Sarah T Stahl1, Charles F Reynolds1, Ellen M Whyte1, Steven M Albert2. 1. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 2. Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
OBJECTIVES: To compare the prevalence of psychiatric diagnoses among older recipients of publicly funded mental health services (county safety-net base services and Medicaid) to psychiatric diagnoses in an insured population of older adults from the same county. DESIGN: Secondary analysis of county human services claims data and claims from an insured population in the same county. SETTING: Inpatient and outpatient clinics in Allegheny County, PA. PARTICIPANTS: Adults aged 65 and older in the county who received treatment for a psychiatric diagnosis in 2012 (county base services, n = 1,457; Medicaid, n = 641; Health plan insurance, n = 5,595). MEASUREMENTS: Psychiatric diagnoses were classified using the International Classification of Diseases, 9th revision (ICD-9). RESULTS: Episodic mood disorders and schizophrenia were more common among county-funded and Medicaid recipients (50-54% vs 34%). Neurotic conditions were more common among older adults with health plan insurance (18% vs 8%). Nearly a quarter of older adults receiving county base services were classified as having "ill-defined and unknown causes of morbidity and mortality," compared <1% among insured and 6% among Medicaid recipients. CONCLUSIONS: The prevalence of psychiatric conditions among older adults varies by insurance coverage, suggesting a role for social and economic factors associated with safety net coverage as well as system-level differences in delivery of mental health services. Comparing the prevalence of psychiatric diagnoses across insurance types offers insight on social determinants of risk for mental disorders in late life.
OBJECTIVES: To compare the prevalence of psychiatric diagnoses among older recipients of publicly funded mental health services (county safety-net base services and Medicaid) to psychiatric diagnoses in an insured population of older adults from the same county. DESIGN: Secondary analysis of county human services claims data and claims from an insured population in the same county. SETTING: Inpatient and outpatient clinics in Allegheny County, PA. PARTICIPANTS: Adults aged 65 and older in the county who received treatment for a psychiatric diagnosis in 2012 (county base services, n = 1,457; Medicaid, n = 641; Health plan insurance, n = 5,595). MEASUREMENTS: Psychiatric diagnoses were classified using the International Classification of Diseases, 9th revision (ICD-9). RESULTS:Episodic mood disorders and schizophrenia were more common among county-funded and Medicaid recipients (50-54% vs 34%). Neurotic conditions were more common among older adults with health plan insurance (18% vs 8%). Nearly a quarter of older adults receiving county base services were classified as having "ill-defined and unknown causes of morbidity and mortality," compared <1% among insured and 6% among Medicaid recipients. CONCLUSIONS: The prevalence of psychiatric conditions among older adults varies by insurance coverage, suggesting a role for social and economic factors associated with safety net coverage as well as system-level differences in delivery of mental health services. Comparing the prevalence of psychiatric diagnoses across insurance types offers insight on social determinants of risk for mental disorders in late life.