Mental health and high-cost health care utilization: new evidence from Axis II disorders

Objective: To analyze the associations between Axis II (A2) disorders and two measures of health care utilization with relatively high cost: emergency department (ED) episodes and hospital admissions.

Data source/study setting: Wave I (2001/2002) and Wave II (2004/2005) of the National Longitudinal Survey on Alcohol and Related Conditions (NESARC).

Study design: A national probability sample of adults. Gender-stratified regression analysis adjusted for a range of covariates associated with health care utilization.

Data collection: The target population of the NESARC is the civilian noninstitutionalized population aged 18 years and older residing in the United States. The cumulative survey response rate is 70.2 percent with a response rate of 81 percent (N=43,093) in Wave I and 86.7 percent (N=34,653) in Wave II.

Principal findings: Both men and women with A2 disorders are at elevated risk for ED episodes and hospital admissions. Associations are robust after adjusting for a rich set of confounding factors, including Axis I (clinical) psychiatric disorders. We find evidence of a dose-response relationship, while antisocial and borderline disorders exhibit the strongest associations with both measures of health care utilization.

Conclusions: This study provides the first published estimates of the associations between A2 disorders and high-cost health care utilization in a large, nationally representative survey. The findings underscore the potential implications of these disorders on health care expenditures.