title: Psychopathology and emotional distress among older high-utilizing health maintenance organization patients.
abstract: BACKGROUND
  Rates of psychopathology are often underestimated in primary care populations, especially older patient groups. High medical utilization is often a reflection of psychopathology and/or emotional distress. Increased awareness of primary care patients' emotional distress can help to improve well-being and reduce unnecessary high utilization of medical services. This study aimed to assess the degree of psychopathology present in a sample of older health maintenance organization (HMO) patients who utilized higher-than-average amounts of medical services.
  
  
  METHODS
  Patients in a large HMO aged 55 years old and older who exceeded the mean number of inpatient and outpatient visits in the past year were recruited. Sixty-nine patients, mostly female (69%) and white (93%), volunteered. Patients were assessed with the Medical Outcomes Study SF-36 health survey and the Symptom Checklist-90-Revised (SCL-90-R).
  
  
  RESULTS
  Respondents made a mean of 41 visits in the previous year to medical providers, versus 24 visits per year for the average patient of this age in the HMO. Significant elevations on SCL-90-R global psychopathology, obsessive-compulsive, somatization, and depression scales were found. All patients met SCL-90-R criteria for psychiatric caseness. SF-36 health ratings were comparable with those of patients with chronic medical conditions assessed in other SF-36 samples.
  
  
  CONCLUSIONS
  Older high-utilizing HMO patients show significantly more psychopathology and view their health status as poorer than that of other medical subpopulations; results suggest that care for these problems is rarely received.
authors.affiliation: Department of Family and Preventive Medicine, University of Utah Health Sciences Center, Salt Lake City 84132, USA. Lhaas@dfpm.utah.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: Haas
authors.forename: D C
authors.initials: DC
authors.lastname: Spendlove
authors.forename: M P
authors.initials: MP
authors.lastname: Silver
authors.forename: T C
authors.initials: TC
authors.lastname: Holmberg
mesh_terms: D000342:Affective Symptoms / Q000453:epidemiology*; D000368:Aged; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged