Elsevier

General Hospital Psychiatry

Volume 31, Issue 1, January–February 2009, Pages 33-35
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Health care utilisation and quality of life in individuals with diabetes and comorbid mental disorders

https://doi.org/10.1016/j.genhosppsych.2008.09.008Get rights and content

Abstract

Objective

To investigate the association of comorbid mental disorders with health care utilisation and quality of life (QoL) in persons with diabetes (PWD).

Method

Data were drawn from the German National Health Interview and Examination Survey (GNHIES). Mental disorders in PWD (n=146) were assessed by means of a standardised clinical interview for mental disorders (M-CIDI). Health care utilisation was assessed by using self-report questionnaires and QoL by using the SF-36.

Results

Controlling for age and sex, mental comorbidity was significantly associated with reduced QoL scores on all SF-36 subscales, except for “bodily pain”. The frequency of physician visits was (insignificantly) higher in PWD with mental disorders compared to PWD without (20.7 vs. 14.4). Among PWD with mental disorders (n=40), only seven individuals reported mental health specialist visits. Mental comorbidity was not associated with hospitalisation days, disability days or utilisation of diabetes-related preventive services.

Conclusions

Comorbid mental disorders were found to be associated with lowered psychosocial and physical aspects of QoL in a nationally representative sample of PWD. Associations with health care utilisation were less consistent. The low rate of mental health specialist visits in PWD with comorbid mental disorders may indicate an under-use of appropriate health care services.

Introduction

The present study examines the association of comorbid mental disorders with health care utilisation and quality of life (QoL) among persons with diabetes (PWD). The following questions are addressed: (1) Do PWD with and without mental comorbidity differ with respect to patterns of health care utilisation? (2) Are comorbid mental disorders in PWD associated with a reduced QoL?

Section snippets

Methods

PWD were recruited in the framework of the German National Health Interview and Examination Survey (GNHIES) [1]. In addition to self-administered questionnaires, participants completed a standardised computer-assisted personal interview (CAPI) conducted by trained study physicians. A definition of diabetes mellitus was based on the question: ‘Has a doctor ever told you …?’ All participants were screened for mental disorders (CIDI-S; N=7124). Subjects aged 65 years and younger who screened

Results

The total sample consisted of 146 PWD. Among these, 40 persons fulfilled the criteria for a mental disorder. PWD with mental disorders reported more physician visits than PWD without, although this difference was not significant (Table 1). Frequencies of mental health specialist visits did not differ significantly between the groups. Among 40 PWD with mental disorders, only seven individuals reported mental health specialist visits. Concerning hospitalisation days, PWD without mental disorders

Discussion

Comorbid mental disorders were found to be associated with lowered QoL in a nationally representative sample of PWD controlling for age and sex. This is shown not only for the psychosocial aspects of QoL, but also for some somatic aspects. These findings are supported by the results of a recent literature review, which demonstrated a negative relationship between QoL and somatic as well as psychiatric comorbidities among chronically ill patients [4].

Associations with health care utilisation

Acknowledgments

We would like to thank the Max Planck Institute for Psychiatry and the Department of Psychology and Psychotherapy of the TU Dresden for providing the GNHIES-MHS survey data [12].

References (12)

There are more references available in the full text version of this article.

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The authors declare that there is no duality of interest associated with this manuscript.

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