National Trends in Psychiatric Not Otherwise Specified (NOS) Diagnosis and Medication Use Among Adults in Outpatient Treatment
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Study Design and Data Source
Outcome Measures
Psychiatric diagnoses.
Psychotropic medications.
Other Study Variables
Statistical Analysis
Results
Characteristics of Physician Office Visits by Adults
Characteristic | 1999–2002 (N=16,061) | 2003–2006 (N=18,921) | 2007–2010 (N=17,044) | p | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Full criteria | NOS | Full criteria | NOS | Full criteria | NOS | ||||||||
N | %b | N | %b | N | %b | N | %b | N | %b | N | %b | ||
Gender | <.001 | ||||||||||||
Female | 5,895 | 57.0 | 3,626 | 66.2 | 6,528 | 57.2 | 4,630 | 66.3 | 5,289 | 56.5 | 4,480 | 64.7 | |
Male | 4,571 | 43.0 | 1,969 | 33.8 | 5,163 | 42.8 | 2,600 | 33.7 | 4,583 | 43.5 | 2,692 | 35.3 | |
Age group | <.001 | ||||||||||||
18–24 | 1,104 | 9.3 | 534 | 8.0 | 1,315 | 10.5 | 803 | 9.1 | 1,112 | 11.1 | 830 | 9.8 | |
25–44 | 5,060 | 44.8 | 2,627 | 47.0 | 5,211 | 41.4 | 3,127 | 42.7 | 4,095 | 40.9 | 2,987 | 40.7 | |
45–64 | 4,302 | 45.8 | 2,434 | 45.0 | 5,165 | 48.1 | 3,300 | 48.2 | 4,665 | 48.1 | 3,355 | 49.5 | |
Race-ethnicity | .370 | ||||||||||||
White | 7,945 | 83.1 | 4,292 | 83.3 | 8,555 | 80.1 | 5,232 | 81.3 | 6,986 | 80.5 | 5,184 | 80.2 | |
Nonwhitec | 2,521 | 16.9 | 1,303 | 16.7 | 3,136 | 19.9 | 1,998 | 18.7 | 2,886 | 19.5 | 1,988 | 19.8 | |
Payment | <.001 | ||||||||||||
Private | 5,655 | 67.1 | 3,192 | 72.9 | 6,138 | 64.9 | 3,751 | 70.8 | 4,952 | 65.0 | 3,749 | 68.6 | |
Publicd | 4,811 | 32.9 | 2,403 | 27.1 | 5,553 | 35.1 | 3,479 | 29.2 | 4,920 | 35.0 | 3,423 | 31.4 | |
Residence | .004 | ||||||||||||
Nonmetropolitan | 1,068 | 12.7 | 648 | 17.3 | 1,155 | 11.5 | 902 | 14.4 | 1,092 | 12.6 | 896 | 15.2 | |
Metropolitan | 9,398 | 87.3 | 4,947 | 82.7 | 10,536 | 88.5 | 6,328 | 85.6 | 8,780 | 87.4 | 6,276 | 84.8 | |
Region | .282 | ||||||||||||
Northeast | 3,377 | 27.3 | 1,744 | 23.7 | 4,428 | 26.3 | 2,643 | 24.0 | 3,693 | 25.6 | 2,346 | 21.7 | |
Midwest | 2,285 | 20.6 | 1,249 | 22.7 | 2,209 | 19.9 | 1,486 | 23.8 | 1,766 | 21.4 | 1,560 | 23.8 | |
South | 2,801 | 29.3 | 1,438 | 30.4 | 2,758 | 32.9 | 1,788 | 33.7 | 2,696 | 31.9 | 1,986 | 35.9 | |
West | 2,003 | 22.8 | 1,164 | 23.1 | 2,296 | 20.8 | 1,313 | 18.5 | 1,717 | 21.1 | 1,280 | 18.6 |
Proportion of NOS Visits Compared With Full-Criteria Visits
Proportion of Visits by Physician Specialty
Characteristic | 1999–2002 | 2003–2006 | 2007–2010 | Interaction | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Full criteria | NOS | Full criteria | NOS | Full criteria | NOS | ||||||||
N | %b | N | %b | N | %b | N | %b | N | %b | N | %b | pc | |
Total psychiatric visits | .003 | ||||||||||||
Psychiatrist | 3,205 | 76.2 | 1,049 | 23.8 | 3,290 | 71.6 | 1,321 | 28.4 | 2,612 | 65.3 | 1,475 | 34.7 | |
Nonpsychiatrist | 1,050 | 43.2 | 1185 | 56.8 | 1,317 | 39.7 | 1,701 | 60.3 | 1,732 | 39.3 | 2,322 | 60.7 | |
Depressive disorders | .26 | ||||||||||||
Psychiatrist | 1,765 | 77.0 | 542 | 23.0 | 1,729 | 78.1 | 494 | 21.9 | 1,405 | 75.1 | 495 | 24.9 | |
Nonpsychiatrist | 218 | 25.6 | 677 | 74.4 | 255 | 20.8 | 956 | 79.2 | 406 | 27.9 | 1,101 | 72.1 | |
Anxiety disorders | .81 | ||||||||||||
Psychiatrist | 731 | 77.7 | 209 | 22.3 | 752 | 71.1 | 319 | 28.9 | 625 | 69.4 | 294 | 30.5 | |
Nonpsychiatrist | 119 | 28.0 | 311 | 72.0 | 139 | 23.1 | 506 | 76.9 | 219 | 21.2 | 806 | 78.8 | |
Bipolar disorders | .91 | ||||||||||||
Psychiatrist | 496 | 96.9 | 20d | 3.1 | 582 | 76.3 | 173 | 23.7 | 397 | 53.9 | 365 | 46.1 | |
Nonpsychiatrist | 62 | 89.3 | 5d | 10.7 | 51 | 55.9 | 64 | 44.1 | 60 | 22.9 | 190 | 77.1 |
Psychotropic Medication Classes in NOS and Full-Criteria Visits
Psychotropic class | 1999–2002 | 2007–2010 | Logistic regressionb | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Full criteria | NOS | Full criteria | NOS | Full criteria | NOS | |||||||
N | %c | N | %c | N | %c | N | %c | AOR | 95% CI | AOR | 95% CI | |
Any psychotropic | 3,078 | 61.6 | 1,542 | 62.7 | 4,856 | 68.7 | 4,341 | 75.2 | 1.4 | 1.2–1.7 | 1.9 | 1.6–2.2 |
Antipsychotics | 756 | 13.7 | 193 | 5.9 | 1,508 | 17.2 | 1,108 | 13.8 | 1.3 | 1.0–1.6 | 2.5 | 1.9–3.1 |
Antidepressants | 2,304 | 45.4 | 1,187 | 48.8 | 3,346 | 46.2 | 3,007 | 52.7 | 1.1 | .9–1.2 | 1.2 | 1.1–1.4 |
Anxiolytics and hypnotics | 1,047 | 21.2 | 502 | 20.2 | 1,829 | 28.2 | 1,703 | 33.4 | 1.5 | 1.3–1.7 | 2.0 | 1.7–2.4 |
Lithium | 168 | 2.9 | 29d | .6 | 158 | 2.2 | 135 | 1.7 | .8 | .6–1.1 | 2.8 | 1.9–4.1 |
Alpha-agonist | 16d | .4 | 5d | .1 | 64 | .8 | 52 | .8 | 1.9 | 1.0–3.6 | 5.6 | 3.0–10.5 |
Anticonvulsants–mood stabilizers | 388 | 6.7 | 135 | 3.7 | 798 | 10.0 | 719 | 9.3 | 1.5 | 1.2–2.0 | 2.6 | 2.1–3.4 |
Stimulants | 241 | 4.4 | 70 | 1.6 | 663 | 11.7 | 321 | 6.0 | 2.9 | 2.3–3.8 | 3.8 | 2.8–5.3 |
Combinations | ||||||||||||
1 drug class | 1,311 | 60.3 | 807 | 74.7 | 2,363 | 52.9 | 2,328 | 58.5 | ||||
2 drug classes | 777 | 30.5 | 310 | 22.0 | 1,627 | 34.8 | 1,393 | 32.2 | ||||
≥3 drug classes | 249 | 9.3 | 59 | 3.3 | 655 | 12.3 | 477 | 9.3 |
Discussion
Low Reliability of NOS Diagnoses
Utility and Limitations of NOS Diagnoses
Can NOS Diagnoses Increase Further?
Consequences of the Rise in NOS Psychiatric Diagnoses
NOS Diagnoses and Psychotropic Medications
NOS Diagnoses and Provider Specialty
Limitations
Conclusions
Supplementary Material
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