Disability and psychiatric disorders in an urban community: 
measurement, prevalence and outcomes

Background. The purpose of this analysis was to examine: (1) the prevalence of psychiatric disorders among disabled people, using seven different measures of disability; (2) variation in disability between and within psychiatric diagnostic categories; and (3) relationship of diagnosis and disability to health service utilization.Method. Data were drawn from Phase I and Phase II of the Eastern Baltimore Mental Health Survey, part of the Epidemiologic Catchment Area Program (ECA) conducted in 1980–1 to survey mental morbidity within the adult population. A total of 810 individuals received both a household interview and a standardized clinical psychiatric evaluation. Estimated prevalence rates were computed using appropriate survey sampling weights.Results. Prevalence of disability ranged from 2·5 to 19·5%, varying with specific disability measure. Among those classified as disabled by any of the measures examined, 56 to 92% had a psychiatric disorder and serious chronic medical conditions were present in the majority of these cases (54 to 78%). Disability was expressed differently among the various diagnostic groups. Diagnostic category and disability were significant independent predictors of medical service utilization and receipt of disability payments.Conclusions. The majority of disabled adults living in the community have diagnosable psychiatric disorders, with the majority of these individuals suffering from significant chronic medical conditions as well, thus making co-morbidity the norm.

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Suicide ideation, plans and attempts in Ukraine: findings from the Ukraine World Mental Health Survey

Psychological Medicine ◽

10.1017/s0033291707009981 ◽

2007 ◽

Vol 37 (6) ◽

pp. 807-819 ◽

Cited By ~ 21

Author(s):

EVELYN J. BROMET ◽

JOHAN M. HAVENAAR ◽

NATHAN TINTLE ◽

STANISLAV KOSTYUCHENKO ◽

ROMAN KOTOV ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Psychiatric Disorders ◽

Service Utilization ◽

Suicide Ideation ◽

World Health ◽

Functional Impairments ◽

World Mental Health ◽

Co Morbidity ◽

The World

Background. Because the suicide rates in Eastern Europe have increased, the epidemiology of suicide behaviors in this part of the world is in urgent need of study. Using data from the Ukraine site of the World Mental Health (WMH) Survey Initiative, we present the first population-based findings from a former Soviet country on the descriptive epidemiology of suicide ideation, plans and attempts, and their links to current functioning and service utilization.Method. In 2002, a nationally representative sample of 4725 adults in Ukraine was interviewed with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Risk factors included demographic characteristics, trauma, smoking, and parental and personal psychiatric disorders. Current functional impairments and recent service utilization were assessed.Results. The lifetime prevalence of suicide ideation was 8·2%. The average age of onset was 31. The key risk factors were female sex, younger age, trauma, parental depression, and prior alcohol, depressive and intermittent explosive disorders, especially the presence of co-morbidity. Ideators had poorer functioning and greater use of health services. One-third of ideators had a plan, and one-fifth made an attempt. Among ideators, young age, smoking and prior psychiatric disorders were risk factors for these behaviors.Conclusions. Together with the increasing suicide rate, these results suggest that suicide intervention programs in Ukraine should focus on the generation of young adults under 30. The associations with co-morbidity, impairments in current functioning and greater service use indicate that a physician education program on suicidality should be comprehensive in scope and a public health priority in Ukraine.

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Psychiatric co-morbidity and hospital utilization in the general medical sector

Psychological Medicine ◽

10.1017/s0033291798008071 ◽

1999 ◽

Vol 29 (2) ◽

pp. 457-464 ◽

Cited By ~ 7

Author(s):

ELIZABETH SAVOCA

Keyword(s):

Psychiatric Disorders ◽

Hospital Admissions ◽

Hospital Costs ◽

Disabled Persons ◽

Economic Evaluations ◽

Medical Conditions ◽

Medical Sector ◽

Co Morbidity ◽

Wide Range ◽

Hospital Use

Background. This article provides evidence about the relationship between psychiatric disorders, physical disorders and hospital use in the general medical sector using a broadly based survey of the US population.Methods. The data are from the 1989 National Health Interview Survey. This survey contains medical and mental health evaluations for the entire sample. In a multivariate framework, the author estimates the effect of mental illness on the probability of being admitted to a general hospital, the number of admissions and the length of stay.Results. Hospital use in the general medical sector is significantly higher for persons with coexisting physical and psychiatric conditions than for those with no psychiatric disorders. For a wide range of medical conditions, the predicted number of hospital admissions and the length of a hospital stay increase substantially when the physical illness is accompanied by a psychiatric condition.Conclusions. One implication of this finding is that economic evaluations of alternative psychiatric treatments should consider any differences in hospital costs related to the treatment of coexisting medical conditions. Another implication pertains to health care systems where insurers have some discretion over which individuals to insure. In the absence of adequate adjustments in insurance payments for high-risk potential enrollees, psychiatrically disabled persons may have more limited access to health insurance.

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