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    Original Investigation
    Pediatrics
    July 23, 2020

    Health Care Use and Costs of Children, Adolescents, and Young Adults With Somatic Symptom and Related Disorders

    Author Affiliations
    • 1The Hospital for Sick Children, Toronto, Ontario, Canada
    • 2Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
    • 3ICES, Toronto, Ontario, Canada
    • 4Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
    • 5Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
    • 6Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
    • 7Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    • 8Centre for Addiction and Mental Health, Toronto, Ontario, Canada
    JAMA Netw Open. 2020;3(7):e2011295. doi:10.1001/jamanetworkopen.2020.11295
    Key Points español 中文 (chinese)

    Question  How do children, adolescents, and young adults with somatic symptom and related disorders use the health care system, and what are the direct health system costs associated with this population?

    Findings  Results from this population-based cohort study suggest that these individuals had substantial health system use and costs before receipt of a diagnosis, especially for those hospitalized. Frequent use and costs persisted after initial diagnosis, and follow-up care by physicians for mental health was poor.

    Meaning  These findings suggest that this population may be under-recognized with inadequately addressed needs. Initiatives for early recognition and engagement with mental health support are warranted.

    Abstract

    Importance  Somatic symptom and related disorders are highly prevalent mental health disorders among young people. Presentation can be varied, and patients often face long delays and see multiple practitioners to receive a diagnosis.

    Objective  To evaluate the health care use and costs in a population-based sample of children and young people with somatic symptom and related disorders in Ontario, Canada.

    Design, Setting, and Participants  This population-based cohort study used linked health and administrative databases in Ontario, Canada, where health services are funded through a universal single-payer health insurance plan. Participants included children aged 4 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 to 24 years residing in Ontario, Canada, during the period of April 1, 2008, to March 31, 2015. Included participants had a first health record diagnosis of somatic symptom and related disorders and were grouped based on the setting of their index somatic symptom and related disorders contact: outpatient, emergency department, or inpatient. Data were analyzed from August 1, 2017, to February 1, 2018.

    Exposures  One year before and 1 year after diagnosis of somatic symptom and related disorders.

    Main Outcomes and Measures  Outcome measures included overall and mental health–specific ambulatory and acute care visits and overall health system costs and sector-specific costs.

    Results  A total of 33 272 patients (median [interquartile range {IQR}] age, 20 [16-22] years; 17 387 female [52.3%]) were included in the analysis. Among these patients, 3875 (11.6%) were aged 4 to 12 years, 7273 (21.9%) were aged 13 to 17 years, and 22 124 (66.5%) were aged 18 to 24 years. A total of 17 893 (53.8%) had their index visit as outpatients, whereas 13 310 (40.0%) and 2069 (6.2%) were diagnosed in the emergency department and inpatient settings, respectively. Ambulatory physician visits were frequent and persisted 1 year after diagnosis within each setting (before vs after 1 year, median [IQR] visits, inpatient setting: 7 [3-13] vs 7 [3-13]; emergency department setting: 4 [2-8] vs 4 [2-9]; outpatient setting: 3 [1-7] vs 4 [2-7]; P < .001). After diagnosis, many did not receive physician-delivered mental health care (35.3% [730 of 2069] in an inpatient setting, 59.1% [7866 of 13 310] in an emergency department setting, 58.5% [10 467 of 17 893] in an outpatient setting; P < .001). Acute care use was frequent and remained so after diagnosis across settings. Of those hospitalized as inpatients at diagnosis, 37.7% (779 of 2069) were readmitted within 1 year. Mean (SD) 2-year patient costs were CAD$9845 ($39 725) (median [IQR], $2401 [$960-$7019]). Hospitalized patients had a 2-year mean (SD) cost of $51 424 ($100 416) (median [IQR], $21 997 [$12 510-$45 841]) per-patient expenditure.

    Conclusion and Relevance  This study found that children and young people with somatic symptom and related disorders frequently used the health system with substantial health system costs before and after diagnosis. Many of these patients did not receive physician-delivered mental health care. These findings suggest that this population may be under-recognized, and initiatives for early recognition and engagement with mental health support may be warranted.

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