mortality and morbidity. It is the third leading cause of death among US adults, with more than 12.1 million adults diagnosed with the disease [1,2]. Although COPD is a disease whose onset begins in midlife, less attention has been paid to adults younger than 65 years with COPD compared to adults older than 65 years [3,4]. Evidence suggests that Medicare beneficiaries younger than 65 years, those who receive Social Security Disability Insurance (SSDI) due to permanent physical or mental disabilities, have considerably poorer health outcomes and higher health service utilization than their older peers [5,6]. Yet knowledge about comorbidities and outcomes among this young and disabled Medicare population with COPD is sparse. The presence of comorbid depression places adults with COPD at higher risk of adverse health outcomes, including mortality [7–11]. Although comorbid depression has been found in up to 80% of COPD patients [12], depression remains underrecognized and undertreated in COPD populations [13–16]. Indeed, emerging research suggests that one fourth of COPD patients may have undiagnosed depression [16], and fewer than one third of COPD patients with comorbid depression receive antidepressant treatment [13,14]. Risk factors for comorbid General Hospital Psychiatry 35 (2013) 612–618 ☆ Author contributions: All authors participated in study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, and preparation of manuscript. ☆☆ Conflict of interest: There was no financial sponsor for this study. Data were provided by the Center for Medicare & Medicaid Services through the Research Data Assistance Center free of charge. Dr. Rattinger was supported by a National Institutes of Health Institutional Career Development Grant (K12 HD043489). ⁎ Corresponding author. Tel.: +1 334 844 5818; fax: +1 334 844 8307. E-mail address: jzq0004@auburn.edu (J. Qian). 0163-8343/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.genhosppsych.2013.06.005 Contents lists available at ScienceDirect General Hospital Psychiatry journal homepage: http://www.ghpjournal.com