Patterns of mental health service utilization in a general hospital and outpatient mental health facilities: analysis of 365,262 psychiatric consultations.
OBJECTIVE
Mental health is one of the priorities of the European Commission. Studies of the use and cost of mental health facilities are needed in order to improve the planning and efficiey of mental health resources. We analyze the patterns of mental health service use in multiple clinical settings to identify factors associated with high cost.


METHODS
22,859 patients received psychiatric care in the catchment area of a Spanish hospital (2000-2004). They had 365,262 psychiatric consultations in multiple settings. Two groups were selected that generated 80% of total costs: the medium cost group (N = 4,212; 50% of costs), and the high cost group (N = 236; 30% of costs). Statistical analyses were performed using univariate and multivariate techniques. Significant variables in univariate analyses were introduced as independent variables in a logistic regression analysis using "high cost" (>7,263$) as dependent variable.


RESULTS
Costs were not evenly distributed throughout the sample. 19.4% of patients generated 80% of costs. The variables associated with high cost were: age group 1 (0-14 years) at the first evaluation, permanent disability, and ICD-10 diagnoses: Organic, including symptomatic, mental disorders; Mental and behavioural disorders due to psychoactive substance use; Schizophrenia, schizotypal and delusional disorders; Behavioural syndromes associated with physiological disturbances and physical factors; External causes of morbidity and mortality; and Factors influencing health status and contact with health services.


CONCLUSIONS
Mental healthcare costs were not evenly distributed throughout the patient population. The highest costs are associated with early onset of the mental disorder, permanent disability, organic mental disorders, substance-related disorders, psychotic disorders, and external factors that influence the health status and contact with health services or cause morbidity and mortality.


CONCLUSIONS
Variables related to psychiatric diagnoses and sociodemographic factors have influence on the cost of mental healthcare.
Baca-Garcia
Enrique
E
Department of Neurosciences, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032, USA. ebacgar2@yahoo.es
Perez-Rodriguez
Maria M
MM
Basurte-Villamor
Ignacio
I
Quintero-Gutierrez
F Javier
FJ
Sevilla-Vicente
Juncal
J
Martinez-Vigo
Maria
M
Artes-Rodriguez
Antonio
A
Fernandez del Moral
Antonio L
AL
Jimenez-Arriero
Miguel A
MA
Gonzalez de Rivera
Jose L
JL
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011570:Psychiatry / Q000191:economics / Q000706:statistics & numerical data*; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D014600:Utilization Review / Q000706:statistics & numerical data