David T Moore1, Robert A Rosenheck2. 1. Department of Psychiatry, Yale University, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT. Electronic address: david.moore@yale.edu. 2. Department of Psychiatry, Yale University, New Haven, CT; Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT; Yale University School of Public Health, New Haven, CT.
Abstract
BACKGROUND: Mental illness is associated with an increased risk for medical hospitalizations. OBJECTIVE: This study investigates the degree to which nonpsychiatric factors account for these hospitalizations. METHODS: Using National Veterans Health Administration (VHA) fiscal year 2012 data for 2 million veterans under the age of 60 years, hospitalization risks were compared for veterans with and without mental illnesses. Bivariate analyses identified factors associated with mental illnesses. Multiple logistic regression was used to calculate adjusted psychiatric risk for medical hospitalization, controlling for these factors. RESULTS: Veterans carrying mental health diagnoses were at increased risk for hospitalizations (odds ratio [OR] = 2.52, 2.48-2.55). Among individual diagnoses, alcohol use disorder (AUD) (OR = 3.84, 3.78-3.91) and drug use disorders (OR = 4.58, 4.50-4.66) were associated with the highest risk. After adjusting for nonpsychiatric medical, addiction-related, and care utilization factors and the use of outpatient medical services, veterans with mental illnesses were at increased risk for medical hospitalization (OR = 1.43, 1.41-1.45). After further adjustment for AUD and drug use, hospitalization risk decreased further (OR = 1.23, 1.21-1.26) while the association of AUD and hospitalizations remained high (OR = 1.77, 1.73-1.81). CONCLUSIONS: Medical comorbidities and service use accounted for most, but not all, of the increased risk of medical hospitalizations associated with mental illness. Even after accounting for poor health, AUD remained strongly associated with medical hospitalization. Published by Elsevier Inc.
BACKGROUND:Mental illness is associated with an increased risk for medical hospitalizations. OBJECTIVE: This study investigates the degree to which nonpsychiatric factors account for these hospitalizations. METHODS: Using National Veterans Health Administration (VHA) fiscal year 2012 data for 2 million veterans under the age of 60 years, hospitalization risks were compared for veterans with and without mental illnesses. Bivariate analyses identified factors associated with mental illnesses. Multiple logistic regression was used to calculate adjusted psychiatric risk for medical hospitalization, controlling for these factors. RESULTS: Veterans carrying mental health diagnoses were at increased risk for hospitalizations (odds ratio [OR] = 2.52, 2.48-2.55). Among individual diagnoses, alcohol use disorder (AUD) (OR = 3.84, 3.78-3.91) and drug use disorders (OR = 4.58, 4.50-4.66) were associated with the highest risk. After adjusting for nonpsychiatric medical, addiction-related, and care utilization factors and the use of outpatient medical services, veterans with mental illnesses were at increased risk for medical hospitalization (OR = 1.43, 1.41-1.45). After further adjustment for AUD and drug use, hospitalization risk decreased further (OR = 1.23, 1.21-1.26) while the association of AUD and hospitalizations remained high (OR = 1.77, 1.73-1.81). CONCLUSIONS: Medical comorbidities and service use accounted for most, but not all, of the increased risk of medical hospitalizations associated with mental illness. Even after accounting for poor health, AUD remained strongly associated with medical hospitalization. Published by Elsevier Inc.
Entities:
Keywords:
alcohol addiction; alcohol/drug abuse; comorbidity; health care services; internal medicine; substance use