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There has been long-standing concern about the quality of medical care
offered to people with mental illness.
To investigate whether the quality of medical care received by people
with mental health conditions, including substance misuse, differs from
the care received by people who have no comparable mental disorder.
A systematic review of studies that examined the quality of medical care
in those with and without mental illness was conducted using robust
critical appraisal techniques.
Of 31 valid studies, 27 examined receipt of medical care in those with
and without mental illness and 10 examined medical care in those with and
without substance use disorder (or dual diagnosis). Nineteen of 27 and 10
of 10, respectively, suggested inferior quality of care in at least one
domain. Twelve studies found no appreciable differences in care or failed
to detect a difference in at least one key area. Several studies showed
an increase in healthcare utilisation but without any increase in
quality. Three studies found superior care for individuals with mental
illness in specific subdomains. There was inadequate information
concerning patient satisfaction and structural differences in healthcare
delivery. There was also inadequate separation of delivery of care from
uptake in care on which to base causal explanations.
Despite similar or more frequent medical contacts, there are often
disparities in the physical healthcare delivered to those with
psychiatric illness although the magnitude of this effect varies
There is strong evidence to support inequalities in medical care
disadvantaging those who have a psychiatric illness or a substance use
disorder. Despite promising approaches to shared care there is a
substantial gap in routine medical care for many individuals with mental
illness or substance use disorders.2,99,100 This is most
apparent in general (internal) medicine and cardiovascular care but may
also be present in diabetes care and cancer care. There is little
evidence to suggest that the recommended enhanced medical care for
individuals with mental illness has been successfully implemented. Future
work must focus on the type and severity of mental illness, patient
factors such as adherence and systems interventions to increase the
quality of care for those with chronic mental illness.
To examine the presence of borderline personality disorder (BPD) traits in Gulf War veterans, and to assess psychiatric comorbidity, health status, healthcare utilization, and quality of life (QOL) along a continuum of BPD trait severity.
BPD and traits were evaluated using the Schedule for Non-Adaptive and Adaptive Personality in 576 veterans who were either deployed to the Persian Gulf (1990–1991) or were on active duty though not deployed to the Gulf. Demographic and military characteristics, personal and family history, psychiatric comorbidity, and QOL were also assessed.
One or more BPD traits were present in 247 subjects (43%), and BPD (≥5 traits) was identified in 15 subjects (3%).The number of traits was significantly associated with age and level of education. Lifetime psychiatric comorbidity was significantly associated with the number of BPD traits present, and level of functioning, health status, healthcare utilization, social functioning, self-injurious tendencies, and military/behavioral problems.
BPD and traits identified in Gulf War veterans were associated with significant psychiatric morbidity, poorer QOL, and increased utilization of healthcare resources. Early recognition and treatment of veterans with BPD symptoms may be warranted to minimize the burden on the healthcare system.
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