Psychiatric Diagnoses and Children with Obesity-related Health Conditions
Psychiatric Diagnoses and Children with Obesity-related Health Conditions
Objective: To examine the association of psychiatric diagnoses and use of health care services in children with obesity-related health conditions.
Method: A retrospective, longitudinal design was used to examine Medicaid claims data. The data set consisted of 13,688 youth diagnosed with type 2 diabetes, metabolic syndrome, dyslipidemia, or obesity.
Results: The presence of any type of psychiatric diagnosis was associated with higher health service use. In particular, the presence of an internalizing diagnosis was more consistently associated with higher service use than the presence of an externalizing diagnosis. Children with both an externalizing and internalizing disorder diagnosis had greater service use than children with a diagnosis in only one of these categories.
Conclusions: These data highlight a subgroup of children with obesity-related health conditions who are at greater risk for higher health service use, and the need for further research on the association between psychiatric diagnosis and health service use.
Pediatric obesity is a major public health issue. Over 33% of children and adolescents in the US are now overweight or at-risk for overweight (Ogden et al., 2006). Overweight children are at elevated risk for a number of negative health conditions including type 2 diabetes (Fagot-Campagna et al., 2000; Glaser, 1999), metabolic syndrome (Weiss et al., 2004), and cardiovascular risk factors such as dyslipidemia (Field, Cook, & Gillman, 2005; Freedman, Dietz, Srinivasan, & Berenson, 1999). These deleterious health conditions are much more common in overweight children relative to their nonoverweight peers (American Diabetes Association – Consensus Statement, 2003; Duncan, Li, & Zhou, 2004; de Ferranti, Gauvreau, Ludwig, Newburger, & Rifai, 2006; Fagot-Campagna et al., 2000; Mei et al., 2007). Unfortunately, the prevalence of these obesity-related health conditions in children continue to increase (Duncan et al., 2004; Fagot-Campagna et al., 2000)
While the health consequences of obesity are substantial, the economic effects of obesity on the health care system are also significant. Obesity-associated hospital expenditures (adjusted for inflation) for children increased by 3-fold from 1979–1981 to 1997–1999 (Wang & Dietz, 2002). Given the increasing prevalence of negative health conditions associated with overweight status, it is not surprising that overweight children incur greater health care expenditures than their nonoverweight counterparts (Hampl, Carroll, Simon, & Sharma, 2007).
Studies with general pediatric populations provide evidence that social, emotional, and behavioral factors are associated with higher health services use and expenditures (Janicke, Finney, & Riley, 2001; Lavigne et al., 1998). Unfortunately, rates of psychiatric diagnosis appear to be greater in children who are overweight or have obesity-related health conditions relative to children with other chronic health conditions (Hesketh, Wake & Waters, 2004; Janicke, Harman, Kelleher, Zhang, in press; Sjoberg, Nilsson, & Leppert, 2005). While data on causal mechanisms are not conclusive, it is likely that the relationship between psychiatric diagnosis and obesity-related health conditions is bidirectional. In some children, being overweight or having an obesity-related health condition can lead to greater psychosocial distress and psychiatric diagnosis (Mustillo et al., 2003). Alternatively, these same social, emotional, and behavior problems can have a negative impact on the behaviors related to establishing or maintaining a healthy weight status (i.e., dietary intake and physical activity) (Gray, Janicke, Ingerski, & Silverstein, 2008; Storch et al., 2007). Such behaviors contribute to increased weight gain and a greater likelihood that health services will be used to treat obesity-related conditions.
While the adult literature provides some evidence that psychosocial distress is related to greater health care expenditures in those with an obesity-related health condition (Kalsekar et al., 2006), there are no data examining the relationship between psychosocial distress and health service use in children who are overweight or have obesity-related health conditions. As the rates of obesity and related health conditions continue to rise, a relationship between increased expenditures and psychosocial distress could signal the potential for an expansion in health service use and expenditures for segments of the pediatric population, placing an even greater burden on the health care system. Understanding specific diagnostic and demographic factors related to greater service use within this population could have important implications for health service providers, researchers, and policymakers.
The purpose of this study is to determine: (a) in this sample of children with an obesity-related condition, do those with a psychiatric diagnosis have greater nonpsychiatric health services use and expenditures than those without a psychiatric diagnosis; and (b) if category of psychiatric disorder, age, gender, and race are related to greater health services use and expenditures for children with obesity-related health conditions. It is hypothesized that for children with an obesity-related diagnosis, the presence of a psychiatric diagnosis will be related to greater nonpsychiatric service use and expenditures than the absence of a psychiatric diagnosis.
Abstract and Introduction
Abstract
Objective: To examine the association of psychiatric diagnoses and use of health care services in children with obesity-related health conditions.
Method: A retrospective, longitudinal design was used to examine Medicaid claims data. The data set consisted of 13,688 youth diagnosed with type 2 diabetes, metabolic syndrome, dyslipidemia, or obesity.
Results: The presence of any type of psychiatric diagnosis was associated with higher health service use. In particular, the presence of an internalizing diagnosis was more consistently associated with higher service use than the presence of an externalizing diagnosis. Children with both an externalizing and internalizing disorder diagnosis had greater service use than children with a diagnosis in only one of these categories.
Conclusions: These data highlight a subgroup of children with obesity-related health conditions who are at greater risk for higher health service use, and the need for further research on the association between psychiatric diagnosis and health service use.
Introduction
Pediatric obesity is a major public health issue. Over 33% of children and adolescents in the US are now overweight or at-risk for overweight (Ogden et al., 2006). Overweight children are at elevated risk for a number of negative health conditions including type 2 diabetes (Fagot-Campagna et al., 2000; Glaser, 1999), metabolic syndrome (Weiss et al., 2004), and cardiovascular risk factors such as dyslipidemia (Field, Cook, & Gillman, 2005; Freedman, Dietz, Srinivasan, & Berenson, 1999). These deleterious health conditions are much more common in overweight children relative to their nonoverweight peers (American Diabetes Association – Consensus Statement, 2003; Duncan, Li, & Zhou, 2004; de Ferranti, Gauvreau, Ludwig, Newburger, & Rifai, 2006; Fagot-Campagna et al., 2000; Mei et al., 2007). Unfortunately, the prevalence of these obesity-related health conditions in children continue to increase (Duncan et al., 2004; Fagot-Campagna et al., 2000)
While the health consequences of obesity are substantial, the economic effects of obesity on the health care system are also significant. Obesity-associated hospital expenditures (adjusted for inflation) for children increased by 3-fold from 1979–1981 to 1997–1999 (Wang & Dietz, 2002). Given the increasing prevalence of negative health conditions associated with overweight status, it is not surprising that overweight children incur greater health care expenditures than their nonoverweight counterparts (Hampl, Carroll, Simon, & Sharma, 2007).
Studies with general pediatric populations provide evidence that social, emotional, and behavioral factors are associated with higher health services use and expenditures (Janicke, Finney, & Riley, 2001; Lavigne et al., 1998). Unfortunately, rates of psychiatric diagnosis appear to be greater in children who are overweight or have obesity-related health conditions relative to children with other chronic health conditions (Hesketh, Wake & Waters, 2004; Janicke, Harman, Kelleher, Zhang, in press; Sjoberg, Nilsson, & Leppert, 2005). While data on causal mechanisms are not conclusive, it is likely that the relationship between psychiatric diagnosis and obesity-related health conditions is bidirectional. In some children, being overweight or having an obesity-related health condition can lead to greater psychosocial distress and psychiatric diagnosis (Mustillo et al., 2003). Alternatively, these same social, emotional, and behavior problems can have a negative impact on the behaviors related to establishing or maintaining a healthy weight status (i.e., dietary intake and physical activity) (Gray, Janicke, Ingerski, & Silverstein, 2008; Storch et al., 2007). Such behaviors contribute to increased weight gain and a greater likelihood that health services will be used to treat obesity-related conditions.
While the adult literature provides some evidence that psychosocial distress is related to greater health care expenditures in those with an obesity-related health condition (Kalsekar et al., 2006), there are no data examining the relationship between psychosocial distress and health service use in children who are overweight or have obesity-related health conditions. As the rates of obesity and related health conditions continue to rise, a relationship between increased expenditures and psychosocial distress could signal the potential for an expansion in health service use and expenditures for segments of the pediatric population, placing an even greater burden on the health care system. Understanding specific diagnostic and demographic factors related to greater service use within this population could have important implications for health service providers, researchers, and policymakers.
The purpose of this study is to determine: (a) in this sample of children with an obesity-related condition, do those with a psychiatric diagnosis have greater nonpsychiatric health services use and expenditures than those without a psychiatric diagnosis; and (b) if category of psychiatric disorder, age, gender, and race are related to greater health services use and expenditures for children with obesity-related health conditions. It is hypothesized that for children with an obesity-related diagnosis, the presence of a psychiatric diagnosis will be related to greater nonpsychiatric service use and expenditures than the absence of a psychiatric diagnosis.