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Brenda M. Booth, PhD; Frederic C. Blow, PhD; Cynthia A. Loveland Cook, PhD

Arch Intern Med. 1998;158:1551-1559.

Background  Although previous research has described a high prevalence of psychiatric comorbidity among general medical and surgical patients, prevalence estimates based on diagnostic criteria and the assessment of health care outcomes including functional status has not been conducted for a broad range of psychiatric disorders.

Methods  A random sample of male medical and surgical admissions to 3 Department of Veterans Affairs Medical Centers was enrolled in the study. Subjects were administered a computerized structured psychiatric diagnostic interview and completed a multidimensional measure of health-related functioning, the Medical Outcomes Study 36-Item Short-Form Health Survey.

Results  Of 1007 medical and surgical inpatients, almost half (46.6%) met lifetime criteria for at least 1 Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition disorder, most commonly for alcohol abuse or dependence (32.5%), posttraumatic stress disorder (10.0%), and major depression or dysthymia (9.0%). Almost one fifth reported recent symptoms, most frequently for major depression or dysthymia (7.0%). Co-occurring psychiatric disorders were associated with substantial and significant (P<.001) impairment on all dimensions of functioning, with the greatest decrements observed in physical and emotional role functioning. Anxiety and mood disorders were associated with the most and somewhat similar reductions in functioning.

Conclusions  The prevalence of co-occurring psychiatric disorders was substantial but consistent with other studies of populations receiving health services. Given the observed additional burden of psychiatric disorders on functioning in medically hospitalized patients, the study indicates the importance of identification and treatment of co-occurring psychiatric disorders in this high-risk and clinically challenging group of patients.

From the HSR&D Field Program for Mental Health, Veterans Affairs Medical Center and the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Dr Booth); Serious Mental Illness Treatment Research and Evaluation Center, HSR&D Field Program, Veterans Affairs Medical Center and Alcohol Research Center and the Department of Psychiatry, University of Michigan, Ann Arbor (Dr Blow); and the Great Lakes HSR&D Field Program, Indianapolis, Ind, and George Warren Brown School of Social Work, Washington University, St Louis, Mo (Dr Cook). Dr Cook is now with the Center for Nursing Research, BJC Health System, St Louis.

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