Dept. of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Juul-Jensens Boulevard 35, Aarhus N, DK-8200, Denmark.
Research, Regional Hospital Central Jutland, Viborg, Denmark.
BMC Health Serv Res. 2023 Aug 7;23(1):834. doi: 10.1186/s12913-023-09802-z.
The long-term prognosis for employees with work-related mental health problems is unclear. We aim to describe long-term trends in health care utilization (HCU) and develop multivariable prognostic models for long-term mental health care utilization.
From the Danish Occupational Medicine Cohort we included mental health patients (N = 17,822) assessed from 2000 to 2013 at Departments of Occupational Medicine. Outcomes were general health (general practitioner, somatic hospital) and mental health (psychiatrist/psychologist, psychiatric hospital) HCU obtained from registries five years before/after assessment. The 10-year period was divided into phases relative to assessment: 5 - 3 years before, 2 years before/after, and 3-5 years after. We developed gender-stratified Lasso-penalized multivariable prognostic models for HCU 3-5 years after assessment assessing both calibration and discrimination.
Prevalent HCU for general practitioner, psychiatrist/psychologist and psychiatric hospital services was relatively stable 5 - 3 years prior to assessment, then rising during the 2 years before/after. At 3-5 years after assessment prevalent general practitioner HCU declined to previous levels, while prevalent HCU for psychologist/psychiatrist and psychiatric hospital services remained elevated compared to previous levels during years 5 - 3. Prognostic models for long-term psychologist/psychiatrist and psychiatric hospital HCU indicated acceptable calibration and modest discrimination.
Prevalent HCU rose two years before/after assessment and remained elevated for psychiatrist/psychologist and psychiatric hospital HCU 3-5 years after. Gender-stratified prognostic models were developed for long-term mental health HCU, but discrimination and calibration should be further improved before out-of-sample application for personal prognosis.
The study was registered at clinicaltrials.gov (Identifier: NCT04459793) prior to analyses.
与工作相关的心理健康问题员工的长期预后尚不清楚。我们旨在描述医疗保健利用（HCU）的长期趋势，并为长期心理健康保健利用建立多变量预后模型。
我们从丹麦职业医学队列中纳入了 2000 年至 2013 年在职业医学科评估的心理健康患者（n=17822）。结果是在评估前/后五年从登记处获得的一般健康（全科医生、综合医院）和心理健康（精神科医生/心理学家、精神病院）HCU。10 年期间分为与评估相关的阶段：评估前 5-3 年、2 年前/后和 3-5 年后。我们为 3-5 年后的 HCU 建立了性别分层的 Lasso 惩罚多变量预后模型，同时评估了校准和区分度。
在评估前 5-3 年，全科医生、精神科医生/心理学家和精神病院服务的普遍 HCU 相对稳定，然后在 2 年前/后上升。在评估后 3-5 年，普遍的全科医生 HCU 下降到以前的水平，而心理学家/精神科医生和精神病院服务的 HCU 则保持在较高水平，持续到 5-3 年。长期心理学家/精神科医生和精神病院 HCU 的预后模型表明校准效果可接受，区分度适中。
在评估前/后两年，HCU 上升，在评估后 3-5 年，精神科医生/心理学家和精神病院 HCU 仍然升高。为长期心理健康 HCU 建立了性别分层的预后模型，但在样本外应用于个人预后之前，应进一步提高区分度和校准度。
在进行分析之前，该研究在 clinicaltrials.gov 上注册（标识符：NCT04459793）。
