Mental health and medical service utilization among employees of a large regional corporation: An examination of medical offset effects.

摘要

Psychiatric comorbidity has a dramatic impact on the utilization of medical services among the general medical population. Prior research suggests that mental health treatment can effectively offset utilization of medical services. Many of these studies, however, do not elaborate on the contributing role of patient utilization history in producing an offset effect. Similarly, few studies have focused on the systemic effect mental health utilization may have on the medical utilization of patients' families.; This study examined the ability of mental health services to offset the medical utilization of individuals diagnosed with a chronic medical condition while controlling for utilization history as both a categorical and continuous variable. In addition, the impact of the patient's mental health services use on the medical utilization of their families was also examined.; A total of 5023 individuals first diagnosed with a chronic medical condition during the index year, 1991, were included in the sample. Patients were grouped by categorical utilization histories. Within each grouping, mental health utilizers and a non-utilizing cohort were compared. Medical utilization in years following the index year was the dependent variable of interest. Analyses also focused on the dose-effect relationship between mental health services use and medical utilization. To examine the effect of mental health utilization by the identified patient on the family system, identical analyses were conducted on the medical utilization of a sample of 4420 families.; This study did not find an offset or collateral offset effect in the medical utilization of its patient and family samples. Mental health utilization was associated with increased medical utilization across years. Utilization history played an important role in differentiating the effect of mental health services on medical utilization for specific patient and family groupings. A significant but minimal dose-effect relationship was found among several patient and family groupings.; While the findings of this study do not support the ability of general mental health services to produce an offset effect, they successfully clarify the relationship between mental health services use and utilization history on subsequent medical utilization, and the broader systemic effect of mental health services use on family utilization.