TY - JOUR
T1 - Behavioral and mental health risk factor profiles among diverse primary care patients
AU - For The MOHR Study Group
AU - Glenn, Beth A.
AU - Crespi, Catherine M.
AU - Rodriguez, Hector P.
AU - Nonzee, Narissa J.
AU - Phillips, Siobhan M.
AU - Sheinfeld Gorin, Sherri N.
AU - Johnson, Sallie Beth
AU - Fernandez, Maria E.
AU - Estabrooks, Paul
AU - Kessler, Rodger
AU - Roby, Dylan H.
AU - Heurtin-Roberts, Suzanne
AU - Rohweder, Catherine L.
AU - Ory, Marcia G.
AU - Krist, Alex H.
N1 - Funding Information:
Funding for the MOHR project was provided by the National Cancer. Institute, Agency for Healthcare Research and Quality, Office of Behavioral and Social Sciences Research, and National Center for Advancing Translational Sciences (NCATS; CTSA Grant Number ULTR00058). Narissa Nonzee was also supported by NIH/NCATS UCLA CTSI Grant Numbers TL1TR000121 and TL1TR001883. The opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the funders. We would also like to thank L. Cindy Chang for her assistance with data cleaning and analysis.
Funding Information:
The purpose of this study is to identify subgroups of primary care patients with co-occurring behavioral health risk factors, to ascertain sociodemographic characteristics associated with these subgroups, and to explore clustering of patient subgroups by clinic type. We anticipated that study results could be used to guide population-level interventions addressing commonly co-occurring risk factors. The study sample comprised adults receiving care from nine primary care practices that participated in the My Own Health Report (MOHR) project, funded by the National Cancer Institute (NCI) and the Agency for Healthcare Research and Quality (AHRQ) ( Krist et al., 2014; Phillips et al., 2014; Krist et al., 2016 ). While several studies have examined the co-occurrence of health risk factors in primary care ( Funderburk et al., 2008; Héroux et al., 2012; Leventhal et al., 2014 ), these studies assessed a limited number of domains. The present study assessed a wider range of health domains. Furthermore, the study sample, which includes patients recruited from urban, rural, suburban, and safety net clinics across the country, is more diverse than prior studies.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/6
Y1 - 2018/6
N2 - Behavioral and mental health risk factors are prevalent among primary care patients and contribute substantially to premature morbidity and mortality and increased health care utilization and costs. Although prior studies have found most adults screen positive for multiple risk factors, limited research has attempted to identify factors that most commonly co-occur, which may guide future interventions. The purpose of this study was to identify subgroups of primary care patients with co-occurring risk factors and to examine sociodemographic characteristics associated with these subgroups. We assessed 12 behavioral health risk factors in a sample of adults (n = 1628) receiving care from nine primary care practices across six U.S. states in 2013. Using latent class analysis, we identified four distinct patient subgroups: a ‘Mental Health Risk’ class (prevalence = 14%; low physical activity, high stress, depressive symptoms, anxiety, and sleepiness), a 'substance Use Risk’ class (29%; highest tobacco, drug, alcohol use), a ‘Dietary Risk’ class (29%; high BMI, poor diet), and a ‘Lower Risk’ class (27%). Compared to the Lower Risk class, patients in the Mental Health Risk class were younger and less likely to be Latino/Hispanic, married, college educated, or employed. Patients in the Substance Use class tended to be younger, male, African American, unmarried, and less educated. African Americans were over 7 times more likely to be in the Dietary Risk versus Lower Risk class (OR 7.7, 95% CI 4.0–14.8). Given the heavy burden of behavioral health issues in primary care, efficiently addressing co-occurring risk factors in this setting is critical.
AB - Behavioral and mental health risk factors are prevalent among primary care patients and contribute substantially to premature morbidity and mortality and increased health care utilization and costs. Although prior studies have found most adults screen positive for multiple risk factors, limited research has attempted to identify factors that most commonly co-occur, which may guide future interventions. The purpose of this study was to identify subgroups of primary care patients with co-occurring risk factors and to examine sociodemographic characteristics associated with these subgroups. We assessed 12 behavioral health risk factors in a sample of adults (n = 1628) receiving care from nine primary care practices across six U.S. states in 2013. Using latent class analysis, we identified four distinct patient subgroups: a ‘Mental Health Risk’ class (prevalence = 14%; low physical activity, high stress, depressive symptoms, anxiety, and sleepiness), a 'substance Use Risk’ class (29%; highest tobacco, drug, alcohol use), a ‘Dietary Risk’ class (29%; high BMI, poor diet), and a ‘Lower Risk’ class (27%). Compared to the Lower Risk class, patients in the Mental Health Risk class were younger and less likely to be Latino/Hispanic, married, college educated, or employed. Patients in the Substance Use class tended to be younger, male, African American, unmarried, and less educated. African Americans were over 7 times more likely to be in the Dietary Risk versus Lower Risk class (OR 7.7, 95% CI 4.0–14.8). Given the heavy burden of behavioral health issues in primary care, efficiently addressing co-occurring risk factors in this setting is critical.
KW - Behavioral health
KW - Latent class analysis
KW - Multiple risk factors
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=85042391206&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85042391206&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2017.12.009
DO - 10.1016/j.ypmed.2017.12.009
M3 - Article
C2 - 29277413
AN - SCOPUS:85042391206
VL - 111
SP - 21
EP - 27
JO - Preventive Medicine
JF - Preventive Medicine
SN - 0091-7435
ER -