Association of serious psychological distress with health services expenditures and utilization in a national sample of US adults

Objective: The Kessler six-item scale has been shown to be a valid and reliable measure of serious psychological distress (SPD) in community samples. We examined the effect of SPD on health service expenditures and utilization for seven categories in a national probability sample of community dwelling adults in the United States. Methods: We used the two-step sample selection model to examine the association between SPD and total, office-based, outpatient, emergency department (ED), inpatient, dental, home health and prescription expenditures and utilization in 18,330 US adults who participated in the 2007 Medical Expenditure Panel Survey (MEPS). Results: SPD was significantly associated with 1735 ( 95% CI: 702-2769) higher total expenditures, 285 higher office expenditures ( 95% CI: 30-539), 183 higher ED expenditures (95% CI: 64-303), 282 (95% CI: 62-503) higher home health expenditures, 614 (95% CI: 403-825) higher prescription expenditures and 41 (95% CI: -103 to 22) lower dental expenditures. SPD was associated with 3.09 (95% CI: 2.09-4.08) more office visits, 0.27 (95% CI: 0.17-0.36) more ED visits, 0.84 (95% CI: 0.36-1.32) more inpatient visits, 2.93 (95% CI: 0.13-5.70) more home health visits, 8.13 (95% CI: 6.08-10.18) more prescriptions and 0.18 (95% CI: -0.30 to -0.07) less dental visits. Conclusions: Among US adults, SPD is associated with significant increases in total expenditures and most other categories of expenditure and utilization. Targeted interventions to mitigate the adverse effects of SPD are needed.