The researchers conducted the study at the Marillac Clinic in Grand Junction, CO. The clinic serves people with no health insurance and with incomes less than 150% of the federal poverty level only. During April and May 1999, 500 patients participated in the study which consisted of completing questionnaires. These questionnaires were then compared with similar questionnaires from a sample of 3000 patients from general primary care settings.
The results of the study showed significantly higher rates of psychiatric disorders for the participants at the Marillac Clinic (51% vs 28%). Additionally, these patients showed lower functional status, increased disability days and increased physician visits. The rates of psychiatric disorders were divided into the following categories:
Mood Disorders
Low-Income, Uninsured Population: 33% | General Population 16%
Anxiety Disorders
Low-Income, Uninsured Population: 36% | General Population 11%
Alcohol Abuse
Low-Income, Uninsured Population: 17% | General Population 7%
Eating Disorders
Low-Income, Uninsured Population: 10% | General Population 7%
As significant as these findings are, the researchers feel that they are, in fact, conservative numbers. The researchers did not test for all psychiatric disorders, including dysthymia, non-alcohol substance abuse, bipolar disorder, etc.
As part of the study, the researchers also asked participants how they would like to be treated for psychiatric disorders. Almost all of the participants (90%) wanted medical providers and mental health providers to work together regarding the patients' health care.
As a result of the study, the researchers have been given 4-year grants to change the way psychiatric disorders are treated at the Marillac Clinic. The clinic will hire counselors and case managers, and will use a model of family health care that emphasizes communication between medical and mental health providers.
The researchers point out that psychiatric disorders may lead to higher rates of disability which then lead to futher poverty. Medical illnesses may be complicated and even caused by psychiatric disorders. Self-care and well-being may decrease as a psychiatric disorder goes untreated. Low-income, uninsured patients want help. Primary care facilities can give them that help by assessing for psychiatric problems, helping patients find proper psychiatric treatment, and keeping communication open with mental health providers.
Reference: Mauksch LB, Tucker SM, Katon WJ, Russo J, Cameron J, Walker E, Spitzer R (2001), Mental illness, functional impairment, and patient preferences for collaborative care in an uninsured, primary care population. J Fam Pract 50(1).