In young patients with SLE, psychiatric comorbidity linked to greater use of health care
SAN DIEGO — Young patients with systemic lupus erythematosus and co-existing psychiatric conditions appear to have greater health care utilization in ambulatory settings in the year after SLE diagnosis. In addition, findings presented at the American College of Rheumatology Annual Meeting linked diagnosis with a new psychiatric condition in this time with greater use of acute care.
“In an adult with lupus, depression has been found to be associated with increased outpatient and emergency visits,” Andrea M. Knight, MD, MSCE, said in during her presentation. “We don’t know that much about the impact of psychiatric comorbidity on health care utilization in youth with lupus. Therefore, we aim to determine the association of psychiatric comorbidity with medical or non-psychiatric services utilization in youth with nuances of lupus.”
In the retrospective cohort study, Knight and colleagues searched a large U.S. database of privately insured patients for administrative claims from 2000 to 2013. They identified 650 patients aged 10 to 24 years (mean age, 18.4 years; 88% were female; 25% with nephritis) with an incident diagnosis of SLE.
They stratified patients into the following three mutually exclusive SLE groups: those with no psychiatric diagnosis; those with a psychiatric diagnosis in the 12 months prior to SLE diagnosis; and those with an incident psychiatric diagnosis in the 12 months after diagnosis of SLE. They determined the mean ambulatory, emergency and inpatient medical encounters in the year after SLE diagnosis. The groups were compared by number of medical visits, and the findings were adjusted for demographic and disease factors.
Researchers found 19% of patients had a psychiatric diagnosis prior to SLE diagnosis, while 16% had an incident psychiatric diagnosis in the year after SLE diagnosis.
patients were diagnosed with depression; 14% were diagnosed with anxiety; and 32% were diagnosed with other psychiatric disorders.
djusted models revealed that compared to patients without a psychiatric diagnosis, greater mean ambulatory visits were seen in those with previous psychiatric diagnoses and those with incident diagnoses (11.6, 14.4 and 18.1 visits, respectively). Acute care visits were more frequent in those with an incident psychiatric diagnosis vs. those without a psychiatric diagnosis (9.5 vs. 5.1 for emergency and 4.9 vs. 2.8 for inpatient). There was no statistically significant difference in patients with preceding psychiatric diagnosis vs. the other two groups in terms of mean emergency or mean inpatient visits.
“We found that new-onset lupus and psychiatric comorbidity have higher health care utilization in ambulatory and acute care settings,” Knight said. “Further investigation is needed to identify the causal factors for this relationship. There is potential for interventions to address psychiatric comorbidity that may decrease health care burden. These may include early identification of mental health conditions, improved mental health resources for rheumatology patients, and improved primary care physician education and collaboration with rheumatologists.” -by Jennifer Byrne
Knight AM, et al. Abstract # 2810; Presented at: American College of Rheumatology Annual Meeting; Nov. 4-8, 2017; San Diego.
Disclosures: The authors report no relevant disclosures.