Nguyen Muoi T, Chan Winnie Y, Keeler Courtney
From the Department of Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, California.
Medicine (Baltimore). 2015 Sep;94(35):e1410. doi: 10.1097/MD.0000000000001410.
Both clinical diagnoses and self-rated measures of mental illness are associated with a variety of outcomes, including physical well-being, health utilization, and expenditure. However, much of current literature primarily utilizes clinically diagnosed data.This cross-sectional study explores the impact of mental illness and health care expenditure using 2 self-rated measures: self-rated measured of perceived mental health status (SRMH) and Kessler Screening Scale for Psychological Distress (K6).Data from the 2011 Medical Expenditure Panel Survey Household Component, a nationally representative sample of noninstitutionalized individuals (n = 18,295), were analyzed using bivariate χ tests and a 2-part model (logistics regression and generalized linear model regression for the first and second stages, respectively).Although predictive of any health expenditure, SRMH alone was not highly predictive of the dollar value of that health expenditure conditional on any spending. By comparison, the K6 measure was significantly and positively associated with the probability of any health expenditure as well as the dollar value of that spending. Taken together, both the K6 and SRMH measures suggest a positive relationship between poor mental health and the probability of any health expenditure and total expenditure conditional on any spending, even when adjusting for other confounding factors such as race/ethnicity, sex, age, educational attainment, insurance status, and some regional characteristics.Our results suggest that psychological distress and SRMH may represent potential pathways linking poor mental health to increased health care expenditure. Further research exploring the nuances of these relationships may aid researchers, practitioners, and policy makers in addressing issues of inflated health care expenditure in populations at risk for poor mental health.
临床诊断和精神疾病的自评测量都与多种结果相关，包括身体健康、医疗利用和支出。然而，当前的许多文献主要使用临床诊断数据。这项横断面研究使用两种自评测量方法探讨精神疾病和医疗保健支出的影响：感知心理健康状况的自评测量（SRMH）和凯斯勒心理困扰筛查量表（K6）。对2011年医疗支出面板调查家庭部分的数据进行了分析，该数据是一个具有全国代表性的非机构化个体样本（n = 18295），使用双变量χ检验和两部分模型（第一阶段和第二阶段分别为逻辑回归和广义线性模型回归）。虽然SRMH单独就能预测任何医疗支出，但在有任何支出的情况下，它并不能很好地预测该医疗支出的美元价值。相比之下，K6测量与任何医疗支出的概率以及该支出的美元价值均呈显著正相关。综合来看，K6和SRMH测量均表明，即使在调整了种族/民族、性别、年龄、教育程度、保险状况和一些地区特征等其他混杂因素后，心理健康不佳与任何医疗支出的概率以及有任何支出情况下的总支出之间仍存在正相关关系。我们的结果表明，心理困扰和SRMH可能代表了将心理健康不佳与医疗保健支出增加联系起来的潜在途径。进一步研究这些关系的细微差别可能有助于研究人员、从业者和政策制定者解决心理健康不佳人群医疗保健支出过高的问题。
