1. Relationship of Affective and other Mental Health Disorders with Arthritis and other Rheumatic Conditions Brennan Martin, MPH, John Pandiani, PhD, Steven M. Banks, PhD, and Jean McCandless, MSW Additional Readings The findings reported here are part of a larger effort to understand the physical health status of adults with serious mental illness in Vermont. Other research by Vermont’s Mental Health Research and Statistics Unit has found: Elevated Risk of Mortality Pandiani JA, Banks SM, Bramley J, Moore R. 2002 Mortality of Mental Health Service Recipients in Vermont and Oklahoma. Psychiatric Services, 53: 1025-1027 Banks SM, Pandiani JA, Schacht LM, and Gauvin L (2000) Age and Mortality Among Problem Drinkers. Addiction, 95: 1249-1254. Elevated incidence of Cancer Pandiani JA, Boyd M, Banks SM, Johnson A (2006) Elevated Cancer Incidence Among Adults With Serious Mental Illness. Psychiatric Services 57: 7, 1032 - 1034 Relationships with Other Health Issues Schacht LM, Pandiani JA, and Banks SM (2007) Access to Community Mental Health Services: A Study of Adult Victims of Trauma. Best Practices in Mental Health: An International Journal 3: 2, 1 - 8 Banks SM (2005) Community Mental Health Service Utilization by Adults with HIV/AIDS in Vermont. NIMH Conference on Mental Health Services Research, Bethesda, MD Pandiani JA and Mongeon J (2006) Viral Hepatitis Infection Among MH and SA Service Recipients. Vermont MH Performance Indicator Brief Report (07/07/06) Pandiani JA and Morabito S (2004) Emergency Room Asthma Diagnosis for CMHC Service Recipients Vermont MH Performance Indicator Brief Report (10/15/04) Pandiani JA and Simon M (2002) Diabetes and Asthma in CRT Caseload. Vermont MH Performance Indicator Brief Report (10/18/02) Access to more than 30 brief PIP reports that relate to health issues is available at http://healthvermont.gov/mh/docs/pips/pip-cross-sector-indicator.aspx#Health Findings Findings indicate that adult mental health service recipients have elevated risk of arthritis and other rheumatic conditions compared to the total population of Medicaid enrollees in Vermont (22% vs. 14% overall). This was true for all diagnostic categories except schizophrenia. The treated prevalence of arthritis and related conditions in the total Medicaid population increased with increasing age for both men and women. The treated prevalence of arthritis and related conditions increased with increasing age among female mental health service recipients in every diagnostic group, but did not increase with increasing age among men with a diagnosis of affective or personality disorders. In these groups, the treated prevalence of arthritis disorders were substantially greater in the 35-49 age group (27% and 24% respectively) than in either the younger or the older age groups. There was no difference between mental health service recipients who received psychiatric medication and those who did not in their treated prevalence of arthritis and other rheumatic conditions. Future Directions Vermont’s Mental Health Research and Statistics Unit plans to continue research on the relationship between mental health disorders and arthritis and related disorders by adding a longitudinal perspective to the research described here. This research will examine the relationship between mental health disorders and arthritis during periods 5 years and 10 years prior to the period covered by the current analysis. This research will focus on changes in overall rates of treatment for the two classes of disorder. This research will also focus on the order in which the disorders are treated. Does treatment of mental health disorders tend to precede or follow treatment of arthritis and other rheumatic disorders? Background This is a work in progress. This project started with an inquiry from the Vermont Department of Health’s Arthritis Program manager to Vermont’s Mental Health Research and Statistics Unit regarding the prevalence of arthritis (arthritis and other rheumatic conditions) among adults with depression. This request was based on her interest in the prevalence of arthritis in populations with a wide range of other disorders. Preliminary analysis led to a broader focus on the prevalence of arthritis and other rheumatic conditions in individuals with a variety of MH diagnoses, the influence of the demographic characteristics of mental health service recipients, and the influence of psychoactive medications. Methods Two data sets were used in this analysis. One data set was extracted from Monthly Service Report (MSR) data files submitted to the Vermont Department of Mental Health during FY2006. This data set included basic demographic and clinical information as well as a record of all services received by adults served by Vermont’s statewide community mental health system of care who had Medicaid coverage (N = 6,082). The second data set, extracted from the Medicaid paid claims database, included all claims that were associated with a diagnosis of arthritis and other rheumatic conditions. The two data sets were linked using the Medicaid number that appears in both data sets. The rates reported here were calculated on the basis of that linkage. The rate of arthritis and other rheumatic diagnoses in the general Medicaid population was based on a comparison of the paid claims and the total number of individuals (N = 114,767) covered by Vermont Medicaid during the report period. Contact Brennan Martin bmartin@vsh.state.vt.us (802) 652-2064 John Pandiani jpandiani@vdh.state.vt.us (802) 863-7249 Jean McCandless jmccand@vdh.state.vt.us (802) 951-4068 File Name: APHA Poster 11072007- Arthritis and Mental Health.PPT Created: October 31, 2007