Preventive medical services use among community mental health patients with severe mental illness:the influence of gender and insurance coverage.

INTRODUCTION: This study examines predictors of reduced preventive health service use in patients with severe mental illness by examining psychiatric diagnoses and demographic factors. METHOD: Of 387 patients approached in 4 community mental health clinics regarding their preventive health services use from January 2005 to May 2007, 234 (60.5%) were interviewed. Of those participants interviewed, 221 had a DSM-IV-TR diagnosis of (1) primary psychotic disorder (schizophrenia or schizoaffective disorder), (2) bipolar disorder, or (3) recurrent major depressive disorder. Psychiatric disorders and demographic factors that predicted high service utilization were analyzed using analysis of variance and χ² tests. RESULTS: In the linear predictive model, use of preventive services was not statistically different among the 3 diagnostic groups. Participants with primary psychotic disorder used a similar number of preventive services compared to those with bipolar disorder and major depression. Women used more services than men (P < .01), and individuals with health insurance used more than uninsured participants (P < .001). CONCLUSION: Male gender and not having medical insurance were predictive of lower preventive health service use in this sample of patients with severe mental illness. Further research is needed to replicate these findings and to improve use of preventive health services in people with severe mental illness.

Use of cancer-screening services among persons with serious mental illness in Sacramento County.

OBJECTIVE: This study examined the use of breast, cervical, colorectal, and prostate cancer-screening services by persons with serious mental illness enrolled in the Sacramento County Mental Health clinics. METHODS: Of 387 outpatients approached from January 2005 to May 2007, 229 were interviewed. RESULTS: Whereas 97% of the women had received cervical cancer screening at least once in their lifetime, more than 50% of eligible persons over age 50 had never received colorectal cancer screening. Recent use of screening services was highest for cervical cancer (69% had had a Pap test in the past three years) and lowest for colorectal cancer (12% had had a fecal occult blood stool test in the past year or a flexible sigmoidoscopy or colonoscopy in the past five years). CONCLUSIONS: Among persons with serious mental illness, lifetime screening of cervical cancer was higher than for breast, prostate, and colorectal cancers. Receipt of routine, timely cancer screening was low, especially for colorectal cancer.

The prevalence of the metabolic syndrome in psychiatric inpatients with primary psychotic and mood disorders.

Patients with severe mental illness have elevated rates of cardiovascular disease (CVD) and diabetes compared with the general population, but little is known about the prevalence of the metabolic syndrome that predisposes patients with severe mental illness to both medical conditions. The purpose of this study was to assess the prevalence of the metabolic syndrome by surveying hospital records of psychiatric inpatients with severe mood and psychotic disorders. The study group was 102 consecutively admitted adult patients with a primary DSM-IV diagnosis of a mood or psychotic disorder. Criteria for comorbid metabolic syndrome required at least three of the five factors defined by the National Cholesterol Education Program. The prevalence of the metabolic syndrome was 38.6% in this cohort, and it was associated with increasing age, body mass index, and Caucasian ethnicity. The metabolic syndrome was common in this cohort of psychiatric inpatients, and the high rate of the metabolic syndrome likely represents an intermediate step in the future development of CVD and diabetes, which may provide a point of early intervention to prevent the occurrence of these two medical illnesses in chronically mentally ill patients.