Service use among patients with serious mental illnesses who presented with physical symptoms at intake

The goal of this study was to examine relationships among serious mental illness, general physical symptoms, and use of mental health services among persons presenting for admission at a community-based mental health center.

Number and type of physical symptoms were assessed during the routine intake process. Individuals (N=1,022) were screened by phone with a modified version of the Physical Health Questionnaire-15. Diagnostic, demographic, and treatment information was tracked prospectively. Data were analyzed for 682 individuals who kept at least one appointment. Analyses examined associations among physical symptoms, diagnosis, and service use over time.

A total of 481 patients (71%) reported three or more physical symptoms. Patients with three or more physical symptoms were significantly older (p<.013), were more likely to be female (p<.001) and Spanish speaking (p<.05), and used significantly more services (p<.001) than did those with fewer physical symptoms. Both the number and the costs of services increased with the number of physical symptoms presented at intake. Patients with major depressive disorder were as likely as patients with schizophrenia or bipolar disorder to report having three or more physical symptoms.

Within a mental health community-based population, most incoming clients with serious mental illness reported three or more physical symptoms. The number of reported physical symptoms was a significant predictor of mental health service use and cost over the episode of care, even after analyses controlled for confounders such as gender, age, and diagnosis.