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Open Access Publications from the University of California

Mental health and high-cost health care utilization: new evidence from Axis II disorders.

  • Author(s): Maclean, Johanna Catherine
  • Xu, Haiyong
  • French, Michael T
  • Ettner, Susan L
  • et al.

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. DATA SOURCE/STUDY SETTING:Wave I (2001/2002) and Wave II (2004/2005) of the National Longitudinal Survey on Alcohol and Related Conditions (NESARC). STUDY DESIGN:A national probability sample of adults. Gender-stratified regression analysis adjusted for a range of covariates associated with health care utilization. DATA COLLECTION: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. PRINCIPAL FINDINGS: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.

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