Presence Of Mental Health Disorders Research Articles

Depression, anxiety and cognitive function in persons with inflammatory rheumatic diseases: cross-sectional results from the German National Cohort (NAKO)

ObjectiveTo assess the presence of mental health disorders in persons with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and Sjögren’s disease (SjD) (all: inflammatory...

Living in Camps Impacts on the Mental Health and Quality of Life of Displaced People in Northwest Syria

The research aimed to study the impact of living in displacement camps on mental health and Quality of life among Syrians in Northwest Syria. A descriptive and analytical approach was utilized, where two scales of mental health (SCL – 90 - R) and Quality of life (WHOQOL – BREF) were applied, with (306) participants. Results show that symptoms of mental health disorders appear at different levels, where the most common disorder is Depression, and the least common is Psychoticism. Quality of life results show that the most common issue was General Health, and the least common was environmental health. Differences between educational status and gender were statistically significant when studying the presence of mental health disorders, where it was lower in males than in females. Quality of life results showed significant differences between all demographic characteristics except the duration of stay in the camp. It was higher in females than in males. It was higher among the employed than the unemployed, and the age (under 18 years) had the highest Quality of life .Regarding marital status, it was highest in the (single and widowed). The Quality of life was highest among the university degree holders. There was a moderate and inverse correlation between Symptoms of mental health disorders and Quality of life, where the correlation coefficient was (-0.382), and this indicates a lower level of mental health with increasing deterioration in Quality of life. The results showed that Quality of life contributes to interpreting the variance in Symptoms of mental health disorders. The beta value (β = - 0.391) means that whenever Quality of life improved by one unit, Symptoms of mental health disorders decreased by (0.391) unit . To conclude, quality of life statistically significantly contributes to explaining mental health disorders among Syrians in displaced camps.

A Scoping Review of Digital-Based Intervention for Reducing Risk of Suicide Among Adults.

Suicide is a serious public health problem, especially among adults. Risk factors for suicide include the presence of mental health disorders, history of previous suicide attempts; substance or alcohol use and lack of social support. The impact of suicide risk includes psychological loss, as well as the trauma and emotional stress that can be felt by the families and communities left behind. Digital interventions have emerged as a promising alternative for suicide risk prevention. Previous research has focused on the findings of various designs, which did not provide clear intervention information to inform the implementation of the intervention. This study aims to describe a digital intervention to reduce the risk of suicidal behavior in adults. The design used in this study was a scoping review. The authors conducted a literature search from the Scopus, PubMed, and CINAHL databases. Inclusion criteria in this study were articles discussing digital interventions aimed at preventing suicide risk in adult populations, English language, full-text, RCT or quasi-experiment design, and publication period of the last 10 years (2014-2024). The major keywords used in the article search were suicide prevention, digital intervention, and adults. Data extraction used manual table and data analysis used descriptive qualitative with a content approach. The results showed that there were 9 articles that discussed digital-based interventions to reduce suicide risk in adults. The various types of digital interventions used were smartphone apps, online learning modules, and game-based interventions. These interventions offer significant potential in reducing the risk of suicidal behavior in adults. Digital interventions have an important role in reducing the risk of suicidal behavior in adults by considering aspects of suitability to individual needs and understanding digital literacy. Then, the development of mental health services and public health policies presented needs to be done with collaboration between stakeholders in suicide prevention efforts.

Implications of the Offshore Oil & Gas Working Environment on Mental Health and Performance of Workers

Abstract This study aimed to investigate the potential effect of the site location on the relationship between the Oil and Gas working environment’s psychosocial hazards, mental health disorders and workers’ Performance. Quantitative methods and deductive approaches have been used. The study’s population was Egyptian Oil & Gas workers, and the study sample included 409 participants. The collected data were statistically analyzed using descriptive analysis, correlation analysis, independent samples t-test, and Structural Equation Modelling (SEM). The results indicated a high levels of psychosocial hazards in the Oil & Gas working environment, where isolation, remoteness and adverse living conditions significantly depicted the highest levels. The presence of mental health disorders was confirmed by screening Depression, Stress and Anxiety among the study sample, where most responses indicated difficulties in their abilities to overcome. Further, the results showed an average level of performance with a noticeably low levels in contextual performance aspects. The study concluded that performance in the offshore Oil & Gas industry is not entirely a functional pattern but can also be influenced by the working environment, where the moderating effect of the site location of the Oil & Gas working environment on workers’ mental health disorders could eventually compromise their performance levels, ultimately harming the interest and sustainability of this vital sector.

Mental Health Assessment of Medical Students in Tanta University: A Cross Sectional Study

Background: Mental health disorders are common in university students, where the most common of them include substance abuse, anxiety, and mood disorders. College students are in a transitory age that’s accompanied by various stressors and during which diverse mental health problems usually appear for the 1st time.
 Objective: To assess presence of mental health disorders among under graduate medical students.
 Methods: 2900 students were invited to complete a survey that was built on Microsoft form app provided by information technology unit and directed to medical students in mentioned grads individually. An e-mail has been sent to each student's academic official e-mail which was provided to students in the first three academic years. Email included GHQ-28 form associated with phrases fostering involvement in the study and assuring anonymity.
 Results: The response rate for the GHQ-28 survey was 25.9% of emailed students completing the questionnaire. The mean GHQ-28 score of 13.78 is considerably higher than general population norms.
 Conclusion: The majority of students (88.16%) scored above the threshold for psychological morbidity and were considered as a possible case indicating elevated psychological distress in this student sample.

A 5-year longitudinal examination of the co-occurring patterns of gambling and other addictive behaviors

ObjectiveWe examined the co-occurring patterns of problem gambling and substance/behavioral addiction severity over a five-year period and the predictors of the different co-occurring patterns of problem gambling and addiction severity. MethodsWe conducted a secondary analysis of the Quinte Longitudinal Study (QLS) data. The QLS is a 5-year prospective longitudinal study of gambling and problem gambling in the Quinte Region in Southern Ontario. The QLS consists of a total of 4,121 participants, including a sample of participants at risk of developing problem gambling. Severity of problem gambling, substance use, and behavioral addictions were used to examine their co-occurring patterns over time. Predictors of the co-occurring patterns included the presence of mental health disorders, personality, stress, happiness, lifesatisfaction, social support, family history, and demographics. ResultsSix co-occurring patterns of problem gambling and addiction severity were identified. The largest co-occurring pattern was characterized by concurrent decrease in gambling and other addictive behaviors. Several co-occurring patterns were characterized by moderate-to-severe problem gambling and other addiction severity that remained stable over time. No co-occurring pattern represented a decrease in gambling followed by increase in other addictive behaviors (e.g., addiction substitution). The presence of mental health disorders, stress, and lifesatisfaction significantly predicted the different co-occurring patterns. ConclusionsTaken together, the results suggest that in a non-clinical sample, gambling and other co-occurring addictive behaviors are likely to simultaneously decrease over time. Comorbidity of mental health disorders significantly influences co-occurring patterns of gambling and other addictive behaviors.

Ontario Adults’ Mental Health and Wellbeing During the First 16 Months of the COVID-19 Pandemic

This study quantitatively assessed adults’ mental health and overall wellbeing over time during the first 16 months of the pandemic in Ontario, Canada. A total of 2,188 participants participated in the study and completed online questionnaires at three time points (baseline—April–July 2020; time 2—July–August 2020; and time 3—July–August 2021), which included demographic questions, the Mental Health Inventory (MHI), and the Personal Wellbeing Index-Adult (PWI-A). One-way repeated-measures ANOVAs revealed a statistically significant increase over time in participants’ mental health (MHI), as well as a significant decrease in their satisfaction with their standard of living, physical health, mental health, personal relationships, safety, community-connectedness, future security, and spirituality/religion (PWI-A). While participants’ mental health improved, their mean scores indicated the presence of mental health disorders. Generally speaking, over the first 16 months of the pandemic, the self-reported mental health of Ontario adults improved, while their perceived wellbeing declined.

Sex differences in LDL-C control in a primary care population: The PORTRAIT-DYS study

Background and aimsCardiovascular (CV) diseases show clear differences in clinical manifestation and treatment outcomes between men and women. To reduce sex disparities in achieving lipid-lowering therapy (LLT) goals, a sex-focused assessment is essential and more studies are needed to bring new evidence to clinicians. This study aims to assess the role of sex in attaining low-density lipoprotein cholesterol (LDL-C) goals, after correction for age, CV risk category, LLT intensity, and presence of mental health disorder and social deprivation. MethodsA retrospective cohort analysis of patients aged 40–85, followed in 1 hospital and 14 primary care centers in Portugal, using electronic health records from 1/1/2012 to 31/12/2020, was performed. The analysis considered an episode-based design, where exposure consists of any time when LLT was started or intensity changed. The likelihood of reaching the LDL-C goal according to contemporary ESC/EAS guidelines was modeled using multivariate Cox regression. LDL-C goal achievement at 180 days was defined as the outcome. The analysis was repeated at 30-day follow-up intervals up to 360 days, and also stratified by CV risk category. ResultsWe identified 40,032 exposure episodes (LLT initiation or intensity change) in 30,323 distinct patients. Male sex, older age, lower CV risk and increasing LLT intensity were associated with improved LDL-C control. Women were 22% less likely to reach the LDL-C goal than men (HR = 0.78, 95% CI:0.73, 0.82) independently of covariates. ConclusionsWomen have a lower likelihood of attaining LDL-C goals than men after adjustment for LLT intensity, age, CV risk category, presence of mental health disorder and social deprivation. This finding underscores the need for further investigation and tailoring of LLT management strategies in women.

Clinical implications of somatic allele expansion in female FMR1 premutation carriers

Carriers of a premutation allele (PM) in the FMR1 gene are at risk of developing a number of Fragile X premutation asssociated disorders (FXPAC), including Fragile X-associated Tremor/Ataxia Syndrome (FXTAS), Fragile X-associated Primary Ovarian Insufficiency (FXPOI), and Fragile X-associated neuropsychiatric disorders (FXAND). We have recently reported somatic CGG allele expansion in female PM; however, its clinical significance remains unclear. The aim of this study was to examine the potential clinical association between somatic FMR1 allele instability and PM associated disorders. Participants comprised of 424 female PM carriers age 0.3– 90 years. FMR1 molecular measures and clinical information on the presence of medical conditions, were determined for all subjects for primary analysis. Two sub-groups of participants (age ≥ 25, N = 377 and age ≥ 50, N = 134) were used in the analysis related to presence of FXPOI and FXTAS, respectively. Among all participants (N = 424), the degree of instability (expansion) was significantly higher (median 2.5 vs 2.0, P = 0.026) in participants with a diagnosis of attention deficit hyperactivity disorder (ADHD) compared to those without. FMR1 mRNA expression was significantly higher in subjects with any psychiatric disorder diagnosis (P = 0.0017); specifically, in those with ADHD (P = 0.009), and with depression (P = 0.025). Somatic FMR1 expansion was associated with the presence of ADHD in female PM and FMR1 mRNA levels were associated with the presence of mental health disorders. The findings of our research are innovative as they suggest a potential role of the CGG expansion in the clinical phenotype of PM and may potentially guide clinical prognosis and management.

Mental health and substance use disorders in young adults with spina bifida.

Although medical advances have allowed most patients with spina bifida (SB) to survive into adulthood, these patients may have physical impairments, urological complications, infections, and neurocognitive deficits. These factors can cause psychological distress and impact the transition from pediatric to adult care. There remains limited research on mental health disorders (MHDs) and substance use disorders (SUDs) in SB patients during this vulnerable transition period. This study aimed to investigate the 10-year incidence of MHDs and SUDs in 18- to 25-year-old patients with SB. TriNetX, a federated de-identified database, was retrospectively queried to identify 18- to 25-year-old patients with SB. The presence of MHDs and SUDs based on ICD-10 codes in SB patients (cohort 1) was analyzed and compared with those of patients without SB (cohort 2). Subgroup analysis was performed on SB patients with hydrocephalus and neurogenic bladder (NB). SB patients were further compared to patients with a spinal cord injury (SCI). After propensity score matching, the authors identified 1494 patients in each cohort. SB patients were more likely to have depression (OR 1.949, 95% CI 1.64-2.317), anxiety (OR 1.603, 95% CI 1.359-1.891), somatoform disorders (OR 2.102, 95% CI 1.052-4.199), and suicidal ideations or attempts and self-harm (OR 1.424, 95% CI 1.014-1.999). The prevalence of attention-deficit/hyperactivity disorder (ADHD) and eating disorders were comparable between cohorts. SB patients also had increased rates of nicotine dependence (OR 1.546, 95% CI 1.22-1.959) but not of alcohol or opioid disorders. In SB patients, the presence of hydrocephalus and NB was not associated with significantly increased rates of any measured MHDs or SUDs. When compared with SCI patients, SB patients were more likely to have anxiety (OR 1.377, 95% CI 1.028-1.845) and ADHD (OR 1.875, 95% CI 1.084-3.242). However, SB patients had lower rates of nicotine dependence (OR 0.682, 95% CI 0.482-0.963) and opioid-related disorders (OR 0.434, 95% CI 0.223-0.845). SB and SCI patients shared similar rates of depression, suicidal ideations or attempts and self-harm, and alcohol-related disorders. Young adults with SB have higher prevalence rates of MHDs and SUDs compared with the general population. Therefore, incorporation of mental health and substance use management is critical to facilitate transition to adulthood.

The association between pediatric mental health disorders and type 1 diabetes-related outcomes.

Transition from pediatric to adult healthcare systems is a difficult process for young adults with Type 1 Diabetes (T1D) and most patients experience a deterioration in disease control. Mental health (MH) disorders are common in individuals with T1D and are believed to play a role in disease control and transition of care. We evaluated the association between the presence of pediatric MH disorder and measures of success in diabetes care in young adults who recently transitioned to adult care. Retrospective cohort study of young adults in a large adult endocrinology system who transitioned from a pediatric hospital system after 2009. MH disorders were diagnosed by clinical pediatric psychologists during routine care at the pediatric hospital. Measurements of Hemoglobin A1c, diabetes-related emergencies, clinic attendance and intervals in transition were assessed and compared between the pediatric and adult hospital systems. 237 young adults were identified and 100 (42%) of these were diagnosed with a MH disorder during pediatric care. Presence of a MH disorder was associated with higher Hemoglobin A1c levels prior to transition and increased rates of diabetes-related hospitalizations during the transition interval. Patients with a MH disorder were less likely to establish a pattern of consistent follow up after transition (p =0.021). MH disorders are common and predict greater challenges with diabetes management and less effective transition into the adult endocrinology system. Early recognition of MH disorders may allow for allocation of more proactive and intensive support for affected patients.

The Association of Mental Health Disorders with Takotsubo Syndrome (Broken Heart Syndrome) Among Older Women.

Background: The prevalence of mental health disorders (MHD) and takotsubo syndrome (TS), also known as broken heart syndrome, is increasing and more common in older women. Mortality among persons with TS is comparable to that of persons with myocardial infarction. Although TS is poorly understood, it is thought to be precipitated by psychological stress. We examined the relationship between MHD and TS among elderly American women. Materials and Methods: Data consisted of 10.9 million hospitalizations among women aged ≥60 years recorded in the National Inpatient Sample from 2007 to 2015. International Classification of Diseases, Ninth Revision, codes were used to define TS, MHD, and other chronic conditions. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MHD and TS. Results: The mean age of patients was 76 years, with 38% of them diagnosed with MHD. Over the 9-year period, the prevalence of TS hospitalizations increased by almost fourfold from 37.1/100,000 to 154.7/100,000, with a higher prevalence among patients with MHD. In multivariable adjusted models, MHD was associated with elevated odds of TS (OR = 1.25; 95% CI: 1.18-1.32), with the odds increasing with the frequency of MHD diagnosis. Among patients with one MHD, the odds of TS were significantly higher among those diagnosed with adjustment, anxiety, and mood disorders but lower among those with suicide ideations and personality disorders. Conclusions: The presence of MHD was associated with elevated odds of TS. Understanding underlying mechanisms linking MHD with TS will enhance MHD management.

Real-World Evidence of Sofosbuvir/Velpatasvir as an Effective and Simple Hepatitis C Virus Treatment and Elimination Tool in Homeless Populations

Background: People experiencing homelessness are disproportionately affected by hepatitis C virus (HCV) and can face specific barriers to care. Simple treatment algorithms could increase linkage to care in this population. Methods: This retrospective real-world analysis pooling data from 15 clinical cohorts evaluated effectiveness of a once-daily sofosbuvir/velpatasvir (SOF/VEL) regimen in HCV-infected people experiencing homelessness. The primary outcome was sustained virological response (SVR) in the effectiveness population (patients with confirmed SVR status). Secondary outcomes included reasons for not achieving SVR, adherence and time between diagnosis and SOF/VEL treatment start. Results: Of 153 patients treated with SOF/VEL for 12 weeks without ribavirin, SVR was 100% in the effectiveness population (n = 122), irrespective of various baseline factors including active injecting drug use and presence of mental health disorders. Conclusion: HCV-infected people experiencing homelessness can successfully be treated with SOF/VEL. SOF/VEL enables implementation of simple treatment algorithms and can support test-and-treat strategies through rapid treatment starts and minimal monitoring.

A systematic review of addiction substitution in recovery: Clinical lore or empirically-based?

This systematic review synthesized the literature examining addiction substitution during recovery from substance use or behavioral addictions. A total of 96 studies were included with sample sizes ranging from 6 to 14,885. The most common recovery addictions were opioids (30.21%), followed by cannabis (20.83%), unspecified use (17.71%), nicotine (12.50%), alcohol (12.50%), cocaine (4.17%), and gambling (2.08%). Statistical results were provided by 70.83% of the studies. Of these, 17.65% found support for addiction substitution, whereas 52.94% found support for concurrent recovery. A total of 19.12% found no statistical changes and 10.29% found both significant increases and decreases. The remaining 29.17% of studies provided descriptive data, without statistical tests. Predictors of addiction substitution were provided by 22.92% of the studies and 11.46% included information on impact of addiction substitution on treatment outcomes. Overall, male gender, younger age, greater substance use severity, and presence of mental health disorders were associated with addiction substitution. Addiction substitution was associated with poorer treatment outcomes. A limitation of the present systematic review is the use of significance counting for the quantitative synthesis. More research examining changes in addiction during recovery would aid in the development of more effective treatments for addictive disorders and prevent addiction substitution.

Associations between mental health disorder and management of physical chronic conditions in China: a pooled cross-sectional analysis

Physical non-communicable diseases (NCDs) and mental health disorders are a rapidly increasing health burden in low-and middle-income countries. This study aims to examine the relationships between mental health disorders and cascade of care in managing four common physical NCDs (hypertension, diabetes, dyslipidemia, chronic kidney disease) in China. We utilized two waves of nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011, 2015) of older adult population aged 45 and above. A series of unadjusted and adjusted mixed-effect logistic regression was applied to evaluate the association between presence of mental health disorder and physical chronic disease awareness, treatment, and control. We found that the odds of dyslipidemia (AOR 1.81, 95% CI 1.36–2.39) and kidney disease awareness (AOR 2.88, 95% CI 2.12–3.92) were higher for individuals with mental chronic conditions, compared to those without mental chronic conditions. The odds of having hypertension treatment was higher for subjects with mental health disorder, compared to those without (AOR 1.32, 95% CI 1.02–1.70). The odds of having physical chronic conditions controlled was not significantly associated with having mental chronic conditions (P > 0.05). These results indicated that adults with mental health disorder have a greater likelihood of awareness of having dyslipidemia and kidney disease, and receiving treatment for hypertension. Strategies to address the growing burden of physical-mental NCDs in China should include efforts to improve management of patients with comorbid health condition and improve access to continual high-quality treatment after the first diagnosis.

Sex and Mental Health Disorder Differences Among Military Service Members With Patellofemoral Syndrome.

Mental health disorders are associated with persistent knee pain, but the association between these conditions has had little investigation in the military. The purpose of this study was to identify rates of mental health disorders in patients with patellofemoral pain (PFP) and determine differences by sex and whether mental health copresence influences outcomes. Eligible patients with a new PFP diagnosis were categorized according to sex and presence of mental health disorders. Outcomes included odds of mental health disorder before/after initial PFP diagnosis based on sex, and knee-related health care use between patients with/without mental health disorders. In 81,832 individuals with PFP (71.1% men; mean age 33; 91.5% active duty), copresence of any mental health disorders was common (18% men; 28% women). Women had more depression and anxiety; men had more post-traumatic stress disorder and substance abuse disorders. Concurrent mental health disorders after initial PFP diagnosis resulted in higher medical costs and odds of a recurrence (OR 1.24; 95% CI 1.20, 1.28; P < .001). Mental health disorders are common in military service members seeking care for patellofemoral pain. Differences in prevalence vary by sex, and presence of mental health disorders adversely affected long-term health care outcomes.

Pain centrality mediates pain self-efficacy and symptom severity among individuals reporting chronic pain.

Chronic pain is consistently associated with the presence of mental health disorders. Although previous research has shown relations between low levels of self-efficacy with chronic pain severity as well as comorbid mental health symptoms, the link between self-efficacy and mental health symptoms in chronic pain is not well understood. This study examined whether pain centrality, the extent to which pain is viewed as central to self-identity, may underlie these associations. Individuals with a diagnosis of chronic pain (N = 89) recruited through MTurkcompleted self-report measures including demographics, self-efficacy, pain centrality, pain severity, depression, and anxiety. Pain severity was associated with higher levels of pain centrality, depression, anxiety, and lower levels of self-efficacy. Path analysis demonstrated pain centrality significantly mediated the relationship between self-efficacy and pain severity, depression, and anxiety. Future studies would benefit from testing whether modifying pain centrality beliefs shift perceptions of control as well as pain and psychological outcomes.

0936 Cardiometabolic Disorders are Independently Associated with Excessive Daytime Sleepiness in Young Adults

Abstract Introduction Cardiometabolic risk factors (CMR), including obesity, hypertension, diabetes and hypercholesterolemia, have been associated with sleep apnea and insufficient sleep, both of which can lead to excessive daytime sleepiness (EDS). We hypothesized that CMR are associated with EDS in young adults independent of sleep apnea, sleep duration and mental health disorders (MHD). Methods The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) and 425 another 7.0 years later during young adulthood (24.4±2.6y). Subjects underwent a 9-h in-lab polysomnography in childhood and adolescence and parent- or self-reported standardized surveys at all time points. Self-reports in young adulthood and in-lab measurements in childhood were used to ascertain CMR and sleep apnea. Parent-reports in childhood and self-reports in young adulthood were used to ascertain the presence of MHD and EDS. Logistic regression models adjusted for age, race, sex, snoring/observed apneas, insomnia symptoms, and sleep duration in young adulthood as well as mean arterial blood pressure, body mass index percentile and apnea/hypopnea index in childhood. Results CMR (OR=2.71, 95%CI=1.69-4.36) and MHD (OR=4.61, 95%CI=2.79-7.62) were associated with EDS in univariate models. After adjusting for covariates in childhood and young adulthood, CMR and MHD remained independently associated with EDS (OR=2.32, 95%CI=1.29-4.16 and OR=2.78, 95%CI=1.59-4.87, respectively). Conclusion EDS in young adults with CMR or MHD does not solely arise from sleep apnea, insufficient sleep or other sleep disturbances. EDS may be the result of central pathophysiologic mechanisms or the functional impairment associated with cardiovascular, metabolic and mental health disorders. These data further support that youth with these disorders should be screened for EDS and appropriately managed. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

Association of Mental Health Disorders With Health Care Spending in the Medicare Population

The degree to which the presence of mental health disorders is associated with additional medical spending on non-mental health conditions is largely unknown. To determine the proportion and degree of total spending directly associated with mental health conditions vs spending on other non-mental health conditions. This retrospective cohort study of 4 358 975 fee-for-service Medicare beneficiaries in the US in 2015 compared spending and health care utilization among Medicare patients with serious mental illness (SMI; defined as bipolar disease, schizophrenia or related psychotic disorders, and major depressive disorder), patients with other common mental health disorders (defined as anxiety disorders, personality disorders, and posttraumatic stress disorder), and patients with no known mental health disorders. Data analysis was conducted from February to October 2019. Diagnosis of an SMI or other common mental health disorder. Risk-adjusted, standardized spending and health care utilization. Multivariable linear regression models were used to adjust for patient characteristics, including demographic characteristics and other medical comorbidities, using hospital referral region fixed effects. Of 4 358 975 Medicare beneficiaries, 987 379 (22.7%) had an SMI, 326 991 (7.5%) had another common mental health disorder, and 3 044 587 (69.8%) had no known mental illness. Compared with patients with no known mental illness, patients with an SMI were younger (mean [SD] age, 72.3 [11.6] years vs 67.4 [15.7] years; P < .001) and more likely to have dual eligibility (633 274 [20.8%] vs 434 447 [44.0%]; P < .001). Patients with an SMI incurred more mean (SE) spending on mental health services than those with other common mental health disorders or no known mental illness ($2024 [3.9] vs $343 [6.2] vs $189 [2.1], respectively; P < .001). Patients with an SMI also had substantially higher mean (SE) spending on medical services for physical conditions than those with other common mental health disorders or no known mental illness ($17 651 [23.6] vs $15 253 [38.2] vs $12 883 [12.8], respectively; P < .001), reflecting $4768 (95% CI, $4713-$4823; 37% increase) more in costs for patients with an SMI and $2370 (95% CI, $2290-$2449; 18.4% increase) more in costs for patients with other common mental health disorders. Among Medicare beneficiaries, $2 686 016 110 of $64 326 262 104 total Medicare spending (4.2%) went to mental health services and an additional $5 482 791 747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders. In this study, having a mental health disorder was associated with spending substantially more on other medical conditions. These findings quantify the extent of additional spending in the Medicare fee-for-service population associated with a diagnosis of a mental health disorder.

563 High Rate of Discordant Pain Levels Reported by Patients and Physicians During Gastrointestinal Endoscopy

INTRODUCTION: Procedural sedation is given to reduce patient anxiety, discomfort, pain and to improve outcomes in endoscopy. Data are limited regarding patient satisfaction with endoscopy. Our goal was to evaluate physician perceptions of patient pain and anxiety before and after endoscopy and factors associated with their correlation. METHODS: We performed a prospective study of 233 consecutive patients who received procedural sedation during endoscopy from August to November 2018 at the Portland VA Medical Center. Patients were given a pre-endoscopy survey to assess expectations and a post-endoscopy survey to assess procedural satisfaction, and physician were given a post-endoscopy survey only. Outcomes included expected and actual pain, anxiety, and sedation level during endoscopy and was reported on a scale from 0 to 5. RESULTS: Upper endoscopy, colonoscopy, and bi-directional endoscopy were performed in 30%, 60%, and 10% of cases, with an average procedural time of 19.1 minutes. Midazolam and fentanyl were most commonly used for sedation with an average dose of 4.0 ±0.1 mg and 102.5 ± 2.7 mcg, respectively. A minority of patients reported alcohol, marijuana, non-opiate pain medication, and opiate use (39%, 15%, 19%, and 16%, respectively). Pre-procedural anxiety and expected level of pain significantly improved with patient's post-procedural assessment (Tables 1 and 2). The average difference of anxiety and pain levels pre-endoscopy and post-endoscopy was 0.48 and 0.41, respectively. There was poor concordance between the physician's perceived patient pain and patient reported pain level during endoscopy (61%) with an overall Cohen's kappa of 0.258. Several factors associated with reduced patient and physician pain correlation included the presence of mental health disorders and use of benzodiazepines, SSRI, or SNRI (Table 3). Despite the discordance, the majority of patients reported satisfaction in pain control and would return for a repeat procedure (85% and 95%, respectively). CONCLUSION: Patients reported higher levels of pre-procedure anxiety and expected pain than actual anxiety and pain post-procedure. Physicians have poor concordance with patients with respect to pain levels, especially with more severe pain scores and in the presence of mental health disorders. Patients at high risk for discordance may benefit from more thorough pre-procedural counseling and a lower threshold for escalating doses of sedation during endoscopy.