Women and Depression - Stoicism or Neglect?

Are women with depression more stoic than men, or are men just getting preferential treatment?

According to the National Institute on Mental Health, women are 70 percent more likely than men to experience depression during their lifetime.  Depression hits women harder than men in nearly every age group.

But if some fascinating data from the Centers for Medicare and Medicaid Services are any indication, we also spend a lot less on treating them than we do men.   

Are women more stoic, or are we just neglecting their mental health needs?

The data that shed some disturbing light on this subject come from the CMS Chronic Conditions Public Use Files.  These files include data for every 2010 Medicare beneficiary – approximately 48 million people.

In 2010, according to the CMS data, 9296 men between the ages of 65 and 69 who were newly-enrolled in Medicare Part B had depression and no other chronic condition.  And so did many more newly-enrolled women in the same age group - 23953 to be exact.

Medicare spent an average of $4650 (Part A, Part B, and Part D combined) on newly-eligible and enrolled 65-69 year old men with depression.  But it spent an average of only $4010 on women with depression in the same age group. 

In other words, Medicare spent 16 percent more on the men than it did on the women.

It is possible that those first-year data were an anomaly.  After all, they represented an average of just seven months of coverage.  It is possible that the men just got earlier, more aggressive treatment for depression when they first enrolled in Medicare, and that the women caught up later on in the year.

But this wasn’t the case.  When I looked at men and women in the same age group who had a full year of Medicare coverage in 2010, the disparity persisted. 

The numbers were just bigger.  There were around 35,000 men and over 85,000 women enrolled in both Parts A and B, and around half those numbers in Part D.  And we did spend more on women with depression - $5761 on average.  But we spent $6386 – or 11 percent more than that – on men.

The difference could be explained in part because men got more hospital-based care.  Medicare spent almost 50 percent more on Part A services, on average, for men.  But it still spent more on their Part B (physician/community) and Part D (prescription drug) care, too.

And here’s the interesting thing – the disparity seemed to persist as men and women aged.

I looked fifteen years down the road, at the 80-84 year old population.  Because women live longer, there were around three times as many women with depression in this age group as there were men.  But we were still spending more on the men.

Among 80-84 year olds with depression and no other chronic condition, Medicare spent 14 percent more overall on men than it did on women – an average of $7141 versus $6247.

And the disparity in spending also persisted when men and women had depression plus certain other chronic conditions – Alzheimer’s Disease and related disorders, and diabetes.

For example, Medicare paid out 23 percent more in first-year care for a 65-69 year old male with depression plus Alzheimer’s Disease or other dementia than it did for a 65-69 year old woman with the same two diseases.  And the difference over a full year was still 10 percent.

And Medicare paid out 34 percent more in the first-year care for a 65-69 year old male with depression plus diabetes than it did for a 65-69 year old woman with same two diseases.  And while that vast difference narrowed over a full year, it was still 7 percent.

These differences also persisted as people aged.  In the 80-84 age group, Medicare paid 22 percent more for men with depression plus diabetes than it did for women, and 7 percent more for depression plus dementia than it did for women.

This disparity cannot be explained away by suggesting that the men might also have other chronic conditions complicating their cases.  These are equivalent groups – neither the men nor the women had any other diagnoses at the time.

So as we enter another Mental Health Month and strive to strip away the stigma and misconceptions related to mental illnesses, perhaps one question we should be asking ourselves is this. 

Is stoicism or stigma the reason we spend less on mental health care for women with depression?

To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/