Robert J. Gregory1. 1. Department of Psychiatry, SUNY Upstate Medical University, Syracuse, N.Y.
Abstract
BACKGROUND: Medical diagnoses can be separated on the basis of whether or not they are associated with significant 1-year mortality risk, i.e., "threatening" versus "nonthreatening," by employing the Charlson Comorbidity Index (CCI). The author examined the psychosocial characteristics and medical utilization patterns of patients assigned multiple nonthreatening medical diagnoses. METHOD: The study population included 125 general medical outpatients seen in psychiatric consultation. The author employed blinded reviews of medical charts, psychological measures, and billing records to assess patients' psychosocial characteristics and medical utilization. RESULTS: The number of nonthreatening diagnoses correlated significantly with age (r = 0.35, p </=.001), diagnosis of somatoform disorder (r = 0.29, p </=.001), somatosensory amplification (r = 0.36, p </=.001), number of ambulatory medical visits (r = 0.24, p </=.01), and emergency room visits (r = 0.18, p </=.05), but did not correlate with CCI scores or medical hospitalization. By contrast, the number of threatening diagnoses, as measured by the CCI, did not correlate with a diagnosis of somatoform disorder or somatic amplification, but did correlate with age and all measures of medical utilization, including hospitalization (r = 0.19, p </=.05). CONCLUSION: Patients with multiple nonthreatening medical diagnoses have different psychosocial characteristics and medical utilization patterns than patients with multiple threatening diagnoses. The association between the number of nonthreatening medical diagnoses assigned to a given patient and measures of somatization suggests that psychosocial factors contribute to diagnostic assignment in patients with multiple nonthreatening medical diagnoses.
BACKGROUND: Medical diagnoses can be separated on the basis of whether or not they are associated with significant 1-year mortality risk, i.e., "threatening" versus "nonthreatening," by employing the Charlson Comorbidity Index (CCI). The author examined the psychosocial characteristics and medical utilization patterns of patients assigned multiple nonthreatening medical diagnoses. METHOD: The study population included 125 general medical outpatients seen in psychiatric consultation. The author employed blinded reviews of medical charts, psychological measures, and billing records to assess patients' psychosocial characteristics and medical utilization. RESULTS: The number of nonthreatening diagnoses correlated significantly with age (r = 0.35, p </=.001), diagnosis of somatoform disorder (r = 0.29, p </=.001), somatosensory amplification (r = 0.36, p </=.001), number of ambulatory medical visits (r = 0.24, p </=.01), and emergency room visits (r = 0.18, p </=.05), but did not correlate with CCI scores or medical hospitalization. By contrast, the number of threatening diagnoses, as measured by the CCI, did not correlate with a diagnosis of somatoform disorder or somatic amplification, but did correlate with age and all measures of medical utilization, including hospitalization (r = 0.19, p </=.05). CONCLUSION:Patients with multiple nonthreatening medical diagnoses have different psychosocial characteristics and medical utilization patterns than patients with multiple threatening diagnoses. The association between the number of nonthreatening medical diagnoses assigned to a given patient and measures of somatization suggests that psychosocial factors contribute to diagnostic assignment in patients with multiple nonthreatening medical diagnoses.