Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 54, Issue 11 M577-M582, Copyright © 1999 by The Gerontological Society of America
Psychopathology and emotional distress among older high-utilizing health maintenance organization patients
LJ Haas, DC Spendlove, MP Silver and TC Holmberg
Department of Family and Preventive Medicine, University of Utah Health Sciences Center, Salt Lake City 84132, USA. [email protected]
BACKGROUND: Rates of psychopathology are often underestimated in primary
care populations, especially older patient groups. High medical utilization
is often a reflection of psychopathology and/or emotional distress.
Increased awareness of primary care patients' emotional distress can help
to improve well-being and reduce unnecessary high utilization of medical
services. This study aimed to assess the degree of psychopathology present
in a sample of older health maintenance organization (HMO) patients who
utilized higher-than-average amounts of medical services. METHODS: Patients
in a large HMO aged 55 years old and older who exceeded the mean number of
inpatient and outpatient visits in the past year were recruited. Sixty-nine
patients, mostly female (69%) and white (93%), volunteered. Patients were
assessed with the Medical Outcomes Study SF-36 health survey and the
Symptom Checklist-90-Revised (SCL-90-R). RESULTS: Respondents made a mean
of 41 visits in the previous year to medical providers, versus 24 visits
per year for the average patient of this age in the HMO. Significant
elevations on SCL-90-R global psychopathology, obsessive-compulsive,
somatization, and depression scales were found. All patients met SCL-90- R
criteria for psychiatric caseness. SF-36 health ratings were comparable
with those of patients with chronic medical conditions assessed in other
SF-36 samples. CONCLUSIONS: Older high-utilizing HMO patients show
significantly more psychopathology and view their health status as poorer
than that of other medical subpopulations; results suggest that care for
these problems is rarely received.
