AHRQ's 2008 National Healthcare Disparities Report shows that the racial and socioeconomic disparities in mental health care declined in some areas but remained the same in others. For example, the gap in treatment for illicit
drug use shrunk between blacks/Hispanics and whites, declined between those with less than a high school education and those with some college education, but remained the same between poor and high-income people. The percentage of adults with a major depressive episode in the past year, who received treatment for it, was significantly lower for blacks than for whites (58.9 vs. 71.1 percent) and for Hispanics than whites (51.8 vs. 73.3 percent). The percentage of adults who received minimally adequate treatment for mood, anxiety, or impulse control disorders was lower among blacks and Hispanics than whites, and was lower among those with less than a high school education than high school graduates. While the quality of health care is slowly improving for the nation as a whole, it is getting worse for
Hispanics, especially those who speak little or no English.
- New Spanish-language consumer guides compare treatments for depression and other conditions.
Spanish speakers who want to know how soon they can expect to feel better when taking an antidepressant can get this and other treatment information from a new Spanish-language consumer guide on depression released by AHRQ. The Agency also released consumer guides in Spanish that compare treatments for five other conditions ranging from arthritis to high blood pressure. The new Spanish-language consumer guides are produced by AHRQ's Effective Health Care Program, the leading Federal effort to conduct comparative effectiveness research. The program is intended to
help patients, doctors, nurses, pharmacists, and others choose the most effective treatments. To access the online Spanish-language consumer guides, as well as AHRQ's English-language consumer guides and companion guides for clinicians, go to http://effectivehealthcare.ahrq.gov/.
Audio versions of many guides also are available.*
- Medicaid-insured blacks are less likely to be treated for mood disorders than their white counterparts.
Nearly all adults who commit suicide suffer from major psychiatric illness, predominantly serious mood disorders such as bipolar disorder. Yet in the year preceding their suicide, blacks insured by Tennessee's Medicaid program
(TennCare) were less likely than their white counterparts to have been treated for mood disorders. Overall, 29 percent of blacks had filled an antidepressant prescription compared with 51 percent of whites. Yet there was no significant difference between the two groups in filled prescriptions for antipsychotic medications. Nearly half of blacks and whites who committed suicide were enrolled in TennCare because of disability. Preceding the suicide, 37
percent of blacks and 49 percent of whites had inpatient admissions or outpatient visits indicating psychiatric disorders. The findings were based on examination of the medical records of TennCare-insured adults who had committed suicide between 1986 and 2004. Ray, Hall, and Meador, "Racial differences in antidepressant treatment preceding suicide in a Medicaid population," Psychiatric Services 58(10):137-1323, 2007 (AHRQ Grant HS10384).
- The time spent in office visits with psychiatrists has equalized among blacks and whites in recent years.
This study reveals progress in eradicating racial differences in the time office-based psychiatrists spend with patients. For example, from 2001 to 2003, black patients had office-based visits with psychiatrists that were an
average of 4.4 minutes shorter than visits by whites (28.3 vs. 32.7 minutes). This difference was reduced to 3.5 minutes after accounting for other factors that could affect visit length. However, by 2004 to 2006, the time spent with the psychiatrist was about the same for black and white patients. Between these periods, there were longer visits by black patients rather than shorter visits by white patients. This suggests that the change was not mediated by the pattern of psychotherapy or medication visits. The findings were based on data from the 2001-2006 National Ambulatory Medical Care Survey on 7,094 office visits to psychiatrists made by white patients and 504 visits by black patients. Olfson, Cheery, and Lewis-Fernandez, and Lewis-Fernandez, "Racial differences in visit duration of outpatient psychiatric visits," Archives of General Psychiatry 66(2):214-221, 2009 (AHRQ grant HS16097).
- The gap between whites, blacks, and Hispanics in use of mental health services is likely caused by underuse by minorities and not overuse by whites.
Racial-ethnic groups differ in their tendency to associate mental health problems with symptoms and their use of mental health-related medications. The researchers used respondents' self-reported mental health (SRMH) assessment and a survey that provides a summary score for emotional functioning to study 55,025 person-year observations. Nearly 70 percent of those surveyed reported "excellent" or "very good" SRMH, with just 7 percent reporting "fair" or "poor" SRMH. Whites were more likely than blacks or Hispanics to associate their mental symptoms with their mental health status. The probability of whites using medication increased from .09 when they reported "excellent" SRMH to .41 when they reported "poor" SRMH. For blacks, the probability rose from .03 for "excellent" SRMH to just .17 for "poor" SRMH; for Hispanics, the probability increased from .05 for "excellent" SRMH to .23 for "poor" SRMH. The findings were based on
analysis of AHRQ's Medical Expenditure Panel Survey data from 2001 to 2004. Zuvekas and Fleishman, "Self-rated mental health and racial/ethnic disparities in mental health service use," Medical Care 46(9):915-923, 2008 (AHRQ Publication No.09-007).*
- White children are about twice as likely to use stimulants as black and Hispanic children with similar mental health problems.
In this study, 5.1 percent of white children compared with 2.8 percent of black and 2.1 percent of Hispanic children purchased at least one stimulant medication during the year for conditions such as attention deficit
hyperactivity disorder. Stimulants most commonly used by children were methylphenidate and amphetamine-dextroamphetamine. Differences in family or individual characteristics accounted for about 25 percent of the differences between whites and Hispanics, but for none of the difference between whites and blacks. Specifically, characteristics such as health insurance, health status, and access to care, for which whites fared better, helped to explain some of the differences between whites and Hispanics. Researchers examined stimulant use among U.S. children aged 5-17 in the Medical Expenditure Panel Survey between 2000 and 2002. Hudson, Miller, and Kirby, "Explaining
racial and ethnic differences in children's use of stimulant medication," Medical Care 45(11):1068-1075, 2007 (AHRQ Publication No: 08-R044).*
Health Information Technology
Health IT shows promise for improving mental health care delivery. For example, electronic communication can enable behavioral health providers to follow the entire treatment path of patients from mental hospitals, protective custody, or crisis centers to various providers in urban or rural community settings. A health information exchange might aid care coordination. Other health IT initiatives that show promise include telepsychiatry and electronic health records. AHRQ recently funded several new projects to explore use of health IT to improve mental health care
delivery, but they have not yet generated findings.
- Telepsychiatry can improve access to therapy for veterans suffering from combat-related posttraumatic stress disorder (PTSD), who live in rural or underserved areas.
Veterans who had 14 weekly 90-minute treatment sessions by telepsychiatry (therapy with a psychiatrist via videoconferencing) or in a room with a psychiatrist had similar outcomes and satisfaction with treatment 3 months later. Researchers interviewed the veterans before treatment and 3 months later, including measures of PTSD, overall psychiatric functioning, depression, and the quality of social relationships. All veterans received cognitive-behavioral group therapy for veterans with PTSD, which focused on social and emotional rehabilitation. In this type of therapy, the psychiatrist helps the person identify thoughts (such as traumatic flashbacks) causing
distress, in order to change their emotional state or behavior. Researchers randomized 38 veterans with combat-related PTSD to telepsychiatry (17) or same-room therapy (21). Frueh, Monnier, Yim, et al., "A randomized trial of telepsychiatry for post-traumatic stress disorder," Journal of Telemedicine and Telecare 13:142-147, 2007 (AHRQ grant HS11642).
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Research on medications for mental health disorders is focusing more closely on the impact of certain medications on priority populations such as children, adolescents, the elderly, and pregnant women. Another area of focus is the comparative effectiveness of various drugs on certain subgroups for certain conditions and their side effects, which will expand in the coming years. For example, AHRQ's Centers for Education and Research on Therapeutics (CERTs) are examining the impact of newer classes of antidepressants called selective serotonin reuptake inhibitors on various
subgroups, including children, and the risk of suicide. The Agency is also examining use of antipsychotics among various populations and their off-label use, as well as a variety of other psychotropic medications.
- Adults taking atypical antipsychotics are at higher risk of sudden death from cardiac arrthymias and other cardiac problems.
Patients ages 30 to 74 who took atypical antipsychotics such as risperidone, quetiapine,, olanzapine, and clozapine had a significantly higher risk of sudden death from cardiac arrhythmias and other cardiac problems than patients who did not take these medications. The risk of death increased with higher doses of the drug taken. Researchers at one of AHRQ's CERTs found that current users of atypical antipsychotic drugs had a rate of sudden cardiac death twice that of people who didn't use the drugs. This is similar to the death rate of patients taking typical antipsychotics, including haloperidol and thioridazine. They conclude that atypical antipsychotics are not a safer alternative to typical antipsychotics in preventing death from sudden cardiac causes. Ray, Chung, Murray, et al., "Atypical antipsychotic drugs and the risk of sudden cardiac death," New England Journal of Medicine 360:225-235, 2009 (AHRQ grant HS10384).
- Direct-to-consumer advertising seems to boost the number of new users of antidepressants.
Economists at AHRQ used data from the 1996-2003 AHRQ Medical Expenditure Panel Survey to investigate the impact of direct-to-consumer advertising (DTCA) and consumer cost-sharing (out-of-pocket costs) on the demand curve for several newer-generation antidepressants (such as fluoxetine, paroxetine, buproprion, and trazodone). The number of
antidepressant users increased steadily between 1996 and 2003, while the average number of prescriptions filled per user increased only slightly. Refills were influenced by DTCA only at very low or no out-of-pocket costs. The
researchers concluded that DTCA increases the likelihood that an individual will initiate antidepressant use, but has minimal effect on drug compliance at higher price levels. They note that, since most people with depression are untreated, bringing more of them into treatment might benefit both the individual and the public. Meyerhoefer and Zuvekas, "The shape of demand: What does it tell us about direct-to-consumer marketing of antidepressants?" Berkeley Electronic Journal of Economic Analysis and Policy 8(2), 2008 (AHRQ Publication No. 08-R062).*
- Study reveals a more than twofold jump in use of antidepressants among low-income pregnant women insured by Tennessee Medicaid (TennCare).
The proportion of pregnant women using antidepressants increased from 5.7 percent of pregnancies in 1999 to 13.4 percent in 2003, after adjustment for maternal age, race, parity, and other factors. This was largely due to greater
use of selective serotonin reuptake inhibitors (SSRIs), which more than tripled from 2.9 percent of pregnancies in 1999 to 10.2 percent in 2003. For women giving birth in 2003, 10 percent took antidepressants during the first trimester, 6.4 percent during the second, and 5.9 during the third. The use of SSRIs during both early and late pregnancy has been linked to neonatal problems such as neurological and cardiovascular abnormalities. Researchers linked the pharmacy records of 105,335 predominantly young, low-income pregnant women enrolled in TennCare from 1999-2003 to birth certificates. Cooper, Willy, Pont, et al., "Increasing use of antidepressants in pregnancy," Journal of Obstetrics and Gynecology 196(6):544el-544e5, 2007 (AHRQ grant HS10384).
- Newer class of antidepressants are similarly effective, but side effects differ.
Today's most commonly prescribed second-generation antidepressants are similar in effectiveness to each other, but differ when it comes to possible side effects, according to this report. The findings, based on a review of nearly 300 published studies of second-generation antidepressants, show that about 6 in 10 adult patients get some relief from the drugs. The same proportion also experience at least one side effect, ranging from nausea to dizziness and sexual dysfunction. About one in four of those patients will improve with the addition or substitution of a different drug in the same class. Overall, current evidence on the drugs is insufficient for clinicians to predict which medications will work best for individual patients, conclude the authors. They analyzed the benefits and risks of a dozen second-generation antidepressants: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine. The report, Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression, from AHRQ's Effective Health Care program, can be found at http://effectivehealthcare.ahrq.gov.
- Evidence is lacking to support many off-label uses of atypical antipsychotic drugs.
Some newer antipsychotic medications approved to treat schizophrenia and bipolar disorder are being prescribed to millions of Americans for depression, dementia, and other psychiatric disorders without strong evidence that such off-label uses are effective, according to this report. The review of these drugs—called atypical antipsychotics—identified the medications' potential for serious side effects (ranging from stroke and sedation to gastrointestinal problems), while pointing to an urgent need for more research into new treatments for the growing population of dementia. The review was authored by AHRQ's Southern California/RAND Evidence-based Practice Center. The center examined 84 published studies on atypical antipsychotics and summarized evidence about dementia, depression,
obsessive-compulsive disorder, posttraumatic stress disorder, personality disorders, and Tourette's syndrome. The report, Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics, from AHRQ's Effective Health Care program, can be found at http://www.effectivehealthcare.ahrq.gov.
- Maine Medicaid policy requiring prior authorization for new users of atypical antipsychotics increased patient risk of treatment discontinuity.
In July 2003, Maine implemented a Medicaid policy requiring prior authorization for new users of atypical antipsychotics, medications commonly prescribed for conditions such as schizophrenia or bipolar disorder. As a result of the Maine policy, patients experienced a 29 percent greater risk of treatment discontinuity than patients who were able to receive atypical antipsychotics, before the preauthorization policy was implemented. There was a 3 percent increase in preferred atypical antipsychotic use and a 5.6 percent decrease in nonpreferred atypical antipsychotic use, which led to an overall decrease in spending for atypical antipsychotics. Disruptions in antipsychotic medications can lead to psychotic episodes and hospitalizations among individuals with schizophrenia. In fact, Maine suspended the prior authorization policy in March 2004 after many reports of adverse effects. Soumerai, Zhang, Ross-Degnan, et al., "Use of atypical antipsychotic drugs for schizophrenia in Maine Medicaid following a policy change," Health Affairs 27(3):w185-w195, 2008 (AHRQ grant HS10391).
- Patients who receive follow-up care from a psychiatrist or take the newer antidepressants are more likely to continue taking antidepressant medication.
This study found that only half of patients with depression adhered to antidepressant therapy for the first 4 months of treatment and only 42 percent of patients kept taking their antidepressants from 17 to 33 weeks after starting treatment. Patients who received follow-up care from a psychiatrist (28 percent of patients) were more likely to continue taking their antidepressant medication. Those who took the newer antidepressants (selective serotonin reuptake inhibitors), which have fewer side effects and are easier to tolerate than older drugs, were also more likely to continue taking their medication. Younger age, alcohol or other substance abuse, coexisting cardiovascular or metabolic conditions, use of older generation antidepressants, and residence in lower-income neighborhoods were associated with lower medication adherence during the first 4 months of treatment. Akincigil, Bowblis, Levin, et al., "Adherence to antidepressant treatment among privately insured patients diagnosed with depression," Medical Care 45 (4):363-369, 2007 (AHRQ grant HS16097).
- Far more people receive prescriptions for antidepressants from primary care physicians than psychiatrists.
More than 70 percent of patients reported receiving their antidepressant prescription from their primary care provider in the past year. These patients were typically at least 65 years old, female, and residents of non-urban
areas. Nearly 30 percent of patients received their prescriptions for antidepressants from psychiatrists, usually in higher doses. The patients tended to meet established criteria for major depressive, bipolar, panic, or post-traumatic stress disorders or social phobia, and to have a large number of mood and anxiety symptoms. The conservative approach by primary care providers may be because of side effects associated with older tricyclic antidepressants. These findings were based on examination of antidepressant prescribing patterns of psychiatrists and primary care providers for 928 patients ages 18 and older. Mojtabi and Olfson, "National patterns in antidepressant treatment by psychiatrists and general medical providers,"Journal of Clinical Psychiatry 69(7):1064-1074, 2008 (AHRQ grant HS16097).
- Adverse drug events and medication errors involving psychiatric medications are common among patients at psychiatric hospitals.
Despite the movement of mental health patients out of psychiatric hospitals, more than a quarter of all hospital admissions are for psychiatric hospitalizations. Of 1,559 patients admitted at 1 psychiatric hospital in 2004 and 2005, mostly for mood disorders and schizophrenia, the rate of adverse drug events (ADEs) and serious medication errors (MEs) were 10 and 6.3 per 1,000 patient days, respectively. Preventable ADEs accounted for 13 percent of the 191 ADEs. Atypical antipsychotics accounted for over one-third of ADEs (37 percent). Two thirds of ADEs were significantly harmful, 31 percent were considered serious, and 2 percent were considered life-threatening events. Nonpsychiatric drugs were associated with nearly one-third of all preventable ADEs and near misses. The most common types of MEs were wrong dose (24.6 percent), drug-drug interaction (17.2 percent), and omitted medication (13.8 percent). The researchers identified MEs and ADEs from medical charts, progress notes, and test results; nursing and physician reports; and pharmacy intervention reports. Rothschild, Mann, Keohane, et al., "Medication safety in a psychiatric hospital," General Hospital Psychiatry 29:156-162, 2007 (AHRQ grant HS11534).
- The incidence of medication errors in the outpatient treatment of attention deficit hyperactivity disorder (ADHD) is significant.
Researchers searched the U.S. Pharmacopeia MEDMARX® database for reports involving medications used in the outpatient treatment of attention-deficit hyperactivity disorder (ADHD) in children between 2003 and 2005. Of 361 error reports, 329 involved medications used only in the treatment of ADHD and 32 involved medications used for ADHD and other conditions. Among first-listed generic medications, methylphenidate (MPH) and its derivatives (43 percent) and dextroamphetamine, alone and combined with amphetamine salts (41 percent), accounted for more than four out of five error reports. Improper dose, wrong dosage form, and prescribing errors were the 3 most common errors listed in the 361 reports. Improper dose was a significantly more common error with MPH. Wrong dosage form was the second most common error type. This is more likely when multiple formulations of the same medication have names that sound or look similar. Bundy, Rinke, Shore, and others, "Medication errors in the ambulatory treatment of pediatric attention deficit hyperactivity disorder," Joint Commission Journal on Quality and Patient Safety 34(9), pp. 552-560, 2008 (AHRQ grant HS16774).
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- Report shows that people treated for depression in primary care clinics that coordinate mental and physical health services fare better.
The AHRQ evidence report, Integration of Mental Health/Substance Abuse and Primary Care, also found that patients treated in specialty mental health centers appear to benefit when the facilities offer general medical care, but the number of studies was too limited to draw firm conclusions. Prepared by the AHRQ-supported University of Minnesota Evidence based Research Center in Minneapolis, the report did not find sufficient evidence to draw conclusions about the impact of integrating mental health and physical medicine services on patients with anxiety disorders, alcohol use disorders, or other mental or behavioral health problems. It did identify financial barriers to combining mental health and physical health services. These included lack of reimbursement for consultations, communication activities between providers, telephone conversations with patients, and other care management functions, such as payment to care coordinators. To view the full evidence report, go to http://www.ahrq.gov/clinic/tp/mhsapctp.htm (AHRQ Contract No. 290-02-009; AHRQ Publication No. 09-E003).*
- Hospitalized trauma victims expressing three or more concerns after injury are more likely to suffer from post traumatic stress disorder (PTSD).
Of 120 hospitalized injury survivors, 84 percent expressed 1 or more severe concerns and 14.3 percent expressed 3 severe concerns. Physical health concerns (68 percent) were predominant, with the patients focusing on extent of their injury, pain, and worries about being able to take care of themselves. These concerns were followed by work and finance (59 percent); social, such as the impact of the trauma on family and friends (44 percent); medical (8 percent); and legal (5 percent) concerns. Patients who reported three severe concerns had significantly elevated scores on a PTSD checklist (17-item questionnaire) compared with other groups 1,3,6, and 12 months after injury. Researchers interviewed adult survivors of unintentional (e.g., motor cycle accidents) or intentional (e.g., assault)
injuries within an average of 3 days following hospital admission. Zatzick, Russo, Rajotter, et al.,"Strengthening the patient-provider relationship in the aftermath of physical trauma through an understanding of the nature and severity of posttraumatic concerns," Psychiatry, 70(3):260-273, 2007 (AHRQ grant HS11372).
- Emergency departments vary in their approach to psychiatric emergencies, underscoring the need for standards.
With the lack of State psychiatric facilities and community support, persons in psychiatric crisis often end up at the hospital emergency department (ED). Yet, there are no established best practices for managing these ED patients. A hospital's approach to ED psychiatric emergencies tended to be largely influenced by its available resources and
circumstances. For example, hospitals with an ED psychiatric emergency service (EDPES) had more inpatient psychiatric beds and a larger share of the market and served a greater volume of psychiatric patients compared with those without an EDPES. Hospitals that used a contractual EDPES had the slowest response time and were more likely to contract for other clinical services as well. The survey of ED administrators at 71 hospitals in 2 States found that 45 percent of hospitals used an in-house psychiatric service, 41 percent had a contractual structure, and 14 percent had no
psychiatric services. Brown, "A survey of emergency department psychiatric services," General Hospital Psychiatry 29:475-480, 2007 (AHRQ grant HS13859).
- Nearly one-fourth of all adult stays in U.S. community hospitals involve depressive, bipolar, schizophrenia, and other mental health disorders or substance use-related disorders.
This report presents the first documentation of the full impact of mental health and substance abuse disorders on U.S. community hospitals. According to the report, about 1.9 million of the 7.6 million stays were for patients who were hospitalized primarily because of a mental health or substance abuse problem. In the other 5.7 million stays, patients were admitted for another condition but they also were diagnosed as having a mental health or substance abuse disorder. Nearly two-thirds of costs were billed to the government (Medicare and Medicaid). Patients who had been diagnosed with both a mental health condition and a substance abuse disorder accounted for 1 million of the nearly 8 million stays. In addition, 240,000 women hospitalized for childbirth or pregnancy had mental health or substance abuse problems. Suicide attempts accounted for nearly 179,000 hospital stays. The report is based on 2004 data from AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a nationally representative database of hospital inpatient stays. (AHRQ Publication No. 07-0008).*
- When people with mood disorders are hospitalized for treatment, between 20 and 50 percent of them return to the hospital within a year.
Nearly a quarter of people with major depression, bipolar disorder, or both conditions were hospitalized from 1999 to 2000. Twenty-four percent of the people hospitalized with mood disorders were rehospitalized within 3 months after they were discharged. Thirty-six percent of people hospitalized for mood disorders also had received diagnoses of alcohol or drug abuse. People with mood disorders who abused drugs or alcohol had a risk of readmission that was 58 percent and 46 percent greater, respectively, than those who did not abuse drugs or alcohol. Researchers at the Rutgers University Center for Education and Research on Therapeutics analyzed Medicaid claims data from five States from 1999 to 2000. Prince, Akincigil, Hoover, et al., "Substance abuse and hospitalization for mood disorder
among Medicaid beneficiaries," American Journal of Public Health 99(1):160-167, 2009 (AHRQ grant HS16097).
- Diagnosis of bipolar disorder among U.S. youth jumped 40-fold during office visits between 1994 and 2003.
The number of office visits in which youth were diagnosed with bipolar disorder rose from 25 to 1,003 visits per 100,000 population between 1994 and 2003. Youth and adults were equally likely to have coexisting mental disorders, but youth were 10 times more likely to be also diagnosed with attention deficit hyperactivity disorder (ADHD). Visit duration and frequency of psychotherapy were also similar for youth and adults. Nearly two-thirds of youth and adults were likely to receive a combination of drugs such as a mood stabilizer and antidepressant or a mood stabilizer and antipsychotic. Diagnosis of bipolar disorder in youth can be more difficult due to the overlap of symptoms with other more prevalent psychiatric disorders. Researchers analyzed bipolar diagnostic patterns from annual data from the National Ambulatory Medical Care Survey. They examined 154 youth visits and 808 adult visits to physicians in which this diagnosis was received. Moreno, Laje, Blanco, Jiang, et al., "National trends in the outpatient diagnosis and treatment of bipolar disorder in youth," Archives of General Psychiatry 64(9):1032-1039, 2007 (AHRQ grant HS16097).
- The 1990s brought many changes in psychiatric care, including tighter admission criteria for hospital stays and a wealth of new drug therapies.
Despite no significant decline in mental disorders during the 1990s, the overall rate of psychiatric admissions was 28 percent lower. A reduction in stays for depression accounted for nearly half of that decrease, and stays for substance use disorders declined as well. However, inpatient stays for bipolar disorder and schizophrenia did not change during the study period, most likely because these patients exhibit severe symptoms, such a psychosis or lack of behavior control. The authors observe that this pattern of use fits with an intensive care model. Average hospital stays dropped from nearly 18 days in 1992 to just 12 in 2002, and costs per stay went from about $6,500 to $6,000. These findings were based on analysis of Medicare data from 1992 and 2002 for patients over age 65 who had psychiatric conditions and were insured by fee-for-service plans. Akincigil, A, Hoover, D.R, Walkup, J.T, and others,
"Hospitalizations for psychiatric illness among community-dwelling elderly persons in 1992 and 2002," Psychiatric Services 59(9):1046-1048, 2008 (AHRQ grant HS16097).
- Eating disorders are sending more Americans to the hospital.
The number of men and women hospitalized due to eating disorders that caused anemia, kidney failure, erratic heart rhythms, or other problems rose 18 percent between 1999 and 2006, according to AHRQ data. AHRQ's analysis also found that between 1999 and 2006:
- Hospitalizations for eating disorders rose most sharply for children under 12 years of age— 119 percent, followed by a 48 percent rise among patients ages 45 to 64.
- Hospitalizations for men increased by 37 percent, but women continued to dominate hospitalizations for eating
disorders (89 percent in 2006).
- Admissions for anorexia, the most common eating disorder, remained relatively stable. People with anorexia typically lose extreme amounts of weight by not eating enough food, over-exercising, self-inducing vomiting, or using laxatives. In contrast, hospitalizations for bulimia declined 7 percent. Bulimia is binge eating followed by purging by vomiting or use of laxatives and can lead to severe dehydration or stomach and intestinal problems.
- Hospitalizations for less common eating disorders increased 38 percent. Those disorders include pica, an obsession with eating nonedible substances such as clay or plaster, and psychogenic vomiting, which is vomiting caused by anxiety and stress.
For more information, see Hospitalizations for Eating Disorders from 1999 to 2006, HCUP Statistical Brief #70 (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb70.jsp).
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For more information on AHRQ initiatives related to mental health, please contact:
Charlotte Mullican, M.P.H.
Senior Advisor for Mental Health Research
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 6054
Rockville, MD 20850
For more information about AHRQ and its research portfolio and funding opportunities, visit the Agency's Web site at http://www.ahrq.gov.
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* Items marked with an asterisk (*) are available free from the AHRQ Clearinghouse. To order, contact the clearinghouse at:
Phone: 800-358-9295 or request electronically by sending an e-mail to email@example.com.
Please use the AHRQ publication number when ordering.
Current as of September 2009
AHRQ Publication No. 09-P011
Mental Health Research Findings. Program Brief. AHRQ Publication No. 09-P011, September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/mentalhth.htm