Psychological Distress in Adults With Myocardial Infarction: Implications for Health Care Utilization and Expenditure

Abstract

Background: Myocardial infarction (MI) poses a major financial burden on the U.S. health care system, but its impact on medical expenses and health care utilization when coupled with psychological distress remains unknown.

Objectives: The study aims to investigate the association between psychological distress and healthcare utilization and medical expenditures in adults with a history of MI.

Methods: We analyzed the 2017-2021 Medical Expenditure Panel Survey to identify 44,716 adults with a history of MI. Psychological distress was measured using the Kessler (K6) questionnaire, with a score of ≥13 indicating clinically significant distress. Differences in medical expenditures and health care utilization between patients with MI with and without psychological distress were assessed using weighted generalized linear and negative binomial regression models. Expenditures, medical visits, and prescribed medications are reported as means and 95% CI.

Results: Among 9,773,458 weighted adults, 970,049 experienced psychological distress. Adults with MI and psychological distress were younger, more likely to be female (51.1% vs 37.5%; P < 0.001), less educated (11.1 vs 12.5 years; P < 0.001), lower income, and were more likely to have public insurance, compared to those without psychological distress. Adults with psychological distress and a history of MI had higher average medical expenses ($31,577 vs $15,830; P < 0.001) and greater health care utilization including office visits (8.3 vs 5.7; P = 0.01), inpatient visits (0.6 vs 0.3; P < 0.001), emergency room visits (0.7 vs 0.3; P < 0.001), and prescribed medications including refills (42.3 vs 28; P < 0.001).

Conclusions: Psychological distress is correlated with increased medical expenditures and health care utilization in patients with MI. This research highlights the need for interventions addressing psychological needs in patients with MI.

Keywords: MEPS; health care utilization; medical expenditure; mental health; myocardial infarction; psychological distress.

Graphical abstract

Figure 1

Study Flow Chart Flow chart depicting the selection process for study participants from the 2017 to 2021 medical expenditure panel survey data. Starting with 79,871 observations, exclusions were made for inapplicable or missing responses related to myocardial infarction and psychological distress. The final sample included 1,874 participants with myocardial infarction, divided into groups with and without psychological distress. Weighted sample sizes are shown for context. MEPS = Medical Expenditure Panel Survey; MI = myocardial infarction.

Figure 2

Sociodemographics, Behavioral, and Comorbidity Predictors Associated With Psychological Distress in Participants With Myocardial Infarction Forest plot showing adjusted odds ratios and confidence intervals for predictors of psychological distress in myocardial infarction patients. Factors like female sex, smoking, and angina are linked to higher odds of distress, while regular exercise, higher income, and college education are associated with lower odds, illustrating the influence of demographic and health factors. Note: usual source of care is the particular medical professional, doctor's office, clinic, health center, or other place where a person would usually go if sick or in need of advice about his or her health. BMI = body mass index; COPD = chronic obstructive pulmonary disease.

Central Illustration

Impact of Psychological Distress on Medical Expenditures and Health Care Utilization of Adults With Myocardial Infarction, 2017 to 2021 Summary of increased medical expenditures and health care utilization in myocardial infarction patients with psychological distress. Those with psychological distress show higher office visits, emergency room visits, inpatient stays, and prescription refills, as well as greater costs across total medical, inpatient, emergency room visit, and medication expenses. Predictors of psychological distress include female sex, smoking, and lower income, underscoring the added health care burden in this population. aOR = adjusted OR; ER = emergency room; other abbreviation as in Figure 1.