Mental illness, functional impairment, and patient preferences for collaborative care in an uninsured, primary care population.
OBJECTIVE
Our goal was to compare the prevalence of mental illness and its impact on functional status in an indigent uninsured primary care population with a general primary care sample. We also hoped to assess patient preferences about mental health and medical service integration.


METHODS
We compared a survey of consecutive primary care adults in April and May 1999 with a 1997-98 survey of 3000 general population primary care patients. Both studies used the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire and the 20-question Medical Outcomes Study Short Form.


METHODS
The patients were from a private nonprofit primary care clinic in Grand Junction, Colorado, that served only low-income uninsured people. We approached a total of 589 consecutive patients and enrolled 500 of them.


METHODS
The main outcomes were the prevalence of psychiatric illnesses and the relationship with functional impairment. We compared our findings with a more generalizable primary care population.


RESULTS
This low-income uninsured population had a higher prevalence of 1 or more psychiatric disorders (51% vs 28%): mood disorders (33% vs 16%), anxiety disorders (36% vs 11%), probable alcohol abuse (17% vs 7%), and eating disorders (10% vs 7%). Having psychiatric disorders was associated with lower functional status and more disability days compared with not having mental illness. Patients indicated a preference for mental health providers and medical providers to communicate about their care.


CONCLUSIONS
This low-income uninsured primary care population has an extremely high prevalence of mental disorders with impaired function. It may be important in low-income primary care settings to include collaborative care designs to effectively treat common mental disorders, improve functional status, and enhance patient self-care.
Mauksch
L B
LB
Department of Family Medicine, University of Washington School of Medicine, Seattle, USA. mauksch@u.washington.edu
Tucker
S M
SM
Katon
W J
WJ
Russo
J
J
Cameron
J
J
Walker
E
E
Spitzer
R
R
D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D001008:Anxiety Disorders / Q000453:epidemiology; D003120:Colorado; D001068:Feeding and Eating Disorders / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology; D010348:Patient Care Team; D017060:Patient Satisfaction; D015995:Prevalence