Healthcare Utilization and Health-Related Quality of Life for Adults with SMI: The Role of Co-Occurring Physical Health Conditions

Background/Purpose:  Mounting chronic condition rates have prompted enhanced efforts in the U.S. to identify and intervene in regard to health and healthcare disparities. Use of healthcare is a theoretical precursor to improved health, and health-related quality of life (HRQOL) provides important information regarding health beyond diagnoses. While it is well-known that people with serious mental illness (SMI) experience higher rates of many physical health conditions, research on healthcare and HRQOL for those with co-occurring conditions are limited, providing an incomplete picture of health for this marginalized population. To help fill these critical gaps, the purpose of this study was to examine relationships between co-occurring physical health conditions (e.g., at least one, number of conditions, specific conditions), and healthcare utilization and HRQOL, for adults with SMI.

Methods:  This study used data from the Medical Expenditures Panel Survey, collected from three panels of participants between 2012-2015, and included persons 18-70 years of age who reported an SMI diagnosis (n=648). Physical health conditions (IV) was measured using 14 priority conditions (e.g., asthma, hypertension, diabetes), and was included as a dichotomous variable and summed continuous variable in multivariate analyses. The dependent variables were healthcare utilization (i.e., total outpatient and emergency healthcare visits in one year), and physical and mental HRQOL (i.e., physical component scale [PCS] and mental component scale [MCS] derived from the SF-12). Multivariate linear regression models were completed to examine relationships for at least one condition and number of conditions, controlling for structural and illness factors known to be related to healthcare utilization and HRQOL. Then, relationships for specific physical health conditions were examined using independent t-tests.

Results:  Over 80% of the sample reported at least one priority health condition, and the three most commonly reported conditions included joint pain (50%), hypertension (44%), and high cholesterol (42%). Participants reported an average of 10 healthcare visits, and had an average PCS of 43.93 and MCS of 38.64. Multivariate linear regression results indicated that having at least one priority health condition was associated with higher total healthcare visits (B=2.518, p<.001), and lower physical (B= -8.165, p<.001) and mental HRQOL (B= -4.427, p<.01); similarly, number of conditions was related to healthcare visits (B=.881, p<.001), physical HRQOL (B= -2.451, p<.001), and mental HRQOL (B= -.968, p<.001). Differences were also found in terms of which specific conditions were related to higher healthcare visits, and lower physical and mental HRQOL.

Conclusion/Implications:  People with SMI are likely to report chronic physical health conditions, and co-occurring conditions are related to increased use of healthcare, and lower physical and mental HRQOL.  Findings inform knowledge regarding healthcare utilization patterns, and is vital for those whose research and practice focuses on those with SMI. Findings regarding HRQOL highlight the connection between physical and mental health, and suggest that efforts to improve physical health conditions for those with SMI may not only improve physical health, but also mental health. Implications for better inclusion of physical health in social work assessment/treatment planning processes with adults with SMI will be provided.