Psychiatric diagnosis receipt after low back pain diagnosis across the US Military Health System and Veterans Health Administration

IF 4 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Pain Pub Date : 2025-05-14 DOI:10.1016/j.jpain.2025.105441

Patricia K. Carreño MA , Monnique Johnson MD , Janiece L. Taylor PhD , Letitia E. Travaglini PhD , Alexander G. Velosky MHI , Leah M. Adams PhD , Krista B. Highland PhD

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引用次数: 0

Abstract

The objective of this retrospective observational cohort study was to evaluate psychiatric diagnosis receipt after low back pain (LBP) diagnosis across the US Military Health System (MHS) and Veterans Health Administration (VHA). Medical records (N = 197,925) of patients who received a LBP diagnosis March 2021 - March 2022 were analyzed. Primary outcomes were time-to-psychiatric diagnosis and diagnosis type within 1-year post-index LBP diagnosis. In a Poisson generalized additive model, incidence rate ratios (IRRs) of psychiatric diagnosis were higher for patients with a female administrative gender marker (ref. male; 1.40; 95% CI 1.31–1.50); Black (ref. Non-Hispanic White; 1.35; 95% CI 1.29–1.42) and Hispanic (ref. Non-Hispanic White; 1.13; 95% CI 1.06–1.20) patients, and patients with co-occurring non-LBP pain (1.29; 95% CI 1.24–1.33) and nicotine dependence (1.14; 95% CI 1.05–1.25). IRRs were lower for patients with elevated CCI scores (0.89; 95% CI 0.79–1.00) and those diagnosed with obesity (0.91; 95% CI 0.85–0.96). A generalized linear model indicated the adjustment-related versus other psychiatric diagnosis odds ratio (OR) was higher for Black patients (1.18; 95% CI 1.05–1.31) and those with an obesity diagnosis (1.17; 95% CI 1.01, 1.35); and lower for retired service members (0.71; 95% CI 0.58–0.88) and Veterans (ref. active duty service member; 0.59; 95% CI 0.4–0.73), and patients with a female administrative gender marker (0.83; 95% CI 0.71–0.97). The present findings indicate variation in psychiatric diagnoses receipt among patients with LBP across the MHS and VHA, which warrant system-level interventions to improve timing and quality of care.

Perspective

Variation across both receipt and type of psychiatric diagnosis in military-connected patients within a year after low back pain diagnosis indicate further inquiry is needed to better understand mediators (e.g., differences in stigma, access to care) and impact of new policies (e.g., the Brandon Act).

查看原文本刊更多论文

美国军事卫生系统和退伍军人健康管理局腰痛诊断后的精神病学诊断收据。

这项回顾性观察性队列研究的目的是评估美国军事卫生系统（MHS）和退伍军人健康管理局（VHA）在腰痛（LBP）诊断后的精神病学诊断接受情况。分析了2021年3月至2022年3月诊断为LBP的患者的医疗记录（N = 197,925）。主要结局为LBP诊断后1年内到精神科诊断的时间和诊断类型。在泊松广义加性模型中，具有女性行政性别标记(参考男性；1.40;95% ci 1.31-1.50)；黑人(参考：非西班牙裔白人；1.35;95% CI 1.29-1.42)和西班牙裔(参考文献：非西班牙裔白人；1.13;95% CI 1.06-1.20)和同时发生非腰痛的患者(1.29；95% CI 1.24-1.33)和尼古丁依赖(1.14；95% ci 1.05-1.25)。高CCI评分患者的irr较低(0.89；95% CI 0.79-1.00)和被诊断为肥胖的患者(0.91；95% ci 0.85-0.96)。广义线性模型显示，黑人患者与调整相关的精神病诊断优势比（OR）更高(1.18；95% CI 1.05-1.31)和诊断为肥胖的患者(1.17；95% ci 1.01, 1.35)；退休军人更低(0.71；95% CI 0.58-0.88)和Veterans(退伍军人；0.59;95% CI 0.4-0.73)，女性行政性别标记(0.83；95% ci 0.71-0.97)。目前的研究结果表明，在MHS和VHA中，LBP患者的精神病学诊断接收不公平，这需要系统层面的干预来改善护理的时间和质量。观点：腰痛诊断后一年内，与军队有关的患者的精神病诊断的接收和类型的差异表明，需要进一步调查，以更好地了解中介因素（例如，耻辱的差异，获得护理的机会）和新政策的影响（例如，布兰登法案）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pain 医学-临床神经学

CiteScore

6.30

自引率

7.50%

发文量

441

审稿时长

42 days

期刊介绍： The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addition, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal. The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research.