title: Mental health and high-cost health care utilization: new evidence from Axis II disorders.
abstract: OBJECTIVE
  To analyze the associations between Axis II (A2) disorders and two measures of health care utilization with relatively high cost: emergency department (ED) episodes and hospital admissions.
  
  
  METHODS
  Wave I (2001/2002) and Wave II (2004/2005) of the National Longitudinal Survey on Alcohol and Related Conditions (NESARC).
  
  
  METHODS
  A national probability sample of adults. Gender-stratified regression analysis adjusted for a range of covariates associated with health care utilization.
  
  
  METHODS
  The target population of the NESARC is the civilian noninstitutionalized population aged 18 years and older residing in the United States. The cumulative survey response rate is 70.2 percent with a response rate of 81 percent (N=43,093) in Wave I and 86.7 percent (N=34,653) in Wave II.
  
  
  RESULTS
  Both men and women with A2 disorders are at elevated risk for ED episodes and hospital admissions. Associations are robust after adjusting for a rich set of confounding factors, including Axis I (clinical) psychiatric disorders. We find evidence of a dose-response relationship, while antisocial and borderline disorders exhibit the strongest associations with both measures of health care utilization.
  
  
  CONCLUSIONS
  This study provides the first published estimates of the associations between A2 disorders and high-cost health care utilization in a large, nationally representative survey. The findings underscore the potential implications of these disorders on health care expenditures.
authors.affiliation: Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Johanna Catherine
authors.initials: JC
authors.lastname: Maclean
authors.forename: Haiyong
authors.initials: H
authors.lastname: Xu
authors.forename: Michael T
authors.initials: MT
authors.lastname: French
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
mesh_terms: D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology; D008603:Mental Health / Q000191:economics*; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors
keywords: Axis II disorders; ED episodes; health care utilization; hospital admissions; mental health