Stahl Sarah T, Reynolds Charles F, Whyte Ellen M, Albert Steven M
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Am Geriatr Soc. 2017 Jul;65(7):1569-1572. doi: 10.1111/jgs.14865. Epub 2017 Mar 17.
To compare the prevalence of psychiatric diagnoses among older recipients of publicly funded mental health services (county safety-net base services and Medicaid) to psychiatric diagnoses in an insured population of older adults from the same county.
Secondary analysis of county human services claims data and claims from an insured population in the same county.
Inpatient and outpatient clinics in Allegheny County, PA.
Adults aged 65 and older in the county who received treatment for a psychiatric diagnosis in 2012 (county base services, n = 1,457; Medicaid, n = 641; Health plan insurance, n = 5,595).
Psychiatric diagnoses were classified using the International Classification of Diseases, 9th revision (ICD-9).
Episodic mood disorders and schizophrenia were more common among county-funded and Medicaid recipients (50-54% vs 34%). Neurotic conditions were more common among older adults with health plan insurance (18% vs 8%). Nearly a quarter of older adults receiving county base services were classified as having "ill-defined and unknown causes of morbidity and mortality," compared <1% among insured and 6% among Medicaid recipients.
The prevalence of psychiatric conditions among older adults varies by insurance coverage, suggesting a role for social and economic factors associated with safety net coverage as well as system-level differences in delivery of mental health services. Comparing the prevalence of psychiatric diagnoses across insurance types offers insight on social determinants of risk for mental disorders in late life.
比较公共资助心理健康服务的老年受助者（县安全网基础服务和医疗补助）与来自同一县的参保老年人群体的精神疾病诊断患病率。
对县公共服务索赔数据和同一县参保人群体的索赔数据进行二次分析。
宾夕法尼亚州阿勒格尼县的 inpatient 和 outpatient 诊所。
2012 年在该县接受精神疾病诊断治疗的 65 岁及以上成年人（县基础服务，n = 1457；医疗补助，n = 641；健康保险计划，n = 5595）。
使用《国际疾病分类》第九版（ICD - 9）对精神疾病诊断进行分类。
发作性情绪障碍和精神分裂症在县资助和医疗补助受助者中更为常见（50 - 54% 对 34%）。神经症在有健康保险计划的老年人中更为常见（18% 对 8%）。近四分之一接受县基础服务的老年人被归类为患有“病因不明和未知的发病及死亡原因”，而参保人群中这一比例不到 1%，医疗补助受助者中为 6%。
老年人中精神疾病的患病率因保险覆盖范围而异，这表明与安全网覆盖相关的社会和经济因素以及心理健康服务提供方面的系统层面差异发挥了作用。比较不同保险类型的精神疾病诊断患病率有助于深入了解晚年精神障碍风险的社会决定因素。
