Psychiatric disease and hypercholesterolemia in an urban academic primary care clinic.

BACKGROUND: There are limited data regarding the quality of cardiovascular risk reduction in primary care settings with a high prevalence of psychiatric disease. OBJECTIVE: To determine if there are differences in the rates of testing and treatment for hypercholesterolemia between patients with and without psychiatric disease. STUDY DESIGN: Cross-sectional chart review. PATIENTS: 197 adult patients of a hospital-based, academic primary care clinic. METHOD: Medical records were reviewed for demographic information, documented psychiatric disease, cardiovascular risk factors, prescription for cholesterol-lowering medication, and a serum total cholesterol result within 5 years of the most recent clinic visit. RESULTS: Subjects with (N = 76) and without (N = 121) psychiatric disease had similar clinical and demographic characteristics (all p > .05) as well as rates of cholesterol testing (92% vs. 93%, p = .91). Neither diagnosis of hypercholesterolemia nor prescription for cholesterol-lowering medication were associated with psychiatric disease (p = 1.00 and p = .34, respectively). The mean serum total cholesterol was 15 mg/dL higher for patients with psychiatric disease than for those without (p = .016). CONCLUSION: In this patient population, the presence of psychiatric disease was not associated with differential rates of hypercholesterolemia testing, diagnosis, or treatment. We observed higher mean serum total cholesterol levels in subjects with psychiatric disease. Further study is needed to examine the implications of our findings.

Health care utilization and receipt of cholesterol testing by veterans with and those without mental illness.

OBJECTIVE: We examined the relationship between mental illness, health care utilization and rates of cholesterol testing. METHODS: We conducted a retrospective cohort study using Veterans Affairs (VA) administrative data on 64,490 United States veterans who used VA New England Health Care System outpatient services between January 1998 and June 2001. A total of 10,100 veterans (15.7%) had a mental illness treated with medication. We examined the interaction between mental illness and outpatient service utilization with respect to the likelihood of receiving a cholesterol test, adjusting for major demographic and clinical covariates. RESULTS: Among veterans using VA outpatient services infrequently, those with mental illness were less likely than non-mentally ill control subjects to receive a cholesterol test during the study period (first quartile adjusted OR=0.45, 95% CI=0.37-0.54; second quartile adjusted OR=0.50, 95% CI=0.45-0.57). Mentally ill subjects with more frequent utilization of VA services were as likely as (third quartile adjusted OR=1.01, 95% CI=0.91-1.13) or more likely than (fourth quartile adjusted OR=2.73, 95% CI=2.46-3.03) non-mentally ill subjects to receive cholesterol testing. CONCLUSIONS: Mental illness was associated with a lower likelihood of cholesterol testing in subjects who used fewer VA outpatient services. The observed disparity attenuated at higher levels of service utilization.

The association between impulsiveness and sexual risk behaviors in adolescent and young adult women.

Cross-sectional survey data from 462 female adolescents were analyzed to determine associations between impulsiveness and sexual risk behaviors and related outcomes. Higher impulsiveness was significantly associated with early age of first sexual intercourse, higher number of sexual partners, non-use of contraception and condoms, and prior Chlamydia infection.