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Brief Reports   |    
Reasons for Not Seeking General Medical Care Among Individuals With Serious Mental Illness
Ramin Mojtabai, M.D., Ph.D.; Bernadette Cullen, M.B.B.Ch., B.A.O.; Anita Everett, M.D.; Katie L. Nugent, Ph.D.; Akira Sawa, M.D., Ph.D.; Vandad Sharifi, M.D.; Yoichiro Takayanagi, M.D., Ph.D.; Jaimie S. Toroney, M.H.S.; William W. Eaton, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300348
View Author and Article Information

The authors are with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: rm322@columbia.edu). Dr. Mojtabai, Dr. Cullen, Dr. Everett, and Dr. Sawa are also with the Department of Psychiatry, Johns Hopkins Medical Institutions, Baltimore.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  The study compared delays in seeking general medical care among adults with serious mental illness and a general population sample. Associations of delays with health status and use of emergency department services among individuals with serious mental illness were also assessed.

Methods  Data for 271 persons with serious mental illness (clinic sample) and 40,016 participants in the National Health Interview Survey (NHIS sample) were compared.

Results  Fifty-three percent of the clinic sample and 13% of the NHIS sample reported delays, most because of difficulties accessing services. In the clinic sample, delays were associated with receipt of routine care at a public clinic, rather than a physician’s office; more severe depressive symptoms; and functional difficulties. Delays were also associated with poorer health status and use of emergency department services.

Conclusions  Integration of services as envisioned in the Affordable Care Act and targeted case management may reduce delays among individuals with serious mental illness.

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Figure 1 Reasons for delays in seeking general medical care in two samplesa

aThe clinic sample comprised adults with serious mental illness in two urban Baltimore clinics. The comparison sample comprised participants in the 2008–2011 National Health Interview Survey (NHIS) residing in the South census region. Financial reasons and stigma were assessed only in the clinic sample. All other reasons (see descriptions in text) were assessed in both samples. Reported percentages for the five reasons were adjusted in logistic regression models. Lines represent 95% confidence intervals.

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