Spiro A, Hankin CS, Lee A, Kazis L; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Avron Spiro III, Ph.D., Research Scientist, Center for Health Quality, Outcomes, and Economic Research (CHQOER), Building 70 VAMC, 200 Springs Road, Bedford MA 01730. Tel: 781 687 2945; Fax: 781 687 2150. Email: aspiro3@bu.edu
Research Objective: The recent report of the US Surgeon General on Mental Health highlights the growing recognition of the contribution of mental disorders to the disease burden of society, in terms of economic costs, public health, and individual suffering. The Veterans Health Administration (VHA) of the US Department of Veterans Affairs operates the largest integrated health care system in the nation, and is relatively unique compared to other systems in providing eligible patients with unencumbered access to mental health services. The VHA serves approximately 3.5 million veterans annually. Compared to the general US population, VHA enrollees are generally older, less well-educated, less insured, and have more disease, worse health status, and more negative health behaviors. The VHA provides mental health services to about 550,000 patients who account for 25% of outpatient visits and 20% of inpatient episodes. However, little is known about the prevalence of mental disorders among this population; the purpose of the present study was to obtain such information.Study Design: From 3.5 million VHA enrollees, we randomly sampled 1.5 million who were mailed a brief questionnaire including the Veterans SF-36 health status measure, as well as items assessing demographics, health behaviors, and health conditions. In addition, we extracted all ICD-9 diagnoses on these patients from VA administrative data files for the past 3 years. We examined the prevalence (based on ICD-9 codes) of 5 selected mental conditions (depression, anxiety, alcohol, PTSD, schizophrenia) for the sample as a whole, as well as stratified by geographic region (the 22 Veterans Integrated Service Networks, VISNs). We also compared the prevalence of mental disorders in our sample to those in the Epidemiological Catchment Area (ECA) study and the National Comorbidity Study (NCS).Population Studied: The 1.5 million represent a random sample of all VHA enrollees as of October 1, 1999. Principal Findings: The prevalence of mental disorder was substantial: 14.1% of the sample had been diagnosed with depression; 8.8% with anxiety, 7.1% with PTSD, 8.5% with alcohol disorders; and 4.7% with schizophrenia. The prevalence of diagnosed disorder varied by a factor of at least 2 among the 22 VISNs (e.g., the prevalence of PTSD ranged from 4.2% to 10.6%. The prevalence of mental disorders was higher among VHA enrollees than in the ECA or NCS for depression, PTSD, and schizophrenia; and comparable for anxiety and alcohol disorders.Conclusions: Mental disorders are prevalent among VHA enrollees, although the prevalence varies markedly among VISNs. It remains to be determined whether this variation represents differences among VISNs in casemix (including selection factors) or in outcomes of care..Implications for Policy, Delivery, or Practice: The prevalence of mental disorders is substantial. Further study is required to understand the implications of regional variations for service delivery and resource allocation in the VHA.Primary Funding Source: Office of Performance and Quality (10Q) and Health Services Research and Development (HSR&D) Service, Veterans Health Administration, Department of Veterans Affairs
Publication Types:
Keywords:
- Comorbidity
- Delivery of Health Care, Integrated
- Depressive Disorder
- Health Status
- Health Surveys
- Hospitals, Veterans
- Humans
- Mental Disorders
- Mental Health Services
- Prevalence
- Questionnaires
- Stress Disorders, Post-Traumatic
- United States Department of Veterans Affairs
- Veterans
- organization & administration
- hsrmtgs
Other ID:
UI: 102272162
From Meeting Abstracts