Psychiatric Diagnoses Among Older Recipients of Publicly Funded Mental Health Services

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Abstract

OBJECTIVES:

To compare the prevalence of psychiatric diagnoses among older recipients of publicly funded mental health services (county safety-net base services and Medicaid) to psychiatric diagnoses in an insured population of older adults from the same county.

DESIGN:

Secondary analysis of county human services claims data and claims from an insured population in the same county.

SETTING:

Inpatient and outpatient clinics in Allegheny County, PA.

PARTICIPANTS:

Adults aged 65 and older in the county who received treatment for a psychiatric diagnosis in 2012 (county base services, n = 1,457; Medicaid, n = 641; Health plan insurance, n = 5,595).

MEASUREMENTS:

Psychiatric diagnoses were classified using the International Classification of Diseases, 9th revision (ICD-9).

RESULTS:

Episodic mood disorders and schizophrenia were more common among county-funded and Medicaid recipients (50–54% vs 34%). Neurotic conditions were more common among older adults with health plan insurance (18% vs 8%). Nearly a quarter of older adults receiving county base services were classified as having “ill-defined and unknown causes of morbidity and mortality,” compared <1% among insured and 6% among Medicaid recipients.

CONCLUSIONS:

The prevalence of psychiatric conditions among older adults varies by insurance coverage, suggesting a role for social and economic factors associated with safety net coverage as well as system-level differences in delivery of mental health services. Comparing the prevalence of psychiatric diagnoses across insurance types offers insight on social determinants of risk for mental disorders in late life.

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