1
|
Hung CC, Tu HP, Chung CM. Selective Serotonin Reuptake Inhibitors for Cessation of Betel Quid Use in Patients with Major Depressive Disorder in Taiwan. Biomedicines 2024; 12:2633. [PMID: 39595197 PMCID: PMC11591801 DOI: 10.3390/biomedicines12112633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 11/17/2024] [Accepted: 11/17/2024] [Indexed: 11/28/2024] Open
Abstract
Background/Objectives: Major depressive disorder (MDD) frequently co-occurs with substance use disorders such as alcohol and nicotine use disorders. Comorbid substance use disorders worsen the clinical symptoms of MDD and exacerbate addictive behaviors and presentations. However, the relationship between MDD and betel quid use disorder (BUD) in Taiwan has not been extensively investigated. Methods: We performed this cross-sectional study investigated associations between betel quid use, BUD, and MDD specifically in the Taiwanese population. Long-term betel quid use is a major public health concern, contributing significantly to the high incidence of oral cancers, which rank fifth among the top ten most common cancers in Taiwan. Results: Among patients with MDD, the current BUD prevalence rate was 7.32%, and the lifetime BUD prevalence rate was 15.45%. Patients with comorbid BUD were more likely to have severe alcohol and nicotine dependence disorders and required longer antidepressant treatment. Conclusions: Notably, 16.98% of patients with comorbid BUD who received selective serotonin reuptake inhibitor treatment achieved abstinence. BUD has a detrimental effect on health outcomes in patients with MDD, and selective serotonin reuptake inhibitor treatment may be required to be prolonged for betel quid abstinence therapy to be effective. Additional studies should investigate medication therapies for betel quid addiction disorders.
Collapse
Affiliation(s)
- Chung-Chieh Hung
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Chia-Min Chung
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
- Department of Psychiatry and Center for Addiction and Mental Health, China Medical University Hospital, Taichung 40447, Taiwan
| |
Collapse
|
2
|
Srifuengfung M, Lenze EJ, Roose SP, Brown PJ, Lavretsky H, Karp JF, Reynolds CF, Yingling M, Sa-Nguanpanich N, Mulsant BH. Alcohol and substance use in older adults with treatment-resistant depression. Int J Geriatr Psychiatry 2024; 39:e6105. [PMID: 38822571 DOI: 10.1002/gps.6105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Alcohol and substance use are increasing in older adults, many of whom have depression, and treatment in this context may be more hazardous. We assessed alcohol and other substance use patterns in older adults with treatment-resistant depression (TRD). We examined patient characteristics associated with higher alcohol consumption and examined the moderating effect of alcohol on the association between clinical variables and falls during antidepressant treatment. METHODS This secondary and exploratory analysis used baseline clinical data and data on falls during treatment from a large randomized antidepressant trial in older adults with TRD (the OPTIMUM trial). Multivariable ordinal logistic regression was used to identify variables associated with higher alcohol use. An interaction model was used to evaluate the moderating effect of alcohol on falls during treatment. RESULTS Of 687 participants, 51% acknowledged using alcohol: 10% were hazardous drinkers (AUDIT-10 score ≥5) and 41% were low-risk drinkers (score 1-4). Benzodiazepine use was seen in 24% of all participants and in 21% of drinkers. Use of other substances (mostly cannabis) was associated with alcohol consumption: it was seen in 5%, 9%, and 15% of abstainers, low-risk drinkers, and hazardous drinkers, respectively. Unexpectedly, use of other substances predicted increased risk of falls during antidepressant treatment only in abstainers. CONCLUSIONS One-half of older adults with TRD in this study acknowledged using alcohol. Use of alcohol concurrent with benzodiazepine and other substances was common. Risks-such as falls-of using alcohol and other substances during antidepressant treatment needs further study.
Collapse
Affiliation(s)
- Maytinee Srifuengfung
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Steven P Roose
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York, USA
| | - Patrick J Brown
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine-Tucson, University of Arizona, Tucson, Arizona, USA
| | - Charles F Reynolds
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Yingling
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Naratip Sa-Nguanpanich
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Rodriguez Alvarez AA, Yuming S, Kothari J, Digumarthy SR, Byrne NM, Li Y, Christiani DC. Sex disparities in lung cancer survival rates based on screening status. Lung Cancer 2022; 171:115-120. [PMID: 35939954 PMCID: PMC9618021 DOI: 10.1016/j.lungcan.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Low dose computed tomography (LDCT) became the standard method for lung cancer (LC) screening in 2013. However, it is unclear whether there are differences in survival rates based on sex and whether the differences depend on screening status. We aimed to evaluate the LC survival rates between females and males based on screening. MATERIAL AND METHODS This retrospective cohort study examined data from the Boston LC Study (BLCS) between 2013 and 2021. LC screening depends on patients' demographics (age and smoking history) to determine whether a person is a high-risk individual and, therefore, undergo LDCT. Descriptive statistics were calculated for race, age, histology, smoking history, stage, and treatment. These variables' distributions were compared between sex and screening status using t-test and chi-square, respectively. Cox proportional hazards model and Kaplan-Meier curves were used to compare survival between sex and screening. Propensity score matching was applied to account for selection bias in screening when evaluating the association between screening and stage. RESULTS A total of 1,216 LC patients were identified with a screening incidence of 9.4 %, among whom 56 % were female. Unscreened males had 1.59 times higher risk of mortality than unscreened females (P=.0002) and had a worse 5-year survival (male 50 %; 95 %CI, 0.38,0.6 vs female 70 %; 95 %CI,0.62,0.76). In contrast, there were no significant differences in survival between sexes among screened. In a balanced cohort of screened and unscreened, the odds of being diagnosed at late stages for females and smokers were 1.33 and 2.51 times that of males and nonsmokers; however, there were no statistical significance. CONCLUSION Unscreened females had a lower risk of mortality and better survival than unscreened males, while among the screened population, there was no difference in the overall survival. These observations demonstrate the influence of sex on survival prognosis in LC when screening is not performed.
Collapse
Affiliation(s)
| | - Sun Yuming
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States
| | - Jui Kothari
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building I Room 1401, Boston, MA 02115, United States; Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02115, United States
| | - Subba R Digumarthy
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building I Room 1401, Boston, MA 02115, United States; Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02115, United States; Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Nicole M Byrne
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, United States
| | - Yi Li
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States
| | - David C Christiani
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building I Room 1401, Boston, MA 02115, United States; Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02115, United States; Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| |
Collapse
|
4
|
Fernandez-Rodrigues V, Sanchez-Carro Y, Lagunas LN, Rico-Uribe LA, Pemau A, Diaz-Carracedo P, Diaz-Marsa M, Hervas G, de la Torre-Luque A. Risk factors for suicidal behaviour in late-life depression: A systematic review. World J Psychiatry 2022; 12:187-203. [PMID: 35111588 PMCID: PMC8783161 DOI: 10.5498/wjp.v12.i1.187] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/17/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. METHODS A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide). RESULTS Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. CONCLUSION To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.
Collapse
Affiliation(s)
| | - Yolanda Sanchez-Carro
- Department of Psychiatry, Universidad Autonoma de Madrid, Madrid 28046, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
| | - Luisa Natalia Lagunas
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
| | - Laura Alejandra Rico-Uribe
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Psychology, La Rioja International University, Logrono 26006, Spain
| | - Andres Pemau
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | | | - Marina Diaz-Marsa
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
- Institute of Psychiatry and Mental Health, San Carlos Clinical Hospital, Madrid 28040, Spain
| | - Gonzalo Hervas
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
| |
Collapse
|
5
|
Webb LM, Chen CY. The COVID-19 pandemic's impact on older adults' mental health: Contributing factors, coping strategies, and opportunities for improvement. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5647. [PMID: 34729802 PMCID: PMC8646312 DOI: 10.1002/gps.5647] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Rates of anxiety and depression have increased during the COVID‐19 pandemic in older adults. Younger generations have reported higher rates of anxiety and depression during the pandemic compared to older adults. Factors influencing the risk of mental illness in older adults during the pandemic include sex, age group, location, living situation, socioeconomic status, and medical and psychiatric comorbidities. Strategies for older adults, caregivers, and health‐care providers may mitigate the effects of social isolation on the older adult population.
Collapse
Affiliation(s)
- Lauren M. Webb
- Division of Geriatrics and GerontologyMayo Clinic Alix School of MedicineRochesterMinnesotaUSA
| | - Christina Y. Chen
- Department of Community Internal MedicineMayo ClinicRochesterMinnesotaUSA
| |
Collapse
|
6
|
Mudd J, Larkins S, Watt K. The impact of excess alcohol consumption on health care utilisation in regional patients with chronic disease - a retrospective chart audit. Aust N Z J Public Health 2020; 44:457-461. [PMID: 33044787 DOI: 10.1111/1753-6405.13020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To understand the impact of alcohol consumption on the health utilisation of people with chronic diseases. METHODS A retrospective chart audit was undertaken in two primary care settings in a regional Australian city. Three indicator conditions were selected: type 2 diabetes, chronic obstructive pulmonary disease and chronic kidney disease. The audits were analysed to examine the impact of alcohol consumption on primary care and hospital-based health utilisation. RESULTS A total of 457 records were audited. Alcohol consumption decreased engagement in the primary care setting, with fewer visits, prescriptions and lower primary care costs. There was a U-shaped association between alcohol consumption and hospital attendance rates and costs. Admission rates were unchanged but a decrease in length of stay was observed in non-smokers in the highest alcohol consumption category. CONCLUSION Excess alcohol consumption decreases engagement in primary care and results in increased emergency department attendance, but not admissions to hospital. In those who are admitted to hospital, alcohol is associated with a decreased length of stay. Implications for public health: Alcohol consumption should be considered as a potential cause of decreased engagement in primary care. Follow-up and recall of patients may reduce shifting of care to the hospital environment.
Collapse
Affiliation(s)
- Julie Mudd
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 Discovery Dr, Douglas, Queensland.,College of Medicine and Dentistry, James Cook University, 1 Discovery Dr, Douglas, Queensland
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, 1 Discovery Dr, Douglas, Queensland
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 Discovery Dr, Douglas, Queensland
| |
Collapse
|
7
|
Beeler PE, Cheetham M, Held U, Battegay E. Depression is independently associated with increased length of stay and readmissions in multimorbid inpatients. Eur J Intern Med 2020; 73:59-66. [PMID: 31791574 DOI: 10.1016/j.ejim.2019.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the impact of depression across a broad range of multimorbid patients hospitalized for reasons other than depression. The objective of the study was to investigate in a large sample of multimorbid inpatients whether ancillary depression is associated with increased length of stay (LOS) and readmissions, two important clinical outcomes with implications for healthcare utilization and costs. METHODS We retrospectively analyzed a cohort of 253,009 multimorbid inpatients aged ≥18 at an academic medical center, 8/2009-8/2017. PRIMARY OUTCOME LOS. SECONDARY OUTCOMES LOS related to different main diagnoses, readmissions within 1, 3, 6, 12, and 24-months after discharge. RESULTS Multivariable linear regression showed 24% longer LOS in patients with ancillary depression (1.24; 95% confidence interval [CI]: 1.22, 1.25). Females stayed 22% longer (1.22; 95% CI: 1.20, 1.25), males 24% (1.24; 95% CI: 1.22, 1.27). We identified 16 main diagnosis clusters in which ancillary depression was associated with significant LOS increases, with associations being strongest for "Failure and rejection of transplanted organs and tissues", "Other noninfective gastroenteritis and colitis", and "Other soft tissue disorders, not elsewhere classified". Multivariable logistic and Poisson regression showed independent associations of ancillary depression with increased readmission odds and frequencies at 1, 3, 6, 12, and 24 months. CONCLUSIONS Ancillary depression was independently associated with increased LOS and more readmissions across a broad range of multimorbid inpatients.
Collapse
Affiliation(s)
- P E Beeler
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
| | - M Cheetham
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland.
| | - U Held
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
| | - E Battegay
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
8
|
Pickard JG, Sacco P, van den Berk-Clark C, Cabrera-Nguyen EP. The effect of legal mandates on substance use disorder treatment completion among older adults. Aging Ment Health 2020; 24:497-503. [PMID: 30588828 DOI: 10.1080/13607863.2018.1544209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: This study seeks to determine the relationship between referral type (legally mandated versus non-mandated) and substance use disorder (SUD) treatment completion among older adults and by primary substance used.Method: We used data from the Treatment Episode Data Set - Discharges (TEDS-D) from 2011. Using data for persons age 55 and over (n = 104,747), we used propensity score matching (PSM) to address selection bias and attenuate the likelihood of a type I error. Logistic regression models estimated the effect of referral type on treatment completion based on treatment for a primary substance for five categories of substances.Results: In the matched sample, those who faced treatment mandates had 71% greater odds of completing treatment compared with those who entered treatment voluntarily (OR =1.71, 95% CI [1.64, 1.79]). Based on the primary drug used, odds of treatment completion were highest for alcohol, with 86% greater treatment completion for the mandated individuals compared with those entering treatment without a legal mandate (OR =1.86, 95% CI [1.75, 1.97]).Conclusion: These findings suggest that the motivating influence of treatment mandates may encourage completion of SUD treatment among older adults. Although the legal mandates for treatment are punitive, they may act to keep older adults with SUD engaged in treatment, an important factor as treatment completion is inversely related to relapse of a SUD.
Collapse
Affiliation(s)
- Joseph G Pickard
- University of Missouri-St. Louis, School of Social Work, St. Louis, MO, USA
| | - Paul Sacco
- University of Maryland-Baltimore, School of Social Work, Baltimore, MD, USA
| | - Carissa van den Berk-Clark
- Saint Louis University School of Medicine, Department of Family and Community Medicine, St. Louis, MO, USA
| | | |
Collapse
|
9
|
Guo Y, Sun J, Hu S, Nicholas S, Wang J. Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193526. [PMID: 31547207 PMCID: PMC6801864 DOI: 10.3390/ijerph16193526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 01/24/2023]
Abstract
Background: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families’ financial burden. Methods: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital’s information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. Results: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children’s mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). Conclusions: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty—insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China’s health insurance schemes—especially to allow migrant families to gain basic medical insurance.
Collapse
Affiliation(s)
- Yawei Guo
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China.
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jian 250014, China.
| | - Simeng Hu
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China.
| | - Stephen Nicholas
- School of Management and School of Economics, Tianjin Normal University, West Bin Shui Avenue, Tianjin 300074, China.
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2038, Australia.
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun, Guangzhou, Guangdong 510420, China.
- Top Education Institute, 1 Central Avenue, Australian Technology Park, Eveleigh, Sydney, NSW 2015, Australia.
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, No.54 Dongsi Lishi Hutong, Dongcheng District, Beijing 100010, China.
- Center for Health Economics and Management at School of Economics and Management, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, Hubei Province 430072, China.
| |
Collapse
|
10
|
Wani RJ, Tak HJ, Watanabe-Galloway S, Klepser DG, Wehbi NK, Chen LW, Wilson FA. Predictors and Costs of 30-Day Readmissions After Index Hospitalizations for Alcohol-Related Disorders in U.S. Adults. Alcohol Clin Exp Res 2019; 43:857-868. [PMID: 30861148 DOI: 10.1111/acer.14021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2015, the Hospital Readmissions Reduction Program mandated financial penalties to hospitals with greater rates of readmissions for certain conditions. Alcohol-related disorders (ARD) are the fourth leading cause of 30-day readmissions. Yet, there is a dearth of national-level research to identify high-risk patient populations and predictors of 30-day readmission. This study examined patient- and hospital-level predictors for index hospitalizations with principal diagnosis of ARD and predicted the cost of 30-day readmissions. METHODS The 2014 Nationwide Readmissions Database was used to identify ARD-related index hospitalizations. Multivariable logistic regression was used to estimate patient- and hospital-level predictors for readmissions, and a 2-part model was used to predict the incremental cost conditional upon readmission. RESULTS In 2014, 285,767 index hospitalizations for ARD were recorded, and 18.9% of ARD-associated hospitalizations resulted in at least one 30-day readmission. Patients who were males, aged 45 to 64 years, Medicaid enrollees, living in urban and low-income areas, or with 1 to 2 comorbidities had high risk of readmission. Index hospitalization costs were higher among readmitted patients ($8,840 vs. $8,036, p < 0.01). Predicted mean costs for readmissions on index stay with ARD were greater among those aged 45 to 64 years ($1,908, p < 0.001), Medicare enrollees ($2,133, p < 0.001), rural residents ($1,841, p < 0.01), living in high-income areas ($1,876, p < 0.001), with 4 or more comorbidities ($2,415, p < 0.001), or admitted in large metropolitan hospitals ($2,032, p < 0.001), with large number of beds ($1,964, p < 0.001), with government ownership ($2,109, p < 0.001), or with low volume of ARD cases ($2,155, p < 0.001). CONCLUSIONS One in 5 ARD-related index hospitalizations resulted in a 30-day readmission. Overall, costs of index hospitalizations for ARD were $2.3 billion, of which $512 million were spent on hospitalizations that resulted in at least 1 readmission. There is a need to develop patient-centric health programs to reduce readmission rates and costs among ARD patients.
Collapse
Affiliation(s)
- Rajvi J Wani
- College of Education and Human Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Hyo Jung Tak
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Donald G Klepser
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nizar K Wehbi
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Li-Wu Chen
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Fernando A Wilson
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| |
Collapse
|
11
|
Pavkovic B, Zaric M, Markovic M, Klacar M, Huljic A, Caricic A. Double screening for dual disorder, alcoholism and depression. Psychiatry Res 2018; 270:483-489. [PMID: 30326431 DOI: 10.1016/j.psychres.2018.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 01/20/2023]
Abstract
Comorbidity of alcohol use disorder and major depressive disorder has been reported in samples. The aim of this study was to examine the relationship between alcoholism and depression in undiagnosed patients by simultaneously applying screening tests for both disorders. A total of 421 subjects were included in the study, of which 246 were female. Two screening tests, the Michigan Alcoholism Screening Test and the Beck Depression Inventory, were used. In the total sample, 28.03% of the respondents engaged in some type of harmful alcohol use and 55.82% experienced some level of depression; 24.70% of the respondents had both at the same time, some type of harmful alcohol use and some level of depression. Results of statistical analysis showed that a more problematic alcohol use type was associated with a more severe level of depression, with a greater positive association between problematic alcohol use and severity of depressive symptoms among females and more harmful alcohol consumption among males. This study points to the importance of screening for alcoholism and depression, because their timely detection and treatment improves the quality of life in newly diagnosed individuals and reduces the economic burden on society for health services due to greater use if a greater severity of dual disorder is reached.
Collapse
Affiliation(s)
- Bojan Pavkovic
- Health Center "Dr Simo Milosevic", Požeška 82, Čukarica, Belgrade 11231, Serbia.
| | - Marija Zaric
- Health Center "Dr Simo Milosevic", Požeška 82, Čukarica, Belgrade 11231, Serbia
| | - Mirjana Markovic
- Health Center "Dr Simo Milosevic", Požeška 82, Čukarica, Belgrade 11231, Serbia
| | - Marija Klacar
- Health Center "Dr Simo Milosevic", Požeška 82, Čukarica, Belgrade 11231, Serbia
| | - Aleksandra Huljic
- Health Center "Dr Simo Milosevic", Požeška 82, Čukarica, Belgrade 11231, Serbia
| | - Aleksandra Caricic
- Health Center "Dr Simo Milosevic", Požeška 82, Čukarica, Belgrade 11231, Serbia
| |
Collapse
|
12
|
Ostergaard M, Jatzkowski L, Seitz R, Speidel S, Weber T, Lübke N, Höcker W, Odenwald M. Integrated Treatment at the First Stage: Increasing Motivation for Alcohol Patients with Comorbid Disorders during Inpatient Detoxification. Alcohol Alcohol 2018; 53:719-727. [DOI: 10.1093/alcalc/agy066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mathias Ostergaard
- Department of Clinical Psychology, University of Konstanz, Universitätsstr. 10, Konstanz, Germany
- Forel Clinic, 8548 Ellikon an der Thur, Switzerland
| | - Leonie Jatzkowski
- Department of Clinical Psychology, University of Konstanz, Universitätsstr. 10, Konstanz, Germany
| | - Raffaela Seitz
- Department of Clinical Psychology, University of Konstanz, Universitätsstr. 10, Konstanz, Germany
| | - Samantha Speidel
- Department of Clinical Psychology, University of Konstanz, Universitätsstr. 10, Konstanz, Germany
| | - Tanja Weber
- Centre for Psychiatry Reichenau, Reichenau, Germany
| | - Norbert Lübke
- Psychiatric Services Thurgau, Münsterlingen, Switzerland
| | | | - Michael Odenwald
- Department of Clinical Psychology, University of Konstanz, Universitätsstr. 10, Konstanz, Germany
- Centre for Psychiatry Reichenau, Reichenau, Germany
| |
Collapse
|
13
|
Nehlin C, Arinell H, Dyster-Aas J, Jess K. Alcohol Habits and Health Care Use in Patients with Psychiatric Disorders. J Dual Diagn 2017; 13:247-253. [PMID: 28665254 DOI: 10.1080/15504263.2017.1347307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE It is common for persons with psychiatric disorders to also have alcohol problems. Studies in the general population as well as in clinical samples have found hazardous or harmful alcohol habits to be particularly prevalent in the presence of psychiatric disorders. This study sought to explore the relationships between drinking habits and health care utilization (psychiatric as well as general medical) in persons seeking psychiatric treatment and to investigate the associations among age, sex, and type or number of diagnoses and health care use and costs. For the planning of targeted interventions, we also sought to identify subgroups with a high prevalence of hazardous drinking habits. METHODS From a psychiatric clinic for affective disorders at a university hospital in Sweden, patients who had been screened for hazardous drinking (N = 609) were selected. Patients with primary psychosis or substance use disorder receive treatment at other clinics and did not participate. Medical records data were grouped and compared. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used for diagnoses and the Alcohol Use Disorders Identification Test for screening. Patients were grouped by drinking habits and sex, age, and diagnosis group, and their psychiatric as well as general medical health care use was compared. RESULTS Abstainers used psychiatric care more than all other drinking groups (p < .001). Psychiatric health care costs were higher in abstainers and low-risk drinkers (1.64 to 1). No differences in general medical care could be identified between drinking groups. Specific subgroups with higher rates of hazardous drinking could not be identified (44% of all males and 34% of all females reported such habits). Inconclusive results from previous research are most likely due to different methods used to classify drinking problems. CONCLUSIONS Abstainers and low-risk drinkers used psychiatric health care to a higher cost than the other drinking groups. Possible explanations are discussed from a clinical and scientific perspective. This study clarifies the need for uniform measures when classifying alcohol use in studies of relationships between alcohol use and health care use. There is also a need to separate former drinkers from abstainers in future studies.
Collapse
Affiliation(s)
- Christina Nehlin
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden.,b Division of Psychiatry , Uppsala University Hospital , Uppsala , Sweden
| | - Hans Arinell
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Johan Dyster-Aas
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden.,b Division of Psychiatry , Uppsala University Hospital , Uppsala , Sweden
| | - Kari Jess
- c School of Education, Health & Social Studies , Dalarna University , Falun , Sweden
| |
Collapse
|
14
|
Lee S, Herrin J, Bobo WV, Johnson R, Sangaralingham LR, Campbell RL. Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005-2013. West J Emerg Med 2017; 18:884-893. [PMID: 28874941 PMCID: PMC5576625 DOI: 10.5811/westjem.2017.6.33850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/08/2017] [Accepted: 06/26/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Our goal was to describe the pattern and identify risk factors of early-return ED visits or inpatient admissions following an index mental health and substance abuse (MHSA)-related ED visit in the United States. METHODS We performed a retrospective cohort study using Optum Labs Data Warehouse, a nationally representative database containing administrative claims data on privately insured and Medicare Advantage enrollees. Authors identified patients presenting to an ED with a primary diagnosis of MHSA between 2005 and 2013 who were discharged home. Study inclusion required continuous insurance enrollment for the 12 months preceding and the 31 days following the index ED visit. During the study period we included only the first ED visit for each patient. RESULTS A total of 49,672 (14.2%) had a return visit to the ED or had a hospitalization within 30 days following discharge. Mean time to the next ED visit or inpatient admission was 11.7 days. An increased age (age 65+ vs. age <18 years; OR 1.65, 95% CI [1.57 to 1.74]), chronic medical comorbidities (Hwang comorbidity 5+ vs 0; OR 1.31, 95% CI [1.27 to 1.35]), prior ED and inpatient utilization (4+ visits vs 0 visits; OR 5.59, 95% CI [5.41 to 5.78]) were associated with return visits within 30 days following discharge. CONCLUSION In an analysis of nearly 350,000 ED visits for MHSA, 14.2 % of patients returned to the ED or hospital within 30 days. This study identified a number of factors associated with return visits for acute care.
Collapse
Affiliation(s)
- Sangil Lee
- The University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
| | - Jeph Herrin
- Yale University School of Medicine, Department of Cardiology, New Havens, Connecticut.,Health Research & Educational Trust, Chicago, Illinois
| | - William V Bobo
- Mayo Clinic, Department of Psychiatry, Rochester, Minnesota
| | - Ryan Johnson
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Ronna L Campbell
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| |
Collapse
|