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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3016 — The Role of Comorbid Psychiatric Conditions on Health Status in Veterans with Epilepsy

Author List:
Zeber JE (VERDICT / UTHSCSA)
Copeland LA (VERDICT / UTHSCSA)
Cramer JA (Yale University)
Amuan M (CHQOER / Bedford VA)
Pugh MV (VERDICT / UTHSCSA)

Objectives:
Psychiatric comorbidities, particularly depression and schizophrenia, are highly prevalent in patients with epilepsy. While depression often has a greater impact on health status than seizure frequency or severity, the ramifications of a broader range of mental illnesses has not been studied. Basic information such as incidence rates and impact on quality of life is largely unknown, and the long-term implications are poorly understood. We examined rates of psychiatric comorbidities in a national sample of veterans with epilepsy, describing the impact on self-reported quality of life.

Methods:
In addition to VA administrative data, this study utilized health status information from the 1999 Large Veterans Health Survey. Multivariate ANCOVA models derived adjusted SF-36V scores (8 scales) on individuals with epilepsy alone (N=7,379) compared to epilepsy patients with the following psychiatric conditions (N=6,320): Major Depression, Schizophrenia, Bipolar Disorder, Anxiety Disorder, Substance Abuse, Post-Traumatic Stress Disorder, and Other mental illness. Analyses controlled for demographics, utilization, and physical comorbidities.

Results:
Predominantly male, highly service-connected, and low income, this population averaged 4.5 medical comorbidities in addition to their psychiatric conditions. Compared to epilepsy patients alone, mean SF-36V scores of veterans with any psychiatric diagnosis averaged 21% lower across all domains. The greatest differences existed in the Role Emotional (36.8 versus 22.7) and Role Physical (24.8 versus 18.1) scales. A strict hierarchical effect was observed regarding specific psychiatric comorbidities, as PTSD consistently corresponded to the lowest scores, followed by Depression (averaging 29.4% and 25.6% less than epilepsy alone, respectively). Schizophrenia appeared to impart the least relative detriment to perceived health states (16.9% lower).

Implications:
Psychiatric comorbidities impart significant emotional and physical burdens on veterans with epilepsy. The high prevalence of mental health problems for this population, especially in context with consistent quality-of-life decrements across diagnoses, illustrates the need for timely recognition and treatment of multiple chronic conditions.

Impacts:
Patients with epilepsy may constitute a group of medically ill veterans uniquely at risk for high physical-psychiatric comorbidity profiles, with concomitant losses in quality of life. Recognizing the additional burden imparted by mental health conditions should enable the VA to better address both medical and psychiatric needs of these severely ill veterans.


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