Preventive service use among people with and without serious mental illnesses.
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Introduction People with serious mental illnesses experience excess morbidity and premature mortality resulting from preventable conditions. The goal was to examine disparities in preventive care that might account for poor health outcomes.Methods In this retrospective cohort study, adults (N=803,276) served by Kaiser Permanente Northwest and federally qualified health centers/safety-net community health clinics were categorized into five groups: schizophrenia spectrum disorders, bipolar disorders/affective psychoses, anxiety disorders, nonpsychotic unipolar depression, and reference groups with no evidence of these specific mental illnesses. The primary outcome was overall preventive care-gap rate, the proportion of incomplete preventive services for which each patient was eligible in 2012-2013. Secondary analyses examined Kaiser Permanente Northwest data from 2002 to 2013. Data were analyzed in 2015.Results Controlling for patient characteristics and health services use, Kaiser Permanente Northwest mean care-gap rates were significantly lower for bipolar disorders/affective psychoses (mean=18.6, p<0.001) and depression groups (mean=18.6, p<0.001) compared with the reference group. Schizophrenia (mean=19.4, p=0.236) and anxiety groups (mean=19.9, p=0.060) did not differ from the reference group (mean=20.3). In community health clinics, schizophrenia (mean=34.1, p<0.001), bipolar/affective psychosis (mean=35.7, p<0.001), anxiety (mean=38.5, p<0.001), and depression groups (mean=36.3, p<0.001) had significantly lower care-gap rates than those in the reference group (mean=40.0). Secondary analyses of diabetes and dyslipidemia screening trends in Kaiser Permanente Northwest showed diagnostic groups consistently had fewer care gaps than patients in the reference group.Conclusions In vastly different settings, individuals with serious mental illnesses received preventive services at equal or better rates than the general population.
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The population suicide risk distribution was calibrated to reproduce suicide attempt and suicide death rates of 175 per 100,000 person-years and 15 per 100,000 person-years, and a fraction of suicide attempts preceded by a prior attempt of 54%.
“We calibrated the population suicide risk distribution to reproduce the following outcomes: suicide attempt and suicide death rates of 175 per 100 000 person-years and 15 per 100 000 person-years, derived from individuals 15 years or older in national emergency department and inpatient databases,20 and fraction of suicide attempts preceded by a prior attempt of 54%, drawn from the National Epidemi”
From Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US (2021) · cites this paper as [21]
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- Authors
- Yarborough, B. J. H., Perrin, N. A., Stumbo, S. P., Muench, J., & Green, C. A.
- Affiliations
- Kaiser Permanente (US)
- Oregon Health & Science University (US)
- Corresponding author
- Yarborough, Bobbi Jo H.
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 54
- Issue
- 1
- Pages
- 1-9
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC5736432
- OpenAlex
- W2766142825
- Cited by
- 13
- References
- 39
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 1 · 2018: 4
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Preventive Medicine (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH096795)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- severe mental illness, preventive medicine, care gaps, health disparities, schizophrenia spectrum disorders, bipolar disorder, affective psychosis, anxiety disorders, depression, community clinics, safety net health care, Kaiser Permanente, diabetes screening, dyslipidemia screening
- MeSH terms
- Adult, Mental Disorders, Community Health Centers, Female, Humans, Male, Mental Health Services, Middle Aged, Preventive Health Services, United States, Safety-net Providers
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