title: Prevalence of behavioral health disorders and associated chronic disease burden in a commercially insured health system: findings of a case-control study.
abstract: OBJECTIVE
  The objective was to examine prevalence of behavioral health disorders (BHDs) and co-occurring chronic medical conditions in a 3.4 million-member integrated health system.
  
  
  METHODS
  Clinical databases identified 255,993 patients diagnosed with the most prevalent BHDs (cases): depression, anxiety, substance use, bipolar spectrum and attention deficit and hyperactivity (ADHD); non-BHD matched controls were created for all unique cases. Cases and controls were compared for prevalence of general medical conditions and specific chronic diseases and the Charlson Comorbidity Index (CMI).
  
  
  RESULTS
  The five most common BHDs were depression (58%), anxiety (42%), substance use (16%), bipolar spectrum (6%) and ADHD (4%). Compared to controls, patients with depression (80.1% vs. 66.3%), anxiety (78.0% vs. 63.0%), substance use (74.0% vs. 59.9%), bipolar (75.3% vs. 60.7%) and ADHD (60.6% vs. 53.1%; all P<.001) had significantly higher prevalence of any medical comorbidities. Excluding ADHD, BHD cases had higher prevalence of selected chronic diseases and average CMI.
  
  
  CONCLUSIONS
  BHDs in a largely commercially insured, employment-based health system are common and associated with a disproportionately higher burden of chronic medical disease and associated 10-year mortality risk rate. Given that co-occurrence of behavioral and medical conditions leads to elevated symptom burden, functional impairment, and healthcare costs, these findings highlight the importance of developing effective collaborative models of care in (nonpublic) employment-based health systems.
authors.affiliation: Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, 75-59 263rd Street, Glen Oaks, NY 11004, USA. Electronic address: JYoung9@NSHS.edu.
authors.forename: John Q
authors.initials: JQ
authors.lastname: Young
authors.affiliation: Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA.
authors.forename: Andrea H
authors.initials: AH
authors.lastname: Kline-Simon
authors.affiliation: The Permanente Medical Group, Kaiser Permanente Northern California, 5755 Cottle Road, San Jose, CA 95123, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Mordecai
authors.affiliation: Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA; Department of Psychiatry, University of California, 401 Parnassus Avenue, Box 0984, San Francisco CA 94143, USA.
authors.forename: Constance
authors.initials: C
authors.lastname: Weisner
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D017281:Cost of Illness; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D015995:Prevalence
keywords: Behavioral/mental health disorders; Chronic conditions; Co-occurring conditions; Epidemiology; Health system