Biomedical subjects

D A Regier

Publications and source records attributed to D A Regier.

82 records · Page 5Linked to original sources

PubMed1980

Utilization of health and mental health services in a large insured population.

The authors analyzed 1975 data on the use of health and mental health services by the 2.3 million people covered by Michigan Blue Cross and Blue Shield. Only 4.6% of the covered population submitted hospital or physician claims for mental disorder; these people accounted for 7.3% of total hospital and physician charges for all health services in the covered population. According to the claims submitted, nonpsychiatric physicians saw almost half of all patients who were given a diagnosis of mental disorder, but psychiatrists accounted for the great bulk of mental health services and charges to these patients. High utilizers comprise a small proportion of all patients but account for a high proportion of charges for mental disorders and for all diagnoses.

Adolescent↗

PubMed1979

The role of the pediatrician in the delivery of mental health services to children.

Nine pediatricians reported on all patients seen during a four-week period in January and February 1976 in Monroe County, N.Y., to determine the prevalence and nature of mental health problems seen in their practices, the characteristics of the affected children, and the treatment provided to them. Of the 3,742 patients seen, 187, or 5.0%,were reported to have an emotional, behavioral, or school problem. The prevalence rate ranged from 1.4% to 7.8% by pediatrician, with five reporting rates within +/- 1.2% of the mean. High rates were associated with children in the 7 to 14 year age group (9.9%), those on Medicaid (8.6%), those who were not living with a father (10.9%), those whose presenting complaint was a chronic physical condition (11.7%), and children with a disease of the digestive system (16.7%) or with ""symptoms, signs and ill-defined conditions'' (14.3%). Functional impairment was reported to be moderate or severe in 40% of the 187 children with mental health problems. The most frequently reported problems (primary or otherwise) were adaptation reaction (22.5%), specific learning disorder (19.3%), hyperkinetic disorder (19.3%), psychosomatic disorder (12.8%), and conduct disorder (12.8%). The most frequent form of treatment provided was supportive therapy or counseling (85.6%) and suggestions regarding environmental changes (43.3%). Drugs were prescribed for 16.0% of the affected children, with 6.4% receiving methylphenidate or amphetamines. Referral for psychological care or consultation was made for 36.9%. The frequency of mental health problems observed by the pediatricians was about five times the annual rate of Monroe County children contacting a psychiatric inpatient or outpatient setting.

Adolescent↗

PubMed1978

The de facto US mental health services system: a public health perspective.

The President's Commission on Mental Health has highlighted a heretofore unmet need for the linkage of data on the prevalence of mental disorder with national data on the use of mental health services. This study analyzes available epidemiological data and recent mental health services research findings to estimate the percent of the population with a mental disorder and the proportion utilizing various types of specialty mental health and general medical treatment settings. Provisional estimates indicate that at least 15% of the US population is affected by mental disorders in one year. In 1975, only one fifth of these were served in the specialty mental health sector, with about three fifths identified in the general medical (primary care) sector.

Commission on Professional and Hospital Activities↗

PubMedDate not supplied

Children's access to mental health care: does insurance matter?

Using data from a 1992 community survey of children and their parents (or guardians), we found major gaps in mental health insurance coverage. Interestingly, private insurance had no statistically significant effect on use of mental health services. Youth without insurance coverage and those with public insurance had higher rates of serious emotional disorder than did those with private insurance. The analysis is based on the National Institute of Mental Health's Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, conducted in three mainland U.S. sites and in Puerto Rico.

Adolescent↗

PubMedDate not supplied

Uses of ambulatory health/mental health utilization data in organized health care settings.

A follow-up assessing uses of findings from NIMH-supported research on health and mental health services utilization in organized health care settings revealed a range of applications across the study sites. The research, conducted primarily for national policy purposes, had an impact on study sites in the following areas: clinician perceptions and attitudes about mental health services provided; program directions; fiscal policy; and further related research. Research team composition and dissemination of study findings are discussed in relation to the applications made.

Attitude of Health Personnel↗

PubMedDate not supplied

Estimating the prevalence of mental disorders in U.S. adults from the Epidemiologic Catchment Area Survey.

The National Institute of Mental Health Epidemiologic Catchment Area Survey is a comprehensive, community-based survey of mental disorders and use of services by adults, ages 18 and older. Diagnoses are based on the criteria in the "Diagnostic and Statistical Manual of Mental Disorders," third edition, and were obtained in five communities in the United States through lay-interviewer administration of the National Institute of Mental Health Diagnostic Interview Schedule. Results from the survey provide the public health field with data on the prevalence and incidence of specific mental disorders in the community, unbiased by the treatment status of the sample. The population with disorders is estimated, and the survey findings that respond to some of the most common requests for information about the epidemiology of mental disorders in the United States are highlighted briefly. Based on the survey, it is estimated that one of every five persons in the United States suffers from a mental disorder in any 6-month period, and that one of every three persons suffers a disorder in his or her lifetime. Fewer than 20 percent of those with a recent mental disorder seek help for their problem, according to the survey. High rates of comorbid substance abuse and mental disorders were found, particularly among those who had sought treatment for their disorders.

Ambulatory Care Facilities↗

PubMedDate not supplied

Suicide attempts in the Epidemiologic Catchment Area Study.

This study examines risk factors for attempted suicide in the general community. Data from the five-site NIMH Epidemiologic Catchment Area (ECA) Study were used to estimate lifetime prevalence and identify risk factors for suicide attempts. Occurrence of suicide attempts and lifetime diagnosis of psychiatric disorder were ascertained, using the NIMH Diagnostic Interview Schedule (DIS). Of 18,571 adult respondents aged 18 and over, 2.9 percent reported that they had attempted suicide at some time in their lives. A weighted logistic regression model was constructed to ascertain significant (p less than .0028 with Bonferroni correction) risk factors for attempted suicide. Persons who had a lifetime diagnosis of a psychiatric disorder had the highest risk of attempted suicide (odds ratio [OR] = 8.4). Females (OR = 3.3), separated or divorced persons (OR = 2.5), Whites (OR = 1.7), persons in the two lowest socioeconomic quartiles (ORs = 2.2, 2.3), and respondents from the Los Angeles ECA (OR = 1.8) were also more likely to have attempted suicide. These findings contribute to an understanding of suicide and suicidal behavior in general populations, outside the clinical setting.

Adolescent↗

PubMedDate not supplied

The Epidemiologic Catchment Area Program of the National Institute of Mental Health.

We hope that the ECA Program can make a significant, and perhaps unique, contribution to the field of psychiatric epidemiology and to mental health services research. If the Program provides total true prevalence data on mental disorders according to the latest diagnostic criteria, that in itself will be a significant contribution. Such data should be of enormous benefit to those interested in etiology as well as those interested in health services research. For researchers interested in etiology, the data can be used to identify, by comparison, high-risk groups; for those interested in health services research, the results can serve as a health planning guide that does not depend on the presence or absence of treatment facilities in a given area. Incidence data will be the second major contribution of the ECA Program. Its two-wave design enhances the study of incidence, etiology, and the natural history of disorders and also allows study of the social behavior of persons entering treatment for mental disorders--a subject important to health planners. Finally, a significant result of the ECA Program may be the establishment of a viable standardized methodology for the epidemiologic study of mental disorders by means of which demonstrably replicable results can be produced. Once we demonstrate the equivalence of method and results, then the stage is set for comparative studies of all sorts.

Catchment Area, Health↗

PubMedDate not supplied

Epidemiology and health service resource allocation policy for alcohol, drug abuse, and mental disorders.

Data from the NIMH Epidemiologic Catchment Area (ECA) Study in Baltimore, Md., are used to illustrate the association between alcohol, drug abuse, and mental disorder diagnoses with health service use. A probability sample of 3,481 adult (age 18 and over) residents of a geographically defined Baltimore City population of 175,000 was found to have a 23.4 per 100 population, 6-month prevalence of 13 specific alcohol, drug, and mental disorders. Of this population, 7.1 percent sought outpatient mental health treatment from both general medical physicians and mental health specialists in a 6-month period. The presence of a mental disorder diagnosis increased the average number of visits to all health providers from 1.91 to 4.06 during the same 6-month period. Although the presence of a mental disorder diagnosis clearly increased the probability of using both general medical and mental health services, only 15.6 percent of the persons with a mental disorder sought any mental health treatment during this 6-month timeframe--leaving 84 percent of those with mental disorders not seeking any outpatient treatment during the same period. The addition of a measure of high symptomatology (a score of 4 or more on the General Health Questionnaire) increased the percentage of persons with mental disorder using services to 30.5 percent. When a measure of disability was added to the diagnosis and the high symptom level score, 54.7 percent of the population could be predicted to use some mental health service. These data demonstrate the necessity of having additional patient assessment measures with a diagnosis to predict probable service use. However, even in the most comprehensive multidimensional model, more research is required to explore the phenomena of presumed unmet need--the 45 percent of those with a diagnosis, disability, and high symptoms who do not use services. Hence, epidemiologists who wish to participate in setting policy for resource allocation must join with their colleagues in economics, sociology, and health services research to identify all factors in addition to disease states that either predispose population groups to use services or represent additional resource allocation needs.

Adult↗

PubMedDate not supplied

Factors relating to the use of mental health services in a neighborhood health center.

Six-month utilization data are presented for the mental health unit of a comprehensive neighborhood health center. Almost 5% of the 16,877 people in Charlestown, Mass., used these services at a rate of 48.7 per 1,000 residents. Nearly all the residents of this Boston neighborhood were white; the median family income was $8,828 annually; and 14% of the families received public assistance. Age, sex, marital status, census tract of residence, and diagnostic factors were quantitatively related to the use of services. Those 0-17 years represented 39.6% of the total caseload and had a utilization rate of 57.0 per 1,000. Boys and women were the biggest users of service, and married adults constituted 47.7% of the adults using the service. About 55% of the patients paid through Medicaid. During the study period 999 diagnoses were recorded for 822 separate patients, or 1.2 diagnoses per patient. Findings from the center's caseload are compared with utilization data for other mental health services and available national data. The study data demonstrate that the health center's goals of providing accessible, family-oriented, comprehensive mental health services that are targeted particularly to the lower socioeconomic groups in the community were largely accomplished.

Adolescent↗