Patterns of diagnoses, comorbidities, and treatment in late-middle-aged and older affective disorder patients: comparison of mental health and medical sectors

Abstract

Objective: To compare the diagnoses, psychiatric and medical comorbidities, and prior and current treatment received by late-middle-aged and older affective disorder patients in mental health and medical service settings and to identify predictors of these patients' length of inpatient care.

Design: Department of Veterans Affairs (VA) nationwide databases are used to examine the prevalence, diagnoses, and inpatient and outpatient treatment received by affective disorder patients in mental health and medical units in Fiscal Year 1990.

Results: Compared with late-middle-aged and older index medical patients (n = 11,701), index mental health patients (n = 9039) were more likely to have affective psychoses and major depressive disorder and less likely to have depressive disorder NOS. Almost 60% of affective disorder patients in mental health settings had comorbid psychiatric diagnoses; this was true of 30% of patients in medical settings. Moreover, more than 80% of affective disorder patients in mental health settings had concomitant medical disorders. Affective disorder patients also had very high rates of prior mental health and medical care. Patients who had more severe affective disorders and comorbid psychiatric and medical diagnoses had longer episodes of inpatient care; in contrast, more intensive prior medical and mental health outpatient care was associated with shorter episodes of inpatient care.

Conclusions: The findings highlight affective disorder patients' high rates of comorbidity and intensive use of health care resources, emphasize the value of outpatient care in reducing the amount of subsequent inpatient care, and underscore the need for closer integration of mental health and medical care.