Prevalence Of Mental Health Diagnoses Research Articles

Mental health disorders and the risk of AIDS-defining illness and death in HIV-infected veterans

Mental health comorbidities are common in HIV-infected veterans and can impact clinical outcomes for HIV. We examined the impact of mental health diagnoses on progression to AIDS-defining illness (ADI) and death in a large cohort of HIV-infected veterans who accessed care between 2001 and 2006. Retrospective cohort study using the national Veterans Health Administration (VHA) HIV Clinical Case Registry. We identified HIV-infected veterans initiating combination antiretroviral therapy (cART) within the VHA between 2000 and 2006. The prevalences of the following mental health diagnoses were examined: schizophrenia, bipolar disorder, depression, anxiety, and substance use disorder. Cox proportional hazards models were constructed to examine the relationship between mental health conditions and two outcomes, all-cause mortality and ADI. Models were computed before and after adjusting for confounding factors including age, race, baseline CD4 cell count, comorbidities and cART adherence. Among 9003 veterans receiving cART, 31% had no mental health diagnosis. Age, race, baseline comorbidity score, CD4, and cART adherence were associated with shorter time to ADI or death. All-cause mortality was more likely among veterans with schizophrenia, bipolar disorder and substance use, and ADI was more likely to occur among veterans with substance use disorder. Our results demonstrate the high prevalence of mental health diagnoses among HIV-infected veterans. In the era of highly active antiretroviral therapy, presence of psychiatric diagnoses impacted survival and development of ADI. More aggressive measures addressing substance abuse and severe mental illness in HIV-infected veterans are necessary.

Quality assurance of sphincterotomy: A prospective single-centre survey

In Ontario, Canada, the patient-centred medical home is a model of primary care delivery that includes 3 model types of interest for this study: enhanced fee-for-service, blended capitation, and team-based blended capitation. All 3 models involve rostering of patients and have similar practice requirements but differ in method of physician reimbursement, with the blended capitation models incorporating adjustments for age and sex, but not case mix, of rostered patients. We evaluated the extent to which persons with mental illness were included in physicians' total practices (as rostered and non-rostered patients) and were included on physicians' rosters across types of medical homes in Ontario. Using population-based administrative data, we considered 3 groups of patients: those with psychotic or bipolar diagnoses, those with other mental health diagnoses, and those with no mental health diagnoses. We modelled the prevalence of mental health diagnoses and the proportion of patients with such diagnoses who were rostered across the 3 medical home model types, controlling for demographic characteristics and case mix. Compared with enhanced fee-for-service practices, and relative to patients without mental illness, the proportions of patients with psychosis or bipolar disorders were not different in blended capitation and team-based blended capitation practices (rate ratio [RR] 0.91, 95% confidence interval [CI] 0.82-1.01; RR 1.06, 95% CI 0.96-1.17, respectively). However, there were fewer patients with other mental illnesses (RR 0.94, 95% CI 0.90-0.99; RR 0.89, 95% CI 0.85-0.94, respectively). Compared with expected proportions, practices based on both capitation models were significantly less likely than enhanced fee-for-service practices to roster patients with psychosis or bipolar disorders (for blended capitation, RR 0.92, 95% CI 0.90-0.93; for team-based capitation, RR 0.92, 95% CI 0.88-0.93) and also patients with other mental illnesses (for blended capitation, RR 0.94, 95% CI 0.92-0.95; for team-based capitation, RR 0.93, 95% CI 0.92-0.94). Persons with mental illness were under-represented in the rosters of Ontario's capitation-based medical homes. These findings suggest a need to direct attention to the incentive structure for including patients with mental illness.

Healthy Patients Who Perceive Poor Health: Why Are They Worried Sick?

To explore characteristics of patients who are physically healthy but who perceive poor health by investigating the hypothesis that mental health problems, financial strain, and deficiencies in social support underlie why these patients are "worried sick." Three hundred forty-eight continuity patients in 2 rural primary care practices were administered the PRIME-MD, the MOS SF-36, a health-related worry (1-item, 5-point) scale, the MOS social support survey, and perceived economic strain instruments. The patient's physician rated physical health on a 10-point scale. Health care utilization was defined as the number of office visits and total office and laboratory charges for 6 months before and after the interview date. Two hundred thirty-seven patients (group A) scored in the upper and middle terciles on the MOS health perceptions scale. One hundred eleven patients scored in the lower tercile on health perceptions: 59 (group B) were rated as having good physical health (physical health rating > 6) and 52 (group C) as having poor health (rating < or = 6). The "worried sick" patients (group B) resembled Group A with regard to physical health, but resembled the sick (group C) with regard to all MOS functional scales, prevalence of mental health diagnoses, and worry. Social support was similar across groups. Only 1 of 3 measures of economic strain was less in group A than B and C. Our measures of mental health problems, financial strain, and deficiencies in social support accounted only in part for the differences among the three groups. Other explanations of why some are "worried sick" require study, such as other life stressors and personality traits.

Healthy Patients Who Perceive Poor Health: Why Are They Worried Sick?

ABSTRACT Objective To explore characteristics of patients who are physically healthy but who perceive poor health by investigating the hypothesis that mental health problems, financial strain, and deficiencies in social support underlie why these patients are worried sick. Methods Three hundred forty-eight continuity patients in 2 rural primary care practices were administered the PRIME-MD, the MOS SF-36, a health-related worry (1-item, 5-point) scale, the MOS social support survey, and perceived economic strain instruments. The patient's physician rated physical health on a 10-point scale. Health care utilization was defined as the number of office visits and total office and laboratory charges for 6 months before and after the interview date. Results Two hundred thirty-seven patients (group A) scored in the upper and middle terciles on the MOS health perceptions scale. One hundred eleven patients scored in the lower tercile on health perceptions: 59 (group B) were rated as having good physical health (physical health rating > 6) and 52 (group C) as having poor health (rating ≤ 6). The worried patients (group B) resembled Group A with regard to physical health, but resembled the sick (group C) with regard to all MOS functional scales, prevalence of mental health diagnoses, and worry. Social support was similar across groups. Only 1 of 3 measures of economic strain was less in group A than Band C. Conclusions Our measures of mental health problems, financial strain, and deficiencies in social support accounted only in part for the differences among the three groups. Other explanations of why some are worried require study, such as other life stressors and personality traits.