Mental comorbidity and its contribution to increased use of acute care hospital services

View the most recent version.

Archived Content

Information identified as archived is provided for reference, research or recordkeeping purposes. It is not subject to the Government of Canada Web Standards and has not been altered or updated since it was archived. Please "contact us" to request a format other than those available.

Archived

This page has been archived on the Web.

[an error occurred while processing this directive]82-622-x[an error occurred while processing this directive] [an error occurred while processing this directive]

by Helen Johansen, Claudia Sanmartin and the Longitudinal Health and Administrative Data Research Team

Executive summary

About one in five Canadians have suffered from a mental condition at some point in their lives. Like other health conditions, mental conditions represent an economic burden to society, and costs are often comparable to physical conditions such as heart disease. Expenditures on mental conditions and addictions for Canadian provinces in 2003/2004 were $6.6 billion, of which $5.5 billion was from public sources.

Major psychiatric conditions are often associated with physical comorbidity—in particular, diabetes, cardiovascular disease, high blood pressure and respiratory conditions. Reasons for this association are diverse, and not fully understood. Many health conditions increase the risk for a mental condition. Mental comorbidity can complicate help-seeking, diagnosis, and treatment, and it influences prognosis. Hence understanding the burden of mental conditions as a comorbid condition among those with physical morbidities is important.

This report represents an assessment of a comprehensive set of factors associated with acute-care hospitalizations for mental conditions in Canada. The first part explores the overall burden of a mental condition as the most responsible condition (the condition considered most responsible for the hospitalization) and as a comorbid condition (a diagnosed condition other than the most responsible for the hospitalization) in acute-care hospitals in Canada. It presents the number of hospitalizations, the number of hospital days and the average length of stay of a hospitalization. In the second part, linked health survey and hospital data are used to describe the socioeconomic and lifestyle factor characteristics of patients who were admitted to an acute-care hospital with a mental condition within four years after responding to the survey.

Key findings

Part 1: Understanding the burden of mental conditions on acute-care hospitalizations

• Those who were discharged at least once from an acute-care hospital with a diagnosed mental condition represent 1% of Canadians but 14.7% of hospitalized individuals.
• Altogether hospitalizations at an acute-care hospital by people with a diagnosed mental condition accounted for 29% of hospital days: 12.4% (2.5 million) of hospital days were associated with a most responsible diagnosis of a mental condition and 16.6% (3.3 million) of hospital days were associated with a comorbid diagnosis of a mental condition.
• On average, the length of stay for hospitalizations with a comorbid diagnosis of a mental condition is twice as long compared with those admitted without one. This finding is consistent across ages, provinces and major disease types.
• Hospitalizations with a most responsible diagnosis of a mood, psychotic or organic (dementia, delirium) condition contain a high number of hospital days, as do hospitalizations with a comorbid diagnosis of an organic, substance or mood mental condition.
• Variations across provinces and health regions were noted. Some variations reflect potential differences in diagnostic coding practices.

Part 2: Characteristics of individuals admitted to acute-care hospital with a mental condition

• Results of the linked survey and hospital data reveal significant differences in the socioeconomic and lifestyle factors of those who experienced a hospitalization with a diagnosis of a mental condition (most responsible or comorbid) compared with those hospitalizations who did not.
• Those in lower income groups and those with less than a high school education were at higher risk of hospitalization with a diagnosis of a mental condition.
• Smokers were more likely to experience a hospitalization with a diagnosis of a mental condition compared with non-smokers.
• Those single (never married), separated/divorced or widowed were at higher risk of hospitalization with a diagnosis of a mental condition than those who were married.
• Those admitted to hospital with a documented mental condition were more likely to have had chronic physical conditions and disability.
• Those who are hospitalized with a diagnosis of a mental condition were more likely to report an unmet health care need compared with those who were not hospitalized.