Department of Psychiatry, Yale University, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT.
Department of Psychiatry, Yale University, New Haven, CT; Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT; Yale University School of Public Health, New Haven, CT.
Psychosomatics. 2019 Nov-Dec;60(6):591-598. doi: 10.1016/j.psym.2019.04.005. Epub 2019 Apr 28.
Mental illness is associated with an increased risk for medical hospitalizations.
This study investigates the degree to which nonpsychiatric factors account for these hospitalizations.
Using National Veterans Health Administration (VHA) fiscal year 2012 data for 2 million veterans under the age of 60 years, hospitalization risks were compared for veterans with and without mental illnesses. Bivariate analyses identified factors associated with mental illnesses. Multiple logistic regression was used to calculate adjusted psychiatric risk for medical hospitalization, controlling for these factors.
Veterans carrying mental health diagnoses were at increased risk for hospitalizations (odds ratio [OR] = 2.52, 2.48-2.55). Among individual diagnoses, alcohol use disorder (AUD) (OR = 3.84, 3.78-3.91) and drug use disorders (OR = 4.58, 4.50-4.66) were associated with the highest risk. After adjusting for nonpsychiatric medical, addiction-related, and care utilization factors and the use of outpatient medical services, veterans with mental illnesses were at increased risk for medical hospitalization (OR = 1.43, 1.41-1.45). After further adjustment for AUD and drug use, hospitalization risk decreased further (OR = 1.23, 1.21-1.26) while the association of AUD and hospitalizations remained high (OR = 1.77, 1.73-1.81).
Medical comorbidities and service use accounted for most, but not all, of the increased risk of medical hospitalizations associated with mental illness. Even after accounting for poor health, AUD remained strongly associated with medical hospitalization.
精神疾病与医疗住院风险增加有关。
本研究调查了非精神因素在多大程度上导致了这些住院治疗。
使用 2012 财年国家退伍军人健康管理局（VHA）的 200 万 60 岁以下退伍军人数据，比较了有和没有精神疾病的退伍军人的住院风险。双变量分析确定了与精神疾病相关的因素。采用多变量逻辑回归，在控制这些因素的情况下，计算调整后的精神疾病医疗住院风险。
患有精神疾病诊断的退伍军人住院风险增加（比值比 [OR] = 2.52，2.48-2.55）。在个别诊断中，酒精使用障碍（AUD）（OR = 3.84，3.78-3.91）和药物使用障碍（OR = 4.58，4.50-4.66）与最高风险相关。在调整了非精神医学、成瘾相关和护理利用因素以及门诊医疗服务的使用后，患有精神疾病的退伍军人住院治疗的风险增加（OR = 1.43，1.41-1.45）。在进一步调整 AUD 和药物使用后，住院风险进一步下降（OR = 1.23，1.21-1.26），而 AUD 与住院的关联仍然很高（OR = 1.77，1.73-1.81）。
医疗合并症和服务使用解释了与精神疾病相关的医疗住院风险增加的大部分原因，但不是全部原因。即使考虑到健康状况不佳，AUD 与医疗住院仍然密切相关。
