Top

Published in:

01-10-2008 | Original Paper

Longitudinal Patterns of Health System Retention Among Veterans with Schizophrenia or Bipolar Disorder

Authors: Ellen P. Fischer, John F. McCarthy, Rosalinda V. Ignacio, Frederic C. Blow, Kristen L. Barry, Teresa J. Hudson, Richard R. Owen Jr., Marcia Valenstein

Published in: Community Mental Health Journal | Issue 5/2008

Abstract

Inconsistent service use for schizophrenia and bipolar disorder is associated with poorer outcomes of care. We analyzed VHA National Psychosis Registry data for 164,150 veterans with these disorders to identify characteristics associated with 5-year patterns of survival and with retention in VHA care. Most cohort members (63%) survived the period with no break in VHA healthcare lasting over 12 months. Inconsistent utilization was associated with younger age, no service-connected disability, and less physical comorbidity, regardless of diagnosis. The influence of gender and ethnicity on attrition varied by diagnosis and gap-duration. Variation in attrition by gender and ethnicity warrants additional attention.

Allison, P. D. (1999). Logistic regression using the SAS system: Theory and application. Cary, NC: SAS Institute Inc.

Barry, K. L., Blow, F. C., Baker, R., Brockmann, L., & Leibfried, T. (1999). Veterans with psychosis in the VHA FY 89–FY 98: Access to care, loss to follow-up and mortality. White paper report to the Department of Veterans Affairs. Ann Arbor, MI: Serious Mental Illness Treatment Research & Evaluation Center (SMITREC), Health Services Research and Development Service, VA Ann Arbor Healthcare System.

Blow, F. C., McCarthy, J. F., Valenstein, M., Austin, K., Zeber, J. E., & Gillon, L. (2004a). Care for veterans with psychosis in the Veterans Health Administration: FY03. Ann Arbor, MI: Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Health Services Research and Development Service, VA Ann Arbor Healthcare System.

Blow, F. C., Zeber, J. E., McCarthy, J. F., Valenstein, M., Gillon, L., & Bingham, R. C. (2004b). Ethnicity and diagnostic patterns in veterans with psychoses. Social Psychiatry and Psychiatric Epidemiology, 39, 841–851.PubMed

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.PubMedCrossRef

Cowper, D. C., Hynes, D. M., Kubal, J. D., & Murphy, P. A. (1999). Using administrative databases for outcomes research: Select examples from VA Health Services Research and Development. Journal of Medical Systems, 23(3), 249–259.PubMedCrossRef

de Groot, V., Beckerman, H., Lankhorst, G. J., & Bouter, L. M. (2003). How to measure comorbidity: A critical review of available methods. Journal of Clinical Epidemiology, 56, 221–229.PubMedCrossRef

Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Retrieved November 7, 2006, from http://www.surgeongeneral.gov/library/mentalhealth/home.html.

Department of Veterans Affairs Work Group on the President’s New Freedom Commission on Mental Health Report. (2003). Achieving the promise—transforming mental health care in VA. The Department of Veterans Affairs action agenda. Washington, DC.

Desai, M. M., & Rosenheck, R. A. (2003). Trends in discharge disposition, mortality, and service use among long-stay psychiatric patients in the 1990s. Psychiatric Services, 54(4), 542–548.PubMedCrossRef

Fagiolini, A., Kupfer, D. J., Rucci, P., Scott, J. A., Novick, D. M., & Frank, E. (2004). Suicide attempts and ideation in patients with bipolar I disorder. Journal of Clinical Psychiatry, 65(4), 509–514.PubMedCrossRef

Fischer, E. P., Owen, R. R., & Cuffel, B. J. (1996). Substance abuse, community service use, and symptom severity of urban and rural residents with schizophrenia. Psychiatric Services, 47(9), 980–984.PubMed

Hoff, R. A., & Rosenheck, R. A. (1997). Utilization of mental health services by women in a male-dominated environment: The VA experience. Psychiatric Services, 48(11), 1408–1414.PubMed

Hoff, R. A., & Rosenheck, R. A. (1998a). The use of VA and non-VA mental health services by female veterans. Medical Care, 36(11), 1524–1533.PubMedCrossRef

Hoff, R. A., & Rosenheck, R. A. (1998b). Female veterans’ use of Department of Veterans Affairs health care services. Medical Care, 36(7), 1114–1119.PubMedCrossRef

Hoff, R. A., & Rosenheck, R. A. (2000). Cross-system service use among psychiatric patients: Data from the Department of Veterans Affairs. Journal of Behavioral Health Services & Research, 27(1), 98–106.CrossRef

Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression analysis (2nd ed.). New York, NY: John Wiley & Sons.

Kessler, R. C., Berglund, P. A., Bruce, M. L., Koch, J. R., Laska, E. M., Leaf, P. J., et al. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36(6 Pt 1), 987–1007.PubMed

Killaspy, H., Banerjee, S., King, M., & Lloyd, M. (2000). Prospective controlled study of psychiatric out-patient non-attendance: Characteristics and outcome. British Journal of Psychiatry, 176, 160–165.PubMedCrossRef

Kubal, J. D., Webber, S., Cowper, D. C., Waight, S., & Hynes, D. M. (2000). VIReC insights: A primer on major U.S. mortality databases used in health services research (Rep. No. 5). Hines, IL: VA Information Resource Center.

McCarthy, J. F., & Blow, F. C. (2004). Older patients with serious mental illness: Sensitivity to distance barriers for outpatient care. Medical Care, 42(11), 1073–1080.PubMedCrossRef

McIntyre, R. S., & Konarski, J. Z. (2004). Bipolar disorder: A national health concern. CNS Spectrums, 9(11 Suppl 12), 6–15.PubMed

Murdoch, M., Hodges, J., Cowper, D., Fortier, L., & van Ryn, M. (2003a). Racial disparities in VA service connection for posttraumatic stress disorder disability. Medical Care, 41(4), 536–549.PubMedCrossRef

Murdoch, M., Hodges, J., Hunt, C., Cowper, D., Kressin, N., & O’Brien, N. (2003b). Gender differences in service connection for PTSD. Medical Care, 41(8), 950–961.PubMedCrossRef

Narrow, W. E., Regier, D. A., Norquist, G., Rae, D. S., Kennedy, C., & Arons, B. (2000). Mental health service use by Americans with severe mental illnesses. Social Psychiatry & Psychiatric Epidemiology, 35(4), 147–155.CrossRef

New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Executive summary. Rockville, MD: DHHS Pub. No. SMA-03-3831.

Nosé, M., Barbui, C., & Tansella, M. (2003). How often do patients with psychosis fail to adhere to treatment programs? A systematic review. Psychological Medicine, 33, 1149–1160.PubMedCrossRef

Ouimette, P., Wolfe, J., Daley, J., & Gima, K. (2003). Use of VA health care services by women veterans: Findings from a national sample. Women & Health, 38(2), 77–91.CrossRef

Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system: Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50(2), 85–94.PubMed

Richardson, C. & Waldrop, J. (2003). Veterans 2000. Census 2000 Brief. Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, Census 2000, May 2003.

Sajatovic, M., Davies, M., & Hrouda, D. R. (2004). Enhancement of treatment adherence among patients with bipolar disorder. Psychiatry Services, 55(3), 264–269.CrossRef

Sajatovic, M., Vernon, L., & Semple, W. (1997). Clinical characteristics and health resource use of men and women veterans with serious mental illness. Psychiatric Services, 48(11), 1461–1463.PubMed

Stokes, M. E., Davis, C. S., & Koch, G. G. (2000). Categorial data analysis using the SAS system (2nd ed.). Cary, NC: SAS Institute, Inc.

Swann, A. C. (2005). Long-term treatment in bipolar disorder. Journal of Clinical Psychiatry, 66(Suppl 1), 7–12.PubMed

VHA Directive 2003-068. (2003). Process for managing patients when demand exceeds current clinical capacity. Washington, DC, Department of Veterans Affairs, Veterans Health Administration, December 11, 2003.

VHA Directive 2006-028. (2006). Process for ensuring timely access to outpatient clinical care. Washington, DC, Department of Veterans Affairs, Veterans Health Administration, May 8, 2006.

Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629–640.PubMedCrossRef

Washington, D. L., Caffrey, C., Goldzweig, C., Simon, B., & Yano, E. M. (2003). Availability of comprehensive women’s health care through Department of Veterans Affairs Medical Center. Women’s Health Issues, 13, 50–54.PubMedCrossRef

Weiden, P. J., & Olfson, M. (1995). Cost of relapse in schizophrenia. Schizophrenia Bulletin, 21(3), 419–429.PubMed

Weiss, T. W. (1995). Improvements in VA health services for women veterans. Women and Health, 23(2), 1–12.CrossRef

Westfall, P. H., Tobias, R. D., Rom D., Wolfinger, R. D., & Hochberg, Y. (1999). Multiple comparisons and multiple tests using the SAS ^® system. Cary, NC: SAS Institute Inc.

Yano, E. M., Washington, D. L., Goldzweig, C., Caffrey, C., & Turner, C. (2003). The organization and delivery of women’s health care in Department of Veterans Affairs Medical Center. Women’s Health Issues, 13, 55–61.PubMedCrossRef

Young, A. S., Grusky, O., Jordan, D., & Belin, T. R. (2000). Routine outcome monitoring in a public mental health system: The impact of patients who leave care. Psychiatric Services, 51(1), 85–91.PubMed

Title: Longitudinal Patterns of Health System Retention Among Veterans with Schizophrenia or Bipolar Disorder
Authors: Ellen P. Fischer
John F. McCarthy
Rosalinda V. Ignacio
Frederic C. Blow
Kristen L. Barry
Teresa J. Hudson
Richard R. Owen Jr.
Marcia Valenstein
Publication date: 01-10-2008
Publisher: Springer US
Published in: Community Mental Health Journal / Issue 5/2008
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI: https://doi.org/10.1007/s10597-008-9133-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Longitudinal Patterns of Health System Retention Among Veterans with Schizophrenia or Bipolar Disorder

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2008

Hepatitis C Services and Individuals with Serious Mental Illness

Relationship Between Functional Capacity and Community Responsibility in Patients with Schizophrenia: Differences Between Independent and Assisted Living Settings

Attitudes and Perceived Barriers to Working with Families of Persons with Severe Mental Illness: Mental Health Professionals’ Perspectives

Increasing Social Support for Individuals with Serious Mental Illness: Evaluating the Compeer Model of Intentional Friendship

Client-level Measures of Services Integration Among Chronically Homeless Adults

Family Contact and the Management of Medication Non-adherence in Schizophrenia