Mental health and high-cost health care utilization: New evidence from Axis II disorders

Johanna Catherine MacLean, Haiyong Xu, Michael T. French, Susan L. Ettner

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective To analyze the associations between Axis II (A2) disorders and two measures of health care utilization with relatively high cost: emergency department (ED) episodes and hospital admissions. Data Source/Study Setting Wave I (2001/2002) and Wave II (2004/2005) of the National Longitudinal Survey on Alcohol and Related Conditions (NESARC). Study Design A national probability sample of adults. Gender-stratified regression analysis adjusted for a range of covariates associated with health care utilization. Data Collection The target population of the NESARC is the civilian noninstitutionalized population aged 18 years and older residing in the United States. The cumulative survey response rate is 70.2 percent with a response rate of 81 percent (N = 43,093) in Wave I and 86.7 percent (N = 34,653) in Wave II. Principal Findings Both men and women with A2 disorders are at elevated risk for ED episodes and hospital admissions. Associations are robust after adjusting for a rich set of confounding factors, including Axis I (clinical) psychiatric disorders. We find evidence of a dose-response relationship, while antisocial and borderline disorders exhibit the strongest associations with both measures of health care utilization. Conclusions This study provides the first published estimates of the associations between A2 disorders and high-cost health care utilization in a large, nationally representative survey. The findings underscore the potential implications of these disorders on health care expenditures.

Original languageEnglish (US)
Pages (from-to)683-704
Number of pages22
JournalHealth Services Research
Issue number2
StatePublished - Apr 2014


  • Axis II disorders
  • ED episodes
  • health care utilization
  • hospital admissions
  • mental health

ASJC Scopus subject areas

  • Health Policy


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