Disease Management Update
Volume V, No. 33
December 18, 2008
Dear Healthcare Intelligence Network Client,
According to HHS, mental health problems affect one in every five young people at any given time, but an estimated two-thirds of all young people with mental health problems are not getting the help they need. These statistics coincide with a story showcased in this week's DM Update, which claims physicians are not asking parents if they have concerns about their child’s mental health. In a related study, a study from the Harvard School of Public Health links lower childhood IQ scores with adult mental disorders.
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Table of Contents
- Kids' Mental Health Concerns Meet Barriers in Primary, Specialty Care
- Disease Management Q&A: Morbidity & Mental Illness
- HealthSounds Podcast: ED Diversion Through Behavioral Health Linkages
- Lower Childhood IQ Associated with Higher Risk of Adult Mental Disorders
- Survey of the Month: Tobacco Cessation and Prevention
- Targeting Depression Through Disease Management
1. Kids' Mental Health Concerns Meet Barriers in Primary, Specialty Care
According to the University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health, for most parents, PCPs aren’t asking them if they have concerns about their child’s mental health. The poll asked parents of children ages 5 to 17 the degree to which they interacted with their children’s PCP about mental health issues and how often their child — whether or not they were diagnosed with a mental illness — received specialty mental health services.
“We found that more than one-half of parents (56 percent) report that their primary care physician never asks about whether they have mental health concerns for their child,” says Matthew M. Davis, M.D., M.A.P.P., director of the National Poll on Children’s Health. “We’re concerned that some PCPs may not ask about mental health problems because of not being able to address the issues themselves or because of the lack of specialty mental health services available to which they could refer kids if problems come up.”
Though many parents say their child’s PCP never asks about mental health concerns for their kids, 22 percent of parents report that their child’s PCP regularly asks and 22 percent report being asked sometimes. For parents who have discussed mental health concerns with their child’s PCP, 62 percent report having used specialty mental health services for their children. According to national estimates, one in 10 children in the United States suffers from a serious emotional or mental disturbance. One in five parents in this poll indicate one or more of their children ages 5 to 17 is currently diagnosed with a mental health disorder — most common of which are attention deficit hyperactivity disorder, general behavioral problems and depression.
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2. Disease Management Q&A: Morbidity & Mental Illness
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Elizabeth Reardon, M.P.H., managed care director of Vermont Health Access.
Question: Why is there morbidity and mortality associated with mental illness?
Response: (Elizabeth Reardon) We’re finding that people with severe and persistent mental illness die earlier than similar populations across the country, and there are a number of reasons for that. Why is that morbidity largely due to preventable chronic illnesses? There’s a lot of metabolic disorders. People with mental illnesses also engage in a certain amount of risky behavior, like smoking and inappropriate nutrition. We’re also finding that some psychiatric medications are becoming part of this risk. Some drugs that are called atypical antipsychotics are actually causing weight gains of 40 to 100 pounds. There are also some factors just because of the status of chronic mental illness in our population. There’s a lot of stigma. People themselves may not be motivated. They may be victims of trauma. They may have had histories in the criminal justice system. They may be homeless. Sometimes providers aren’t that comfortable working with people. There is residual stigma. Also, it’s difficult to coordinate care in many cases because the funding streams for mental illness care and for primary care are usually never blended.
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3. HealthSounds Podcast: ED Diversion Through Behavioral Health Linkages
Julie Szempruch, associate vice president and chief nursing officer for the Midtown Mental Health Center, Wishard Health Services, discusses some key points regarding ED use by mental health patients, inluding the challenges involved with triaging such patients, effective strategies for educating this population about proper ED use as well as why the issue of ED patients with mental health issues is getting so much attention now.
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Lower Childhood IQ Associated with Higher Risk of Adult Mental Disorders
In a new, long-term study covering more than three decades, researchers at Harvard School of Public Health (HSPH) found that children with lower IQs showed an increased risk of developing psychiatric disorders as adults, including schizophrenia, depression and generalized anxiety disorder. Lower IQ was also associated with psychiatric disorders that were more persistent and an increased risk of having two or more diagnoses at age 32.
No association was found between lower childhood IQ and substance dependence disorders, simple phobia, panic disorder or obsessive-compulsive disorder. The mechanism through which lower childhood IQ might lead to increased risk of adult anxiety disorders is not known, but the authors suggest some possible explanations. They write that lower childhood IQ might reveal a difference in brain health that makes an individual more vulnerable to certain mental disorders. Another possible mechanism is stress — individuals with lower childhood IQs are less equipped to deal with complex challenges of modern daily life, which may make them more vulnerable to developing mental disorders.
The findings may be helpful in treating individuals with mental health disorders. “Lower childhood IQ was associated with greater severity of mental disorders including persistence over time and having two or more diagnoses at age 32,” said lead author Karestan Koenen, assistant professor of society, human development and health at HSPH. “Since individuals with persistent and multiple mental disorders are more likely to seek services, cognitive ability may be an important factor for clinicians to consider in treatment planning. For example, individuals with lower cognitive ability may find it harder to follow instructions and comply with treatment regimens. By taking clients’ cognitive ability into account, clinicians may improve treatment outcome,” she said. The results may also be helpful in prevention planning. “Educators and pediatricians should be aware that children with lower cognitive ability may be at greater risk of developing psychiatric disorders. Early detection and intervention aimed at ameliorating mental health problems in these children may prevent these problems from carrying over into adulthood,” said Koenen.
To learn more about this research, please visit:
5. Survey of the Month: Tobacco Cessation and Prevention
A CDC report released last month found that from 2000 to 2004, at least 443,000 people in the U.S. died prematurely each year as a result of smoking and exposure to secondhand smoke, an increase from 438,000 deaths annually for 1997-2001. This report also found that smoking costs the nation $193 billion per year in healthcare expenditures and productivity losses — up from a previous estimate of $167 billion — and that smoking results in 5.1 million years of potential life lost in the United States each year. What is your organization doing in the area of tobacco cessation and prevention? Complete HIN's Survey of the Month on tobacco cessation and prevention by December 31 and you’ll get a free executive summary of the compiled results.
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6. Targeting Depression Through Disease Management
Nearly 6 percent of men and almost 10 percent of women worldwide will experience a depressive episode in any given year, and in America alone, approximately 18.8 million adults have depression. In an October 2008 e-survey from the HIN, 250 healthcare professionals shared how their organizations are targeting depression as part of their DM initiatives.
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