Department of Psychiatry, University of California, San Francisco, CA 94143–0984,USA.
Am J Geriatr Psychiatry. 2011 Feb;19(2):176-84. doi: 10.1097/JGP.0b013e3181e56cfa.
This study was conducted to determine the effect of cognitive impairment (CI) on mental healthcare costs for older low-income adults with severe psychiatric illness.
Data were collected from 62 ethnically diverse low-income older adults with severe psychiatric illness who were participating in day programming at a large community mental health center. CI was diagnosed by a neuropsychologist utilizing the Mattis Dementia Rating Scale-Second Edition and structured ratings of functional impairment (Clinical Dementia Rating Scale). Mental healthcare costs for 6, 12, and 24-month intervals before cognitive assessments were obtained for each participant. Substance abuse history was evaluated utilizing a structured questionnaire, depression symptom severity was assessed utilizing the Hamilton Depression Rating Scale, and psychiatric diagnoses were obtained through medical chart abstraction.
CI was exhibited by 61% of participants and was associated with significantly increased mental healthcare costs during 6, 12, and 24-month intervals. Results of a regression analysis indicated that ethnicity and CI were both significant predictors of log transformed mental healthcare costs over 24 months with CI accounting for 13% of the variance in cost data.
CI is a significant factor associated with increased mental healthcare costs in patients with severe psychiatric illness. Identifying targeted interventions to accommodate CI may lead to improving treatment outcomes and reducing the burden of mental healthcare costs for individuals with severe psychiatric illness.
本研究旨在确定认知障碍（CI）对患有严重精神疾病的老年低收入成年人精神保健费用的影响。
本研究的数据来自 62 名患有严重精神疾病且具有不同种族背景的低收入老年成年人，他们正在一家大型社区心理健康中心参加日间项目。认知障碍由神经心理学家通过使用 Mattis 痴呆评定量表第二版和功能障碍的结构化评定（临床痴呆评定量表）进行诊断。对每位参与者进行认知评估之前的 6、12 和 24 个月的精神保健费用进行了评估。利用结构化问卷评估了药物滥用史，利用汉密尔顿抑郁评定量表评估了抑郁症状严重程度，通过医疗记录摘要获取了精神科诊断。
61%的参与者表现出认知障碍，并且与 6、12 和 24 个月的精神保健费用显著增加有关。回归分析的结果表明，种族和认知障碍都是 24 个月内对数变换的精神保健费用的显著预测因素，认知障碍占成本数据方差的 13%。
认知障碍是严重精神疾病患者精神保健费用增加的一个重要因素。确定针对认知障碍的干预措施可能会改善治疗结果并降低严重精神疾病患者的精神保健费用负担。
