1. How Do Health Outcomes Compare in Adults with DD with and without Mental Health Problems? Susan M. Havercamp, Ph.D. University of North Carolina North Carolina Office on Disability and Health Karen Luken, TRS/CTRS North Carolina Office on Disability and Health AAMR 2004

2. Health & DD DD health is invisible to public health and ignored by DD service delivery Research suggests prevalence of health conditions is the same or higher Limitations in function due to problems with communication, physical fitness, and weight Healthcare access can be a challenge, especially in the community

3. Health & Mental Health Mental Health problems may look like physical illness and vice versa Poor physical health may worsen mental health problems (esp. anxiety and depression) Physical health problems may go undetected in persons with mental illness

4. Health Indicators National Core Indicators is a Quality Management protocol for the DD service delivery system Coordinated nationally by Human Services Research Institute (HSRI) Standard instrument, interviewer training, and methodology Three sources of information: self-report, proxy (informant), and case manager (file)

5. DD Sample Selection Stratified random selection of individuals meeting inclusion criteria Adults (age 18+) who receive services from the state division on developmental disabilities Invited to participate in interview (informed consent obtained by case manager)

6. Health Indicator Items Many Items adapted from the BRFSS BRFSS methodology under-represents DD Special considerations in interviewing persons with DD Cloak of competence Acquiescence Memory impairment

7. Physical Health is compared across two groups Adults with Developmental Disabilities without co-occurring Mental Health Problems (n=675; 70.8%) And Adults with Developmental Disabilities and Mental Health Problems (n=341; 29.2%)

8. Of persons with MH problems, MH DiagnosisPercent Depression 23.1% Bipolar Disorder 7.9% Anxiety 9.9% Schizophrenia 43.8% Eating Disorder 1.6% Personality Disorder 11.6%

9. Demographics No MH (n=675) MH (n=341) % male56.755.4 Caucasian63.361.2 African-Amer34.536.8 Hispanic3.31.7 Age (average)35.7 years40.8 years

10. Demographics, continued Level of MRNo MH groupMH group Non-MR 6.85.1 Mild29.052.2 Moderate23.730.1 Severe18.68.1 Profound19.83.0

11. Health Indicators Content Health Risk Behaviors Overall Health Status & Health Conditions Healthcare Access

12. Health Risk Behaviors No MHMH group Relative Risk (RR) Cigarette use11.727.22.32*** Alcohol4.24.81.14 Overweight51.667.61.31* Exercise < once/month 13.010.3.79 * p<.05 *** p<.001

13. Mental Health Risk /Resilience No MHMH groupRR Death (close friend/ family 31.039.71.28 Moved30.039.71.32 Staff change53.156.31.06 Hospitalized21.721.3.98 No Social Support (often lonely /no confidant) 19.224.01.25

14. Chronic Health Conditions No MHMH groupRR Diabetes5.510.51.91* High Blood Pressure11.924.92.09** Headache2.95.31.83 Respiratory Problems5.86.81.17 Urinary Tract Infections4.22.6.62 Sleep Problem2.35.82.52* * p<.05 *** p<.001

15. Health Service Utilization No MHMH groupRR Physical exam (> 1 year) 4.59.72.16* Dentist visit (> 5 years or never) 11.03.6.33* Gynecological exam (>5years or never) 16.122.51.40 Mammogram (never) 50.435.9.71* * p<.05

16. Health Indicators Conclusions Adults with dual diagnosis are more likely to smoke cigarettes and be overweight or obese compared to adults with developmental disabilities without mental health problems. Both groups (MH and noMH) suffer extreme life stress and inadequate social support Adults with dual diagnosis were more likely to have diabetes and high blood pressure The MH group had surprisingly better access to healthcare services

17. Adults with developmental disabilities, and especially those with co-occurring mental health problems, are in need of health promotion and disease prevention initiatives

18. For more information… Contact: Susan M. Havercamp, Ph.D. University of North Carolina CB# 7255 Chapel Hill, NC 27599-7255 Tel. (919) 966-6312 E-mail: susan.havercamp@cdl.unc.edu OR Visit the HSRI website: www.hsri.org/manage/core.html