title: Patterns of mental health service utilization in a general hospital and outpatient mental health facilities: analysis of 365,262 psychiatric consultations.
abstract: 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.
authors.affiliation: Department of Neurosciences, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032, USA. ebacgar2@yahoo.es
authors.forename: Enrique
authors.initials: E
authors.lastname: Baca-Garcia
authors.forename: Maria M
authors.initials: MM
authors.lastname: Perez-Rodriguez
authors.forename: Ignacio
authors.initials: I
authors.lastname: Basurte-Villamor
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Quintero-Gutierrez
authors.forename: Juncal
authors.initials: J
authors.lastname: Sevilla-Vicente
authors.forename: Maria
authors.initials: M
authors.lastname: Martinez-Vigo
authors.forename: Antonio
authors.initials: A
authors.lastname: Artes-Rodriguez
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Fernandez del Moral
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Jimenez-Arriero
authors.forename: Jose L
authors.initials: JL
authors.lastname: Gonzalez de Rivera
mesh_terms: 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