title: Mental health conditions are associated with increased health care utilization among urban family medicine patients.
abstract: OBJECTIVE
  To assess the relationship between the presence of a mental health condition and health care utilization among family medicine patients.
  
  
  METHODS
  We used the Patient Health Questionnaire plus a posttraumatic stress disorder screen to measure 6 common mental health conditions. In a sample of 367 patients recruited from 3 urban family medicine practices affiliated with Boston University Medical Center, we measured self-reported health care utilization of primary care provider visits, emergency department visits, nonpsychiatric hospitalizations, and outpatient mental health visits. We determined the association between screening positive for the mental health conditions and health care utilization using both multivariable logistic regression and Poisson regression methods while controlling for sex, age, race, income, insurance status, marital status, educational level, and the presence of chronic medical conditions.
  
  
  RESULTS
  After controlling for potential confounders, generalized anxiety disorder, panic disorder, and posttraumatic stress disorder were statistically significantly associated with more PCP visits, ED visits, and nonpsychiatric hospitalizations. Neither major nor minor depression were associated with more PCP visits, ED visits, or nonpsychiatric hospitalizations, except that minor depression was associated with 103% increase in PCP visits (P < .001). Alcohol use disorder was associated with 16% fewer PCP visits (P = .01) but 238% more nonpsychiatric hospitalizations (P < .001).
  
  
  CONCLUSIONS
  After controlling for confounders we found that mental health conditions among a sample of family medicine patients were associated with increased use of ED services, nonpsychiatric hospitalizations, and, to a lesser extent, PCP visits.
authors.affiliation: Department of Family Medicine, University of Rochester, Highland Family Medicine, 777 South Clinton Avenue, Rochester, NY 14620, USA. colleen_fogarty@urmc.rochester.edu
authors.forename: Colleen T
authors.initials: CT
authors.lastname: Fogarty
authors.forename: Sapna
authors.initials: S
authors.lastname: Sharma
authors.forename: Veerappa K
authors.initials: VK
authors.lastname: Chetty
authors.forename: Larry
authors.initials: L
authors.lastname: Culpepper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008603:Mental Health; D008875:Middle Aged; D009819:Office Visits / Q000639:trends*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult