Longitudinal patterns of mental health service utilisation by those with mental-physical comorbidity in the community

L Harber-Aschan,M Hotopf,J.S.L Brown,M Henderson,S.L Hatch

doi:10.1016/j.jpsychores.2018.11.005

Abstract

ObjectiveSuccessful healthcare integration demands an understanding of current service utilisation by people with comorbidity. Physical illness may impact on mental health service use (MHSU), but longitudinal studies of comorbidity and MHSU are rare. This study 1) estimated associations between mental-physical comorbidity and longitudinal MHSU patterns; 2) tested whether associations between comorbidity and continuous MHSU are driven by “need”. MethodsSurvey data from a South East London community cohort were used (N = 1052). Common mental disorder symptoms (CMDS) were measured using the Clinical Interview Schedule Revised and self-report of long-standing disorders. A checklist of common conditions measured chronic physical conditions. MHSU captured self-reported use of mental health services in the past year at two time points. “Need” indicators included CMDS at follow-up, suicidal ideation, somatic symptom severity, self-rated health, daily functioning problems and perceived functioning limitations due to emotional health. Analyses used logistic and multinomial regression. ResultsContinuous MHSU (at both time-points) was twice as commonly reported by those with comorbidity than those without physical comorbidity (30.9% vs 12.3%). CMDS at follow-up, suicidal ideation, and perceived functioning limitations due to emotional health only partially explained the association between CMDS-physical comorbidity and continuous MHSU. In the adjusted model, comorbidity remained associated with continuous MHSU (RRR = 3.23, 95% CI: 1.39–7.51; p = .002), while the association for non-comorbid CMDS was fully attenuated (RRR = 1.08, 95% CI: 0.40–2.93; p = .85). ConclusionCMDS-physical comorbidity was strongly associated with continuous MHSU, and “need” did not account for this association, suggesting that comorbidity itself represents a “need” indicator.

Highlights

Mental-physical comorbidity is common and associated with poor health outcomes, significant reductions in functioning, and increased healthcare utilisation and costs[1,2]
Need indicators included Common mental disorder symptoms (CMDS) at follow-up, somatic symptom severity, self-rated health, daily functioning problems, perceived functioning limitations due to emotional health, and suicidal ideation. Whilst we expected these indicators to be associated with comorbidity, we considered them conceptually separate, as they captured illness burden and continuity, beyond the co-occurrence of mental and long-standing physical illness captured by comorbidity
Results from a prospective Dutch population study using more comparable methods showed that the association between physical illness and continuous mental health service use (MHSU) was fully attenuated in their adjusted model [31]

Summary

Introduction

Mental-physical comorbidity is common and associated with poor health outcomes, significant reductions in functioning, and increased healthcare utilisation and costs[1,2]. Several studies report small to modest increases in MHSU by those with comorbid mental-physical illness [3,4,5]. This suggests that increased “need” in terms of poorer perceived health and functioning and greater mental illness severity among those with comorbidity may increase MHSU [6,7]. Other evidence suggests that people with comorbidity use services less and delay help-seeking longer [8,9]. Such “crowd-out” effects could be due to psychiatric symptoms being misattributed to physical conditions, presenting barriers to MHSU

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Results

Discussion

Conclusion