Elsevier

Value in Health

Volume 6, Issue 1, January–February 2003, Pages 40-50
Value in Health

Functional Status and Somatization as Predictors of Medical Offset in Anxious and Depressed Patients

https://doi.org/10.1046/j.1524-4733.2003.00148.xGet rights and content
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Abstract

Objective

Certain anxious/depressed primary care patients decrease medical utilization after mental health treatment. Previous research has established demo-graphic and medical comorbidities as distinguishing these patients. We asked whether characteristics such as symptom severity, somatization, or health-related quality of life (HRQoL) could also distinguish patients who reduce or increase primary care utilization after mental health care.

Methods

Primary care patients in a mixed-model HMO were screened for untreated anxiety with and without depression, using the Symptom Checklist (SCL-90-R) and medical records abstractions, and also for HRQoL (SF-36). We identified 165 symptomatic patients who subsequently received mental health treatment and then defined two subgroups: 1) offset patients (reduced medical utilization the year after initiation of mental health treatment) (N=97); and 2) no-offset patients (increased utilization) (N =68).

Results

Three HRQoL domains (general health perceptions, physical functioning, and role functioning– physical) predicted increased offset savings in the year after initiation of mental health treatment. Each point of improved functioning in these domains was associated with $4 to $10 of additional offset savings. Somatization-related comorbidities were predictive of greater additional costs ($230).

Conclusion

Using models to predict individual patient costs, we found that HRQoL and somatic comorbidities did not predict by anxiety/depression symptom severity or medical comorbidities, but by increasing or decreasing utilization after mental health care. Patients with higher functioning levels and no somatic comorbidities were most likely to reduce utilization. These findings support growing evidence for the need of inclusion of reliable indicators of somatization and patients' functioning in offset research and inpatient care.

Keywords

depression
anxiety
somatization
health-related quality of life
medical offset
outcomes of mental health care

Cited by (0)

Preliminary, partial data from this study have been presented at the 11th Congress of the European College of Neuropsychopharmacology, Paris, France, October 1998, and at the Annual Meeting of the International Society for Technology Assessment in Health Care, Edinburgh, Scotland, June 1999.

*

Deceased November 1999.