Psychosis Diagnoses Trends

The Research Corner item in the July 29 edition of FYI Weekly focused on mental health disorders with a primary diagnosis-related group (DRG) associated with alcohol, drug abuse, or mental health issues. The key takeaways: 66,785 (or 7.8 percent of) 856,733 hospital discharges were mental health related, and among the 11 DRGs evaluated, psychosis accounted for 45,576 (or 68 percent of) mental health discharges. Psychosis is another mental health diagnosis. Oxford Dictionaries define the term as “a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.” For all mental health disorders, the breakdown by gender was 51 percent male and 49 percent female (see Figure 1). Looking at just the psychosis DRG, the gender breakdown is 53 percent female and 47 percent male (see Figure 2). Previous research revealed a concentration of mental health discharges among young adults. A similar trend is observed among those discharged for psychosis. Just five percent of the discharges are attributable to those 65 and older – 74 percent of the patients range in age from 20-64 years (see Figure 3). Even though just five percent of the patients (2,472) are older than 65, the data show that 10,462 (or 23 percent of) patients are on Medicare. This means a significant number of psychosis patients have been determined to be disabled and therefore Medicare-eligible. Slightly more than half of those in the psychosis population (51 percent) are participants in a government health program (Medicare or Medicaid). Another 36 percent have commercial insurance and are most likely part of the workforce, or the spouse, child, or dependent of a working person (see Figure 4). Psychosis, as with other mental illnesses, is not a disease of poor males despite assumptions to the contrary. A map of where psychosis patients live in Virginia illustrates that there are several pockets in the Commonwealth with a high number of patients with psychosis disorder hospitalizations (see Figure 5). Psychosis is considered an ambulatory sensitive condition. This means that if adequate providers or treatment were available, it is likely that these patients would not need inpatient care, or at least to the extent that it is now being provided. Since Virginia started collecting inpatient discharge data in 1993, psychosis has remained the second most likely reason for being admitted to a Virginia hospital. Only childbirth ranks higher as a reason for hospital admission during that period. As yet, Virginia and many other states have not found a successful way to manage these patients, making it a perennial issue during Virginia General Assembly sessions. (8/12)

Figure 1

8-12 Figure 1

Figure 2

8-12 Figure 2

Figure 3

8-12 Figure 3

Figure 4

8-12 Figure 4

Figure 5

8-12 Figure 5