title: Out-of-pocket expenditure burdens in patients with cardiovascular conditions and psychological distress: a nationwide cross-sectional study.
abstract: OBJECTIVE
  This study aimed to estimate the prevalence of psychological distress in individuals with and without cardiovascular risks and events [cardiovascular disease (CVD) conditions] and the incremental effects of psychological distress on the out-of-pocket health care expenditure burdens.
  
  
  METHODS
  We used data from the Comprehensive Survey of Living Conditions 2007, a nationally representative cross-sectional survey in Japan. Psychological distress assessed by the K6 scale, the presence of treated CVD conditions and out-of-pocket health care expenditures as a share of household consumption expenditures were self-reported by 20,763 individuals living alone and aged between 20 and 59 years.
  
  
  RESULTS
  Individuals with obesity [adjusted odds ratio (AOR), 4.3], stroke (AOR, 3.2), ischemic heart disease (AOR, 2.3), hyperlipidemia (AOR, 1.8) or diabetes (AOR, 1.7) were more likely than those without to have serious psychological distress (SPD). With the exception of ischemic heart disease, less than half of CVD patients comorbid with SPD received treatment for mental illness. Patients comorbid with SPD and obesity (AOR, 6.1), SPD and ischemic heart disease (AOR, 3.4), and SPD and hypertension (AOR, 2.6) had higher out-of-pocket burdens than patients with only CVD conditions.
  
  
  CONCLUSIONS
  Our findings suggest the need for physicians to identify and manage SPD in patients with CVD conditions and for policymakers to find solutions to reduce the high out-of-pocket burdens among these patients.
authors: Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan. yokumura@ncnp.go.jp
authors: Yasuyuki
authors: Y
authors: Okumura
authors: Hiroto
authors: H
authors: Ito
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006801:Humans; D006949:Hyperlipidemias / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D007564:Japan / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D009765:Obesity / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D012306:Risk; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult