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Medical hospitalization may be especially distressing for those with psychiatric disorders

Center for Advancing Health

Being hospitalized for a medical illness may have long-term negative effects on those with psychiatric conditions, according to a one-year study of male veterans.

"The findings in this study indicate the need for physicians to evaluate the mental health status of their hospitalized or more seriously ill patients," said lead author Brenda M. Booth, PhD, of the Center for Mental Healthcare and Outcomes Research, at the VA Medical Center, in Little Rock, Arkansas.

Previous research has shown medical illness and hospitalization tends to be hard on everyone -- up to half of medically ill patients report depression, anxiety or distress -- but those who also suffer from psychiatric disorders may be hit even harder with such symptoms when they are hospitalized, according to the study.

Booth and colleagues surveyed more than 700 veterans hospitalized for illnesses such as cancer, heart disease, circulatory disorders and injuries. Approximately half of the veterans had either a current or past history of a psychiatric disorder such as a mood, anxiety or substance abuse disorder.

In general, health-related quality of life declined and psychological distress increased over time for study participants with or without psychiatric disorders -- but those with psychiatric disorders tended to be the most impaired, Booth and colleagues found.

"Our findings indicate the substantial impairments in functioning associated with psychiatric disorders during medical hospitalization are not short term and do not subside but continue over the space of one year," noted Booth. The study results are published in the January 2001 issue of the Journal of General Internal Medicine.

Booth and colleagues suggested the use of brief mental health and substance abuse screening tests. These could be completed by patients before seeing physicians. "One clinical option is to evaluate for signs and symptoms of distress during a medical crisis, continue to observe during follow-up care and intervene later if distress persists longer than a few weeks," said Booth.

Psychiatric disorders may require varying treatment strategies, the researchers noted. Depression and alcohol dependency tend to be treatable by primary care physicians, while disorders such as post-traumatic stress disorder may require the expertise of mental health practitioners. Also, to prevent patients with a history of mood and anxiety disorders from relapsing due to the stress of their medical illnesses, primary care physicians may wish to prescribe preventive medication or refer these individuals to mental health providers.

"It is critical that mental health problems be addressed, accounted for and treated effectively when examining health-related outcomes after medical care," Booth concluded.


This research was funded by grants from the Department of Veterans Affairs, the National Institute of Mental Health, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.

The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at 410-955-9868.

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