People with and without mental health conditions receive preventive care at similar rates

People with schizophrenia and bipolar disorder received preventive health screenings at rates similar to or higher than people without mental illnesses, according to a study of more than 800,000 patients published today in the American Journal of Preventive Medicine.

Nearly 10 million people in the United States live with a serious mental health condition, and they have higher early death rates compared to those without these conditions. In fact, one study found that patients with schizophrenia were 3.5 times more likely to die early, compared to the general population.

The disparity is largely due to preventable causes such as high blood pressure, high cholesterol, diabetes and heart disease, and to modifiable risk factors such as poor diet, lack of exercise, smoking and medications that cause weight gain.

Researchers hypothesized that people with mental illnesses might receive less preventive care than people without these illnesses. However, this study, which included patients within the Kaiser Permanente system and patients who get their care from safety-net clinics, found just the opposite.

Kaiser Permanente patients who were diagnosed with a mental health condition received between 80 and 81 percent of the recommended preventive care, while people with no diagnosis of a mental health condition received about 80 percent of the preventive care recommended for them.

In safety-net clinics, there was a larger difference between the two groups. Patients diagnosed with mental health conditions received between 62 and 70 percent of the preventive services recommended for them, while patients without a diagnosis of a mental health condition received about 60 percent of the recommended care.

"We were pleased to learn that people with mental health conditions received as many or more preventive services as people without these conditions," said Bobbi Jo Yarborough PsyD, lead author and researcher with the Kaiser Permanente Center for Health Research.

However, Yarborough added, the finding doesn't answer the question of why, according to national statistics, these people die earlier.
"It may be that people with mental illnesses aren't getting the support and treatment they need to prevent chronic disease. For example, we know that the medications people take to manage serious mental illnesses can cause rapid weight gain, but there are few programs to help these people manage their weight while they are on the medications," said Yarborough.

To address this need, Yarborough and her colleagues developed a successful weight loss and diabetes risk reduction program, but she says few health systems implement these types of programs.

For the current study, researchers compared the proportion of recommended preventive screenings received among more than 100,000 adults who had a diagnosis of schizophrenia, bipolar or affective psychosis, or other mental health conditions such as anxiety or major depressive disorder, to the proportion of recommended screenings received among nearly 700,000 adults without a diagnosis of mental illness.

Study subjects were members of the Kaiser Permanente Northwest health system, or patients who received care in clinics that serve low-income individuals and those without health insurance. During 2012-2013, the researchers examined the medical records of these patients to find out if they were eligible for and had received 12 preventive services recommended by the U.S. Preventive Services Task Force.

The services included screening for obesity, diabetes, tobacco use, colorectal cancer, high blood pressure and high cholesterol, as well as the pneumococcal and flu vaccines. And for women, screening for breast and cervical cancer, and chlamydia and osteoporosis were also included.

Credit: 
Kaiser Permanente