Comorbidity of Medical Illnesses Among Adults With Serious Mental Illness Who Are Receiving Community Psychiatric Services

Sokal, Joseph; Messias, Erick; Dickerson, Faith; Kreyenbuhl, Julie; Brown, Clayton H.; Goldberg, Richard W.; Dixon, Lisa B.

doi:10.1097/01.nmd.0000130135.78017.96

Cited by 287 publications

(228 citation statements)

References 14 publications

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“…2,5 Much of the disability in patients with mental disorders is attributed to co-occurring general medical conditions. 6 Many of these conditions, notably diabetes (28%), hypertension (30%), and hyperlipidemia (23%), occur more frequently in patients with mental disorders than non-psychiatric patients 7 and are the leading risk factors for cardiovascular disease [CVD] 8 . CVD is the most common condition associated with premature death in patients with mental disorders.…”

Section: Introductionmentioning

confidence: 99%

Quality of Care for Cardiovascular Disease-related Conditions in Patients with and without Mental Disorders

et al. 2008

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OBJECTIVE:We compared the quality of care for cardiovascular disease (CVD)-related risk factors for patients diagnosed with and without mental disorders. METHODS:We identified all patients included in the fiscal year 2005 (FY05) VA External Peer Review Program's (EPRP) national random sample of chart reviews for assessing quality of care for CVD-related conditions. Using the VA's National Psychosis Registry and the National Registry for Depression, we assessed whether patients had received diagnoses of serious mental illness (schizophrenia, bipolar disorder, or other psychoses) or depression during FY05. Using multivariable logistic regression and generalized estimating equation analyses, we assessed patient and facility factors associated with receipt of guideline concordant care for hypertension (total N=24,016), hyperlipidemia (N=46,430), and diabetes (N=10,943).RESULTS: Overall, 70% had good blood pressure control, 90% received a cholesterol (hyperlipidemia) screen, 77% received a retinal exam for diabetes, and 63% received recommended renal tests for diabetes. After adjustment, compared to patients without SMI or depression, patients with SMI were less likely to be assessed for CVD risk factors, notably hyperlipidemia (OR=0.58; p< 0.001), and less likely to receive recommended follow-up assessments for diabetes: foot exam (OR=0.68; p<0.001), retinal exam (OR=0.65; p<0.001), or renal testing (OR= 0.64; p<0.001). Patients with depression were also significantly less likely to receive adequate quality of care compared to non-psychiatric patients, although effects were smaller than those observed for patients with SMI.CONCLUSIONS: Quality of care for major chronic conditions associated with premature CVD-related mortality is suboptimal for VA patients with SMI, especially for procedures requiring care by a specialist.KEY WORDS: quality of care; cardiovascular disease; mental disorders.

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Section: Introductionmentioning

confidence: 99%

Quality of Care for Cardiovascular Disease-related Conditions in Patients with and without Mental Disorders

et al. 2008

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“…[1][2][3] There is evidence that even if individuals with serious mental illness have a regular source of primary care, they may not access services because of a lack of coordination between mental and medical health care. 4,5 Primary care is of value to patients with behavioral disorders.…”

Section: Introductionmentioning

confidence: 99%

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Griswold¹,

Zayas²,

Pastore³

et al. 2008

The Annals of Family Medicine

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PURPOSE Patients with serious psychiatric problems experience diffi culty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients' experiences with health care after a psychiatric crisis.METHODS A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group. Brief, semistructured interviews about health care encounters were conducted at baseline and 1 year later. Five raters, using the content-driven, immersion-crystallization approach, analyzed 112 baseline and year-end interviews from 28 participants in each group. The main outcomes were patients' responses about their care experiences, connections with primary care, and integration of medical and mental health care. Scores for physical function and mental function were compared by analysis of variance (ANOVA). RESULTSAt baseline, most participants described negative experiences in receiving care and emphasized the importance of listening, sensitivity, and respect. Fully 71% of patients in the intervention group said that having a care manager to assist them with primary care connections was benefi cial. Patients in the intervention group had signifi cantly better physical and mental function than their counterparts in the control group at 6 months (P = .03 for each) but not at 12 months. There was also a trend toward functional improvement over the course of the study in the intervention group.CONCLUSIONS This analysis suggests that care management is effective in helping patients access primary care after a psychiatric crisis. It provides evidence on and insight into how care may be delivered more effectively for this population. Future work should assess the sustainability of care connections and longer-term patient health outcomes. Ann Fam Med 2008;6:38-43. DOI: 10.1370/afm.760. INTRODUCTIONP atients with serious mental illness have medical comorbidity and may not receive adequate primary care; they have impaired physical and emotional health and use the emergency department rather than the primary care setting. [1][2][3] There is evidence that even if individuals with serious mental illness have a regular source of primary care, they may not access services because of a lack of coordination between mental and medical health care. 4,5 Primary care is of value to patients with behavioral disorders. In one study, patients with psychiatric disorders viewed primary care as the cornerstone for both their physical and mental health care; they emphasized continuity of care and listening skills as critical components. 6 Getting connected to the physician, however, may pose a problem for patients with serious mental illness who are emerging from psychiatric crisis. Responsiveness of the treatment system and collaboration between mental health and primary care systems can enhance communication between medical and mental health care professionals and positively affect PR IM A RY ...

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“…Similarly, Jones et al analyzed Medicaid claims data for 147 individuals with severe mental illness and found that 74 percent had one diagnosis of chronic health problems, while 50 percent had two or more diagnoses [8]. Sokal et al studied 200 psychiatric outpatients with schizophrenia and affective disorders and found that they had significantly elevated odds of diabetes, lung diseases, and liver problems compared with matched subsets of individuals from the general population [9]. All of these medical conditions may be related to impaired physical and social role functioning and lowered rates of labor force participation.…”

Section: Introductionmentioning

confidence: 99%

Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness

Cook

Razzano

Burke-Miller

et al. 2007

JRRD

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Abstract-Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariate regression analysis examined work outcomes including earnings, hours worked, and competitive employment, as well as whether psychiatric disability was disclosed to coworkers and supervisors. Individuals with any comorbidity had lower earnings and were less likely to work competitively. Those with physical comorbidities had lower earnings, worked fewer hours, and were less likely to work competitively. Disclosure was more likely among those with both cognitive and physical comorbidities, as well as those with learning disabilities. Competitive employment was less likely among those with intellectual disability, visual impairment, and human immunodeficiency virus/acquired immunodeficiency syndrome. The experimental condition was positively related to all outcomes except disclosure. The results suggest that, with some exceptions, comorbidities affect employment outcomes, requiring tailored services and supports to promote vocational success.

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Comorbidity of Medical Illnesses Among Adults With Serious Mental Illness Who Are Receiving Community Psychiatric Services

Cited by 287 publications

References 14 publications

Quality of Care for Cardiovascular Disease-related Conditions in Patients with and without Mental Disorders

Quality of Care for Cardiovascular Disease-related Conditions in Patients with and without Mental Disorders

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness

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