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Diagnosis and Disability among COSP Participants

Diagnosis and Disability among COSP Participants. Meeting the GFA Requirements. According to the GFA, individuals entering the COSP study should “…have a diagnosable mental, behavioral, or emotional disorder…

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Diagnosis and Disability among COSP Participants

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  1. Diagnosis and Disability among COSP Participants Meeting the GFA Requirements

  2. According to the GFA, individuals entering the COSP study should “…have a diagnosable mental, behavioral, or emotional disorder… that has resulted in functional impairment which substantially interferes with or limits one or more major life activities”(p. 5).

  3. Presentation Outline • Preliminary data on diagnosis at baseline • Defining life areas most relevant to functional impairment/disability • Conclusions & next steps

  4. Status of diagnosis data received by June 2001 • 1300 baselines • 35% include diagnosis data (N=452) • 20% of these have more than one Axis I diagnosis (N=92) • Of those, 75% are substance related disorders (N=69) • 2% have an Axis II diagnosis (N=11)

  5. First Axis I DiagnosisJune 2001 (N=452)

  6. Substance-Related Diagnosis within Axis I Diagnosis

  7. Framework for Defining Functional Impairment/ Disability* • Newly developed classification of disability, likely to be widely used around the world • Comprehensive: Includes disability related to mental illness • Model recognizes role of environment process of disability * World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICIDH-2)

  8. Determining Functional Impairment/ Disability among COSP Participants • 1. Define: Major Life Activities or Areas • 2. Select: Relevant COSP items • 3. Measure: COSP items used to determine presence of impairment

  9. Health Condition (disorder/disease) Body Functions Activity Participation Environment Person ICIDH-2 Model: Interactions between components of disability (http://www.who.int/icidh/)

  10. Crossing ICIDH-2 Categories with Related COSP Instruments

  11. Background/Risk-factor Variables • 74% of participants receive income from SSI, SSDI, or both (N=965) • 30% report 12 years or less of education (no diploma or GED) (N=387) • 82% have been hospitalized in their lifetime for mental health services (N=1060) • 37% have hospitalized 6 or more times (N=480)

  12. Physical Functioning • 52% report a physical disability (N=671) • 96% report at least one problem on the Health Status Questionnaire (N=1,222) • 50% report 7 or more

  13. Subjective Side Effects (SSRS)* • Mean rating across all side effects near 1 (“have side effect/not bothered”) • Higher proportion bothered by some specific side effects (e.g., dry mouth, tired/sleepy) *Ratings are from 0 (no symptom in past week) to 4 (extremely bothered by symptom)

  14. Mental Functioning • Hopkins Symptom Checklist (HSCL)* • Mean rating across all items=1.99 • (a little bothered) • Standard Deviation=0.63 • 50% scored 1.92 or higher • Cutoff for clinical “case” = 1.75 • (Sandanger et al. 1998) *Ratings are from 1 (not at all bothered/distressed by symptom in past week) to 4 (extremely bothered)

  15. Colorado Symptom Index (CSI)* • Mean rating across all items=2.40 (2=“once a month”), Standard Deviation=0.92 • 50% scored 2.30 or higher *Ratings are from 1=no experience of symptom in past month to 5=every day in past month

  16. Physical and Mental Functioning • Recent Hospitalizations and Emergency Services: Psychiatric or Physical Health • 33% used 1 or 2 crisis/emergency services in the past 4 months (N=433) • 13% used > 2 emergency/crisis services in the past 4 months (N=168)

  17. Activities and Participation, Employment • 53% either working/volunteering, OR occupied as student, homemaker/caregiver, military reserve (N=690) • 42% answered “no” to work and to other listed activities(N=541)

  18. Activities and Participation, Housing • 7% reported a current living situation that may indicate crisis (N=89) • 14% will have to move from current housing(N=181) • 10% “not at all” confident of ability to pay for current housing(N=133)

  19. Activities and Participation, Interpersonal Interactions & Relationships • 38% of participants live alone (N=490) • 47%(N=614)“single-never married”;36%(N=459)“divorced” or “separated”;4%(N=57)“widowed”

  20. Objective Social Inclusion Scale* • Mean total score was 2.91 (3=“at least once a month”), Standard Deviation=0.87 • 25% had total score of 2 (“less than once a month”) or lower *Ratings are from 1=no engagement in social activities/interactions to 5=every day

  21. Conclusions and Next Steps • Diagnosis data incomplete, but meets GFA so far • Disability in population indicated across several CP measures at baseline • Next: Pulling together the “disability” measures

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