Functional status and somatization as predictors of medical offset in anxious and depressed patients.
OBJECTIVE
Certain anxious/depressed primary care patients decrease medical utilization after mental health treatment. Previous research has established demo-graphic and medical comorbidities as distinguishing these patients. We asked whether characteristics such as symptom severity, somatization, or health-related quality of life (HRQoL) could also distinguish patients who reduce or increase primary care utilization after mental health care.


METHODS
Primary care patients in a mixed-model HMO were screened for untreated anxiety with and without depression, using the Symptom Checklist (SCL-90-R) and medical records abstractions, and also for HRQoL (SF-36). We identified 165 symptomatic patients who subsequently received mental health treatment and then defined two subgroups: 1) offset patients (reduced medical utilization the year after initiation of mental health treatment) (N=97); and 2) no-offset patients (increased utilization) (N =68).


RESULTS
Three HRQoL domains (general health perceptions, physical functioning, and role functioning- physical) predicted increased offset savings in the year after initiation of mental health treatment. Each point of improved functioning in these domains was associated with 4 dollars to 10 dollars of additional offset savings. Somatization-related comorbidities were predictive of greater additional costs (230 dollars).


CONCLUSIONS
Using models to predict individual patient costs, we found that HRQoL and somatic comorbidities did not predict by anxiety/depression symptom severity or medical comorbidities, but by increasing or decreasing utilization after mental health care. Patients with higher functioning levels and no somatic comorbidities were most likely to reduce utilization. These findings support growing evidence for the need of inclusion of reliable indicators of somatization and patients' functioning in offset research and inpatient care.
Fifer
Sheila K
SK
The Lewin Group, San Francisco, CA, USA. karen.cravotto@quintiles.com
Buesching
Don P
DP
Henke
Curtis J
CJ
Potter
Lori P
LP
Mathias
Susan D
SD
Schonfeld
Warren H
WH
Patrick
Donald L
DL
D000203:Activities of Daily Living; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003120:Colorado / Q000453:epidemiology; D015897:Comorbidity; D017046:Cost Savings; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*