Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-22T18:19:37.940Z Has data issue: false hasContentIssue false
  • English
  • Français

Healthcare use and costs associated with post-traumatic stress syndrome in a community sample of older adults: results from the ESA-Services study

Published online by Cambridge University Press:  24 November 2015

Catherine Lamoureux-Lamarche ,
Helen-Maria Vasiliadis ,
Michel Préville  and
Djamal Berbiche
Catherine Lamoureux-Lamarche*
Affiliation:
Clinical Sciences Program, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, QC, Canada Research Center, Charles-Le Moyne Hospital, Longueuil, QC, Canada
Helen-Maria Vasiliadis
Affiliation:
Research Center, Charles-Le Moyne Hospital, Longueuil, QC, Canada Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, QC, Canada
Michel Préville
Affiliation:
Research Center, Charles-Le Moyne Hospital, Longueuil, QC, Canada Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, QC, Canada
Djamal Berbiche
Affiliation:
Research Center, Charles-Le Moyne Hospital, Longueuil, QC, Canada
*
Correspondence should be addressed to: Catherine Lamoureux-Lamarche, Master Student in Clinical Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Bureau 200, Longueuil, QC, J4 K 0A8, Canada. Phone: +450-466-5433; Fax: +450 670-4135. Email: [email protected].
Get access

Abstract

Background:

Studies have shown higher healthcare utilization and costs associated with post-traumatic stress syndrome (PTSS) in veterans and community adult populations. Given the aging population and the impact on health system resources, it is important to understand the economic consequences of PTSS.

Methods:

The data retained came from 1,456 older adults aged 65 years and over recruited in primary medical clinics in the province of Quebec. PTSS was measured with the PTSS scale. Healthcare services (outpatient, emergency department (ED) visits, and inpatient stay) and medication use were captured separately from provincial administrative databases. Healthcare costs incurred in the past year included costs related to outpatient and ED visits, physician fees, inpatient stay, and medication use. Costs were calculated using a healthcare system perspective. χ2 and Mann–Whitney analyses were used to assess healthcare use. Generalized linear models (GLM) with a gamma distribution (Log Link) were used to evaluate the healthcare costs associated with PTSS.

Results:

Results showed a significant difference in the number mental health outpatient visits, the number of total prescriptions and the use (presence of at least one prescription) of antidepressants (ADs) and benzodiazepines (BZDs). The multivariate analyses showed that costs associated with outpatient visits, ED visits, mental health inpatient stays, physician fees, and medication use were significantly associated with the presence of PTSS. The total adjusted healthcare cost difference between groups was significant and reached $838 CAN.

Conclusions:

Respondents with PTSS were more likely to be prescribed psychotropic medications and to have higher ambulatory costs but not inpatient services related costs, more research is required to better understand whether the mental health needs of individuals with a probable PTSS are being met.

Keywords

Post-traumatic stress syndromehealthcare usecostshealth economicsaging; mental healthprimary healthcarecost-illness study
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 6 , June 2016 , pp. 903 - 911
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Canadian Agency for Drugs and Technologies for Health (CADTH) (2006). Guidelines for the Economic Evaluation of Health Technologies: Canada, 3rd edn. Canada: CADTH.Google Scholar
Chan, D., Cheadle, A. D., Reiber, G., Unützer, J. and Chaney, E. F. (2009). Health care utilization and its costs for depressed veterans with and without comorbid PTSD symptoms. Psychiatric Services, 60, 1612–1617. doi:10.1176/appi.ps.60.12.1612.CrossRefGoogle ScholarPubMed
Christianson, S. and Marren, J. (2012). The Impact of Event Scale-Revised (IES-R). Medsurg Nursing, 21, 321–322.Google ScholarPubMed
Drummond, M. F., Sculpher, M., Torrance, G. W., O’Brien, B. J. and Stoddart, G. L. (2005). Methods for the Economic Evaluation of Health Care Programmes, 3rd edn. New York: Oxford University Press.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi:10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Glaesmer, H., Brähler, E., Gündel, H. and Riedel-Heller, S. G. (2011a). The association of traumatic experiences and posttraumatic stress disorder with physical morbidity in old age: a German population-based study. Psychosomatic Medicine, 73, 401–406. doi: 10.1097/PSY.0b013e31821b47e8.CrossRefGoogle ScholarPubMed
Glaesmer, H., Brähler, E., Riedel-Heller, S. G., Freyberger, H. J. and Kuwert, P. (2011b). The association of traumatic experiences and posttraumatic stress disorder with health care utilization in the elderly - a German population based study. General Hospital Psychiatry, 33, 177–184. doi:10.1016/j.genhosppsych.2010.12.006.CrossRefGoogle ScholarPubMed
Glaesmer, H., Kaiser, M., Brähler, E., Freyberger, H. J. and Kuwert, P. (2012). Posttraumatic stress disorder and its comorbidity with depression and somatisation in the elderly - a German community-based study. Aging & Mental Health, 16, 403–412. doi: 10.1080/13607863.2011.615740.CrossRefGoogle Scholar
Ivanova, J. I. et al. (2011). Cost of post-traumatic stress disorder vs major depressive disorder among patients covered by Medicaid or private insurance. American Journal of Managed Care, 17, 314–323.Google ScholarPubMed
Marshall, R. P., Jorm, A. F., Grayson, D. A. and O’Toole, B. I. (2000). Medical-care costs associated with posttraumatic stress disorder in Vietnam veterans. Australian and New Zealand Journal of Psychiatry, 34, 954–962. doi:10.1046/j.1440-1614.2000.00831.x.Google Scholar
Pietrzak, R. H., Goldstein, M. B., Malley, J. C., Johnson, D. C. and Southwick, S. M. (2009). Subsyndromal posttraumatic stress disorder is associated with health and psychosocial difficulties in veterans of operations enduring freedom and Iraqi freedom. Depression and Anxiety, 26, 739–744. doi:10.1002/da.20574.Google Scholar
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M. and Grant, B. F. (2012). Psychiatric comorbidity of full and partial posttraumatic stress disorder among older adults in the United States: results from wave 2 of the national epidemiologic survey on alcohol and related conditions. American Journal of Geriatric Psychiatry, 20, 380–390. doi:10.1097/JGP.0b013e31820d92e7.Google Scholar
Préville, M. et al. (2008). The epidemiology of psychiatric disorders in Quebec's older adult population. Canadian Journal of Psychiatry, 53, 822–832.CrossRefGoogle ScholarPubMed
Préville, M. et al. (2014). The six-month prevalence of the post-traumatic stress syndrome (PTSS) among older adults: validity and reliability of the PTSS scale. Canadian Journal of Psychiatry, 59, 548–555.Google Scholar
Reinharz, D., Lesage, A. D. and Contandriopoulos, A. D. (2000). Cost-effectiveness analysis of psychiatric deinstitutionalization. Canadian Journal of Psychiatry, 45, 533–538.Google Scholar
Rosenheck, R., Frisman, L. and Neale, M. (1994). Estimating the capital component of mental health care costs in the public sector. Administration and Policy in Mental Health, 21, 493–509. doi:10.1007/BF00707261.Google Scholar
Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C. and Asmundson, G. J. (2007). Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69, 242–248. doi:10.1097/PSY.0b013e31803146d8.CrossRefGoogle Scholar
Spitzer, C., Barnow, S., Völzke, H., John, U., Freyberger, H. J. and Grabe, H. J. (2009). Trauma, posttraumatic stress disorder, and physical illness: findings from the general population. Psychosomatic Medicine, 71, 1012–1017. doi: 10.1097/PSY.0b013e3181bc76b5.CrossRefGoogle ScholarPubMed
Van Ameringen, M., Mancini, C., Patterson, B. and Boyle, M. H. (2008). Post-traumatic stress disorder in Canada. CNS Neuroscience & Therapeutics, 14, 171–181. doi: 10.1111/j.1755-5949.2008.00049.x.CrossRefGoogle ScholarPubMed
van Zelst, W. H., de Beurs, E., Beekman, A. T., van Dyck, R. and Deeg, D. D. (2006). Well-being, physical functioning, and use of health services in the elderly with PTSD and subthreshold PTSD. International Journal of Geriatric Psychiatry, 21, 180–188. doi: 10.1002/gps.1448.CrossRefGoogle ScholarPubMed
Vasiliadis, H., Dionne, P., Préville, M., Gentil, L., Berbiche, D. and Latimer, E. (2013). The excess healthcare costs associated with depression and anxiety in elderly living in the community. American Journal of Geriatric Psychiatry, 21, 536–548. doi: 10.1016/j.jagp.2012.12.016.Google Scholar
Vasiliadis, H. M. et al. (2006). Health care resource use and cost associated with integrated psychological treatment. Journal of Mental Health Policy and Economics, 9, 201–207.Google ScholarPubMed
Volkert, J., Schulz, H., Härter, M., Wlodarczyk, O. and Andreas, S. (2013). The prevalence of mental disorders in older people in Western countries - a meta-analysis. Ageing Research Reviews, 12, 339–353. doi: 10.1016/j.arr.2012.09.004.CrossRefGoogle ScholarPubMed
Walker, E. A., Katon, W., Russo, J., Ciechanowski, P., Newman, E. and Wagner, A. W. (2003). Health care costs associated with posttraumatic stress disorder symptoms in women. Archives of General Psychiatry, 60, 369–374. doi: 10.1001/archpsyc.60.4.369.CrossRefGoogle ScholarPubMed