Prevalence of anxiety and depression in adults who are high users of healthcare services and magnitude of associated costs: a systematic review

Romeu, Daniel and Jadhakhan, Ferozkhan and Taylor, Anna Kathryn and Lindner, Oana C and Blakemore, Amy and Guthrie, Elspeth (2026) Prevalence of anxiety and depression in adults who are high users of healthcare services and magnitude of associated costs: a systematic review. BMJ Open, 16 (5). e099033. ISSN 2044-6055

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Abstract

Objectives

Anxiety and depression are common and associated with higher use of general healthcare services. The aims of this systematic review were to (1) estimate the prevalence of anxiety and depression in adults who are high or costly users of general healthcare services in comparison to routine users and (2) estimate the magnitude of healthcare costs associated with the presence of anxiety and depression.

Design

Systematic review of the available literature.

Data sources

MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and Cochrane Library were systematically searched without language restriction from inception to 1 April 2019 and updated on 25 October 2022, 16 October 2024 and 18 February 2026.

Eligibility criteria

Eligible studies described adults aged ≥18 years who were defined as high or costly general healthcare users and where the prevalence and/or associated costs of anxiety and/or depression were quantified.

Data extraction and synthesis

Three reviewers independently extracted information on study characteristics, exposure and outcomes.

Results

From the 38 412 identified articles, 27 studies from 10 countries (in Europe, North America and Asia) involving 6 145 907 participants met eligibility criteria and were included. There were wide variations in the estimated prevalence of anxiety (3.8–67.2%) and depression (4.7–77.9%) among high healthcare users. The prevalence of both disorders was higher among high healthcare users than routine users in all studies with non-high user comparator groups. Only four studies investigated healthcare costs associated with depression. These uniformly reported that general healthcare costs are higher for those with depression than those without. No studies investigated costs associated with anxiety.

Conclusions

Anxiety and depression are over-represented among high or costly healthcare users, although accurate quantification of the magnitude of difference is precluded by significant methodological heterogeneity and variability in definitions used. Improved identification of covert mental health problems is essential for the provision of effective interventions for patients and healthcare expenditure reduction. Future research should prioritise a standardised approach, with agreed definitions for high and/or costly healthcare use in different contexts.

PROSPERO registration number

CRD42018102628.

Item Type:	Article
Identification Number:	10.1136/bmjopen-2025-099033
Dates:	Date Event 14 April 2026 Accepted 13 May 2026 Published Online
Uncontrolled Keywords:	depression, anxiety, healthcare utilisation, high cost, high healthcare cost, frequent attenders, prevalence, primary care, secondary care, health economics
Subjects:	CAH02 - subjects allied to medicine > CAH02-06 - allied health > CAH02-06-01 - health sciences (non-specific) CAH03 - biological and sport sciences > CAH03-01 - biosciences > CAH03-01-02 - biology (non-specific)
Divisions:	Life and Health Sciences > Life and Sports Sciences
Depositing User:	Gemma Tonks
Date Deposited:	05 Aug 2026 07:59
Last Modified:	05 Aug 2026 07:59
URI:	https://www.open-access.bcu.ac.uk/id/eprint/17146

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