Medical comorbid diagnoses among adult psychiatric inpatients

Abstract

Objective: Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings.

Methods: Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses.

Results: 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals.

Conclusions: A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.

Keywords: Inpatient psychiatric care; Medical comorbidity.

Figure 1.. Distribution of Elixhauser Comorbidity Index (ECI) score by age group among Medicaid beneficiaries with mental disorders admitted to inpatient psychiatry.²

² Source: New York State Medicaid claims records and clinician data for patients ages 18–64 admitted to an inpatient psychiatric unit during 2012–2013 with a principal diagnosis of any mental disorder; Elixhauser Comorbidity Index (ECI) scores based on clinical diagnoses during the 12 months prior to each unique individual’s initial inpatient admission.