Complexity of care and mental illness in medical inpatients

We investigated the complexity of medical inpatient care to learn it was as sociated with the presence and type of mental disorders, and with emotional distress and somatization. Six indicators of care complexity, including le ngth of stay (LOS), were assessed for 294 consecutive medical inpatients. P atients rated their own health and physical disability, and medical consult ants assessed them for chronic and life-threatening diseases. A subsample o f 157 patients was assessed for ICD-10 psychiatric diagnoses by means of an extensive semi-structured interview known as Schedules for Clinical Assess ment in Neuropsychiatry (SCAN). With a few exceptions, the indicators of co mplexity of care were not statistically significantly associated to ICD-10 mental disorders; psychological distress, measured by the SCL-8 rating scal e; or somatization, measured by the Whiteley-7 rating scale. On the other h and, four of six complexity indicators were significantly associated with s elf-rated physical disability or health. or both, when controlling for the severity of the medical condition. In conclusion, complexity of care, inclu ding LOS, was substantially associated with the patient's own health percep tion but only marginally with the presence of mental illness. This is notew orthy, as previously published results concerning the same patients have sh own a clear association of mental illness with utilization of admissions to nonpsychiatric departments, and with utilization of primary care resources . (C) 2001 Elsevier Science Inc. All rights reserved.