Treatment of physical disorder in children with mental disorder: A health care utilization study

Objective: This study examines, across physician billing, ambulatory and inpatient/emergency datasets, the health care utilization of individuals under the age of 18 years for physical disorders in relationship to the existence of a physician assigned psychiatric disorder. Methods: A retrospective sample of all visit records from three datasets (physician billing, ambulatory records, and inpatient/emergency records n = 12687710) was constructed for cases (n = 26392) and comparisons (n = 205281). The mean number of visits for physical disorders (excluding psychiatric disorders) was calculated for groups defined as cases and comparisons with and without psychiatric disorders. Results: Among Cases and Comparisons with and without psychiatric disorders, physical disorders are significantly greater for any with psychiatric disorder over the 16 year s study period in both physician billing and ambulatory datasets. This result differs in the inpatient/emergency dataset in that cases have about 1/3 the number of admissions for physical diagnoses. Conclusion: It was unexpected that cases with a psychiatric diagnosis in the physician billing dataset had fewer physical disorder related inpatient and emergency admissions. We explore the putative explanations for the observed treatment bias related to physical disorders of children with psychiatric disorders.