how do health outcomes compare in adults with dd with and without mental health problems? susan m....
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How Do Health Outcomes Compare in Adults with DD with and without
Mental Health Problems?
Susan M. Havercamp, Ph.D.
University of North Carolina
North Carolina Office on Disability and Health
Karen Luken, TRS/CTRS
North Carolina Office on Disability and Health
AAMR 2004
Health & DD DD health is invisible to public health
and ignored by DD service delivery Research suggests prevalence of
health conditions is the same or higher Limitations in function due to problems
with communication, physical fitness, and weight
Healthcare access can be a challenge, especially in the community
Health & Mental Health
Mental Health problems may look like physical illness and vice versa
Poor physical health may worsen mental health problems (esp. anxiety and depression)
Physical health problems may go undetected in persons with mental illness
Health Indicators National Core Indicators is a Quality Management
protocol for the DD service delivery system Coordinated nationally by Human Services
Research Institute (HSRI) Standard instrument, interviewer training, and
methodology Three sources of information: self-report, proxy
(informant), and case manager (file)
DD Sample Selection
Stratified random selection of individuals meeting inclusion criteria
Adults (age 18+) who receive services from the state division on developmental disabilities
Invited to participate in interview (informed consent obtained by case manager)
Health Indicator Items
Many Items adapted from the BRFSS BRFSS methodology under-represents DD
Special considerations in interviewing persons with DD Cloak of competence Acquiescence Memory impairment
Physical Health is compared across two groups
Adults with Developmental Disabilities without co-occurring Mental Health Problems (n=675; 70.8%)
And Adults with Developmental Disabilities and
Mental Health Problems (n=341; 29.2%)
Of persons with MH problems,
MH Diagnosis PercentDepression 23.1%Bipolar Disorder 7.9%Anxiety 9.9%Schizophrenia 43.8%
Eating Disorder 1.6%Personality Disorder 11.6%
Demographics
No MH
(n=675)
MH
(n=341)
% male 56.7 55.4
Caucasian 63.3 61.2
African-Amer 34.5 36.8
Hispanic 3.3 1.7
Age (average) 35.7 years 40.8 years
Demographics, continued
Level of MR No MH group MH group
Non-MR 6.8 5.1
Mild 29.0 52.2
Moderate 23.7 30.1
Severe 18.6 8.1
Profound 19.8 3.0
Health Indicators Content
Health Risk Behaviors
Overall Health Status & Health Conditions
Healthcare Access
Health Risk Behaviors
No MH MH group
Relative Risk (RR)
Cigarette use 11.7 27.2 2.32***
Alcohol 4.2 4.8 1.14
Overweight 51.6 67.6 1.31*
Exercise < once/month
13.0 10.3 .79
* p<.05
*** p<.001
Mental Health Risk /Resilience
No MH MH group RR
Death
(close friend/ family
31.0 39.7 1.28
Moved 30.0 39.7 1.32
Staff change 53.1 56.3 1.06
Hospitalized 21.7 21.3 .98
No Social Support(often lonely /no confidant)
19.2 24.0 1.25
Chronic Health Conditions
No MH MH group RR
Diabetes 5.5 10.5 1.91*
High Blood Pressure 11.9 24.9 2.09**
Headache 2.9 5.3 1.83
Respiratory Problems 5.8 6.8 1.17
Urinary Tract Infections 4.2 2.6 .62
Sleep Problem 2.3 5.8 2.52*
* p<.05
*** p<.001
Health Service Utilization
No MH MH group RR
Physical exam(> 1 year)
4.5 9.7 2.16*
Dentist visit(> 5 years or never)
11.0 3.6 .33*
Gynecological exam(>5years or never)
16.1 22.5 1.40
Mammogram(never)
50.4 35.9 .71*
* p<.05
Health Indicators Conclusions Adults with dual diagnosis are more likely to
smoke cigarettes and be overweight or obese compared to adults with developmental disabilities without mental health problems.
Both groups (MH and noMH) suffer extreme life stress and inadequate social support
Adults with dual diagnosis were more likely to have diabetes and high blood pressure
The MH group had surprisingly better access to healthcare services
Adults with developmental disabilities, and especially
those with co-occurring mental health problems, are in need of health promotion and disease
prevention initiatives
For more information…Contact: Susan M. Havercamp, Ph.D.University of North CarolinaCB# 7255Chapel Hill, NC 27599-7255Tel. (919) 966-6312E-mail:
Visit the HSRI website:www.hsri.org/manage/core.html