Table 3. Health System Utilization in the Year Before and After Initial Health Record Diagnosis of Somatic Symptom and Related Disorders by Location of Initial Diagnosis, Age-Stratified.
| Health system utilization | Outpatienta | Emergency departmentb | Inpatientc | ||||||
|---|---|---|---|---|---|---|---|---|---|
| 1 y Before diagnosis | 1 y After diagnosis | P value | 1 y Before diagnosis | 1 y After diagnosis | P value | 1 y Before diagnosis | 1 y After diagnosis | P value | |
| Acute care use | |||||||||
| Mental health–related visits | |||||||||
| Emergency department, No. (%) | |||||||||
| 4-12 y | 28 (1.4) | 19 (1.0) | .18 | 38 (2.4) | 69 (4.3) | <.001 | 17 (5.5) | 30 (9.7) | .03 |
| 13-17 y | 177 (5.2) | 187 (5.5) | .55 | 354 (11.3) | 436 (13.9) | <.001 | 120 (16.1) | 135 (18.1) | .23 |
| 18-24 y | 587 (4.7) | 542 (4.3) | .10 | 1059 (12.4) | 1162 (13.6) | .004 | 193 (19.0) | 197 (19.4) | .77 |
| Inpatient, No. (%) | |||||||||
| 4-12 y | 10 (0.5) | 24 (1.2) | .01 | 12 (0.7) | 27 (1.7) | .005 | NA | 22 (7.1) | <.001 |
| 13-17 y | 109 (3.2) | 147 (4.3) | .004 | 142 (4.5) | 223 (7.1) | <.001 | 94 (12.6) | 138 (18.5) | <.001 |
| 18-24 y | 222 (1.8) | 244 (1.9) | .23 | 322 (3.8) | 490 (5.7) | <.001 | 151 (14.9) | 167 (16.4) | .21 |
| All-cause visits | |||||||||
| Emergency department, No. (%) | |||||||||
| 4-12 y | 563 (28.8) | 526 (26.9) | .13 | 951 (59.1) | 828 (51.5) | <.001 | 248 (80.3) | 175 (56.6) | <.001 |
| 13-17 y | 1151 (34.0) | 1129 (33.3) | .50 | 2130 (67.8) | 2052 (65.3) | .01 | 554 (74.5) | 469 (63.0) | <.001 |
| 18-24 y | 4035 (32.2) | 3931 (31.3) | .10 | 6009 (70.2) | 5793 (67.7) | <.001 | 798 (78.5) | 697 (68.6) | <.001 |
| Emergency department, median (IQR) | |||||||||
| 4-12 y | 0 (0-1) | 0 (0-1) | <.001 | 1 (0-2) | 1 (0-2) | <.001 | 2 (1-4) | 1 (0-2) | <.001 |
| 13-17 y | 0 (0-1) | 0 (0-1) | .21 | 1 (0-3) | 1 (0-3) | .04 | 2 (0-4) | 1 (0-3) | .02 |
| 18-24 y | 0 (0-1) | 0 (0-1) | .15 | 1 (0-3) | 1 (0-3) | .06 | 2 (1-4) | 1 (0-4) | .07 |
| Inpatient, No. (%) | |||||||||
| 4-12 y | 112 (5.7) | 120 (6.1) | .47 | 107 (6.7) | 141 (8.8) | .01 | 108 (35.0) | 98 (31.7) | .29 |
| 13-17 y | 261 (7.7) | 304 (9.0) | .02 | 378 (12.0) | 515 (16.4) | <.001 | 294 (39.5) | 294 (39.5) | >.99 |
| 18-24 y | 642 (5.1) | 583 (4.6) | .05 | 1027 (12.0) | 1294 (15.1) | <.001 | 397 (39.1) | 387 (38.1) | .59 |
| Ambulatory visits | |||||||||
| Mental health–related visits | |||||||||
| Family physician, No. (%) | |||||||||
| 4-12 y | 279 (14.2) | 397 (20.3) | <.001 | 198 (12.3) | 233 (14.5) | .04 | 42 (13.6) | 60 (19.4) | .02 |
| 13-17 y | 742 (21.9) | 1059 (31.3) | <.001 | 836 (26.6) | 960 (30.6) | <.001 | 257 (34.5) | 303 (40.7) | .002 |
| 18-24 y | 3750 (29.9) | 4945 (39.4) | <.001 | 2965 (34.6) | 3284 (38.4) | <.001 | 477 (46.9) | 519 (51.1) | .02 |
| Psychiatrist, No. (%) | |||||||||
| 4-12 y | 110 (5.6) | 168 (8.6) | <.001 | 81 (5.0) | 148 (9.2) | <.001 | 69 (22.3) | 99 (32.0) | <.001 |
| 13-17 y | 372 (11.0) | 550 (16.2) | <.001 | 395 (12.6) | 589 (18.7) | <.001 | 311 (41.8) | 349 (46.9) | .01 |
| 18-24 y | 1019 (8.1) | 1333 (10.6) | <.001 | 1003 (11.7) | 1276 (14.9) | <.001 | 328 (32.3) | 384 (37.8) | <.001 |
| Pediatrician, No. (%) | |||||||||
| 4-12 y | 208 (10.6) | 312 (15.9) | <.001 | 208 (12.9) | 254 (15.8) | .002 | 57 (18.4) | 73 (23.6) | .05 |
| 13-17 y | 276 (8.1) | 311 (9.2) | .04 | 306 (9.7) | 343 (10.9) | .04 | 166 (22.3) | 208 (28.0) | .001 |
| 18-24 y | 139 (1.1) | 84 (0.7) | <.001 | 86 (1.0) | 53 (0.6) | <.001 | 19 (1.9) | 6 (0.6) | .001 |
| Any ambulatory, No. (%) | |||||||||
| 4-12 y | 456 (23.3) | 674 (34.4) | <.001 | 369 (22.9) | 476 (29.6) | <.001 | 122 (39.5) | 155 (50.2) | .001 |
| 13-17 y | 1037 (30.6) | 1413 (41.7) | <.001 | 1122 (35.7) | 1324 (42.1) | <.001 | 460 (61.8) | 533 (71.6) | <.001 |
| 18-24 y | 4108 (32.7) | 5338 (42.5) | <.001 | 3264 (38.1) | 3639 (42.5) | <.001 | 585 (57.6) | 651 (64.1) | <.001 |
| Any ambulatory, median (IQR) | |||||||||
| 4-12 y | 0 (0-0) | 0 (0-1) | <.001 | 0 (0-0) | 0 (0-1) | <.001 | 0 (0-1) | 1 (0-3) | <.001 |
| 13-17 y | 0 (0-1) | 0 (0-2) | <.001 | 0 (0-1) | 0 (0-2) | <.001 | 1 (0-4) | 2 (0-7) | <.001 |
| 18-24 y | 0 (0-1) | 0 (0-2) | <.001 | 0 (0-1) | 0 (0-2) | <.001 | 1 (0-5) | 2 (0-6) | <.001 |
| All-cause outpatient visits | |||||||||
| Family physician, No. (%) | |||||||||
| 4-12 y | 1632 (83.4) | 1627 (83.1) | .80 | 1264 (78.6) | 1233 (76.7) | .10 | 245 (79.3) | 223 (72.2) | .01 |
| 13-17 y | 2882 (85.1) | 2910 (85.9) | .27 | 2631 (83.7) | 2675 (85.1) | .06 | 623 (83.7) | 625 (84.0) | .86 |
| 18-24 y | 11 029 (87.9) | 10 950 (87.3) | .09 | 7473 (87.3) | 7576 (88.5) | .003 | 936 (92.1) | 915 (90.1) | .05 |
| Pediatrician, No. (%) | |||||||||
| 4-12 y | 661 (33.8) | 773 (39.5) | <.001 | 693 (43.1) | 828 (51.5) | <.001 | 237 (76.7) | 225 (72.8) | .17 |
| 13-17 y | 775 (22.9) | 721 (21.3) | .02 | 903 (28.7) | 1048 (33.4) | <.001 | 448 (60.2) | 415 (55.8) | .02 |
| 18-24 y | 575 (4.6) | 384 (3.1) | <.001 | 395 (4.6) | 307 (3.6) | <.001 | 81 (8.0) | 39 (3.8) | <.001 |
| Any ambulatory, No. (%) | |||||||||
| 4-12 y | 1755 (89.6) | 1768 (90.3) | .43 | 1419 (88.2) | 1429 (88.9) | .51 | 295 (95.5) | 294 (95.1) | .84 |
| 13-17 y | 3025 (89.3) | 3047 (90.0) | .33 | 2801 (89.1) | 2868 (91.3) | .001 | 716 (96.2) | 713 (95.8) | .68 |
| 18-24 y | 11 156 (88.9) | 11 068 (88.2) | .05 | 7555 (88.3) | 7648 (89.3) | .006 | 960 (94.5) | 948 (93.3) | .19 |
| Any ambulatory, median (IQR) | |||||||||
| 4-12 y | 4 (2-7) | 4 (2-7) | .16 | 3 (2-7) | 4 (2-7) | <.001 | 7 (3-12) | 7 (3-12) | .92 |
| 13-17 y | 3 (1-6) | 4 (2-7) | <.001 | 4 (2-7) | 4 (2-8) | <.001 | 7 (4-13) | 8 (4-14) | <.001 |
| 18-24 y | 3 (1-7) | 3 (1-7) | <.001 | 4 (2-9) | 5 (2-9) | <.001 | 7 (3-13) | 7 (3-13) | .02 |
Abbreviations: IQR, interquartile range; NA, not applicable.
a
1958 patients aged 4 to 12 years; 3387 aged 13 to 17 years; and 12 548 aged 18 to 24 years.
b
1608 patients aged 4 to 12 years; 3142 aged 13 to 17 years; and 8560 aged 18 to 24 years.
c
309 patients aged 4 to 12 years; 774 aged 13 to 17 years; and 1016 aged 18 to 24 years.