Utilization of somatic healthcare in Croatian patients with schizophrenia spectrum disorder, major depression, PTSD and the general population

Vjekoslav Jeleč,Mirela Šentija Knežević,Wei Wang,Nenad Jakšić,Delfa Radić-Krišto,Marina Šagud,Igor Filipčić,Ivana Portolan Pajić,Tomislav Benjak,Ivona Šimunović Filipčić,Ivan Miloloža,Žarko Bajić

doi:10.1186/s12888-019-2190-8

Abstract

BackgroundUtilization of somatic healthcare services is highly predictive of the development of chronic physical illnesses and increased mortality risks. The objective of this study was to assess the differences in healthcare utilization among patients with schizophrenia spectrum disorders (SSD), major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) and the general population in Croatia.MethodsWe enrolled 566 Croatian participants from the general population, 282 with SSD, 178 with MDD, and 86 with PTSD. The primary outcome was a self-reported specialist consultation for non-psychiatric (e.g., somatic) causes within the previous 12 months.ResultsAlthough SSD patients with chronic physical illnesses were significantly more often hospitalized for physical illness than the general population, the proportion of patients who had a specialist consultation were equal in SSD and the general population. MDD and PTSD patients had significantly higher adjusted odds for specialist consultation than the general population and SSD patients (MDD compared to SSD: OR = 2.14; 95% CI 1.27–3.59; PTSD compared to SSD: OR = 2.03; 95% CI 1.00–4.10).ConclusionsSSD patients’ utilization of somatic healthcare is equal to the general population, despite their increased healthcare needs. However, their utilization is lower than in MDD and PTSD patients and, therefore, probably not adequate.Trial registrationThe study protocol was registered at ClinicalTrials.gov (NCT02773108) on May 16, 2016.

Highlights

Study population The study populations were patients diagnosed with spectrum disorders (SSD) (ICD-10, F20-F29), major depressive disorder (MDD) (ICD-10, F32–33, and posttraumatic stress disorder (PTSD) (ICD-10, F43.1) (Using the clinical International Classification of diseases (ICD)-10 psychiatric diagnosis coded as the principal diagnosis), treated in the psychiatric hospital, and the general population (GEP) with the permanent residency in the city of Zagreb and Zagreb County, living in private households
We analyzed 546 psychiatric patients diagnosed with SSD, MDD and PTSD, and 566 patients from the GEP
In the sample from the population of patients diagnosed with SSD 113 (40%) was diagnosed with schizophrenia (ICD-10 F20), 70 (25%) with acute and transient psychotic disorder (ICD10 F23), 46 (16%) with unspecified nonorganic psychosis (ICD-10 F29), 44 (16%) with schizoaffective disorder (ICD-10 F25) and 9 (3%) with other psychosis

Summary

Introduction

It has been known for over two decades that the lifespan of persons with schizophrenia spectrum disorder (SSD) is reduced for 15–20 years, [1] primarily due to a high prevalence of common preventable and/or treatable chronic physical illnesses (CPI) and poor primary care utilization. [2,3,4,5,6] even in three Scandinavian countries thatJeleč et al BMC Psychiatry (2019) 19:203 due to both maladaptive health risk behaviors, such as smoking and sedentary lifestyle, and the physiological effects of their psychiatric illnesses. [10,11,12] the CPI may affect treatment outcomes in SSD and are associated with increased costs. [13,14,15,16] It is essential to manage the symptoms of schizophrenia and to treat comorbid physical illnesses [17] as physical healthcare needs of SSD patients are elevated. Several studies have found the apparent paradox of equality of health services between SSD patients and GEP, but still premature SSD patients’ mortality. [23, 24] the equality of health care utilization between SSD and GEP should be interpreted as an inadequate assessment of SSD patients’ medical healthcare needs. Our rationale was that SSD patients’ physical healthcare needs are not lower than in these two psychiatric patient groups. The objective of our analysis was to assess the differences in health care utilization between SSD patients and GEP, compared to patients diagnosed with MDD and PTSD. The objective of this study was to assess the differences in healthcare utilization among patients with schizophrenia spectrum disorders (SSD), major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) and the general population in Croatia

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Conclusion