Multimorbidity and Its Outcomes Among Patients Attending Psychiatric Care Settings: An Observational Study From Odisha, India.

Background: Multimorbidity, the presence of two or more chronic health conditions is linked to premature mortality among psychiatric patients since the presence of one can further complicate the management of either. Little research has focused on the magnitude and effect of multimorbidity among psychiatric patients in low-and middle-income settings. Our study, provides the first ever data on multimorbidity and its outcomes among patients attending psychiatric clinics in Odisha, India. It further explored whether multimorbidity was associated with higher medical expenditure and the interaction effect of psychiatric illness on this association. Methods: This cross-sectional study included 500 adult patients presenting to the psychiatric clinic of a medical college hospital in Odisha over a period of 6 months (February 2019-July 2019). A validated structured questionnaire, "multimorbidity assessment questionnaire for psychiatric care" (MAQ-PsyC) was used for data collection. We used multinomial logistic model for the effect estimation. Odds ratios (OR) and 95% confidence intervals (CI) for high healthcare utilization and expenditure were calculated by number and pattern of multimorbidity. Data was analyzed by STATA 14. Results: Half (50%) of the psychiatric outpatients had multimorbidity. The relative probabilities of having one additional condition were 5.3 times (RRR = 5.3; 95% CI: 2.3, 11.9) and multiple morbidities were 6.6 times (RRR = 6.6; 95%CI: 3.3, 13.1) higher for patients in 60+ age group. Healthcare utilization i.e., medication use and physician consultation was significantly higher for psychiatric conditions such as mood disorders, schizophrenia, schizotypal and delusional disorders, and for hypertension, cancer, diabetes, among somatic conditions. Out of pocket expenditure (OOPE) was found to be highest for laboratory investigations, followed by medicines and transport expenditure. Within psychiatric conditions, mood disorders incurred highest OOPE ($93.43) while hypertension was the most leading for OOPE in physical morbidities ($93.43). Psychiatric illnesses had a significant interaction effect on the association between multimorbidity and high medical expenditure (P = 0.001). Conclusion: Multimorbidity is highly prevalent in psychiatric patients associated with significantly high healthcare utilization and medical expenditure. Such disproportionate effect of psychiatric multimorbidity on healthcare cost and use insinuates the need for stronger financial protection and tailor-made clinical decision making for these vulnerable patient subgroups.

A study of association of behavioral problems with scholastic backwardness in urban lower middle-class school children.

INTRODUCTION: Scholastic backwardness is a common phenomenon with multifactorial etiology. Behavioral problems are known to occur in children who are scholastically backward (SB). These may be a part of the broad phenomenon, or may exist in cause and effect relationship with scholastic backwardness. AIMS: The aim of this study is to study the presence of behavioral problems associated with scholastic backwardness in school-going children in Pune cantonment. MATERIALS AND METHODS: A total of 300school children aged 8-14 years studying in Class III-IX from two government-aided semi-Marathi schools in Pune cantonment were screened for scholastic backwardness and evaluation of behavioral problems was carried out for positive cases and matched controls. RESULTS: Out of the 28 SB children, behavioral problems were present in 17, giving a prevalence of 60.71%, in comparison with the scholastically normal (SN) group of 50, only 14 of which had behavioral problems, prevalence is 28%. A significant association was found between scholastic backwardness and behavioral problems, which were more prevalent in the SB group compared to matched controls. CONCLUSIONS: Behavioral problems are more prevalent among children who are SB when compared to their SN counterparts. Further research is required to assess in detail whether the behavioral problems are comorbid with scholastic backwardness, lead to scholastic backwardness or occur as a consequence of scholastic backwardness.