Tuesday, October 25, 2011: 10:45 AM
Grand Ballroom EF (Hyatt Regency Chicago)
(DEC) Decision Psychology and Shared Decision Making

Eve Wittenberg, PhD, MPP, Heller School for Social Policy and Mgmt., Waltham, MA and Lisa Prosser, PhD, University of Michigan, Ann Arbor, MI

Purpose: Caregivers report diminished quality of life and negative physical effects of caring for ill individuals.  This study measured the spillover disutility of chronic conditions on household members in the US.   

Method: Medical Expenditures Panel Survey (MEPS) data from 2000-2003 were analyzed to identify the independent effect of the presence of individuals with categories of chronic conditions (by ICD 9 codes) on household members’ utility scores.  Bivariate regressions of categories of conditions on adults’ utility scores were conducted to identify those which significantly affected utility for inclusion in the multivariable model.  A two-stage, multivariable regression model was built to predict EuroQol-5D index weights (EQ-5D) based on the presence of mental health and non-mental health chronic conditions within the household while controlling for other known predictors of utility (including own health status).    

Result: In bivariate analyses, mental disorders was the only category of household chronic conditions that significantly affected adults’ utility scores, so multivariable models included mental and non-mental disorders as categories of conditions. In the first-stage, logistic model, the presence of at least one child in the household with a chronic mental health condition decreased the odds of a co-habiting adult reporting perfect health by 28% (OR for EQ-5D score of 1.0=0.72, 95%CI=0.62,0.82); the presence of an adult in the household with a chronic mental health condition decreased the odds of other adults reporting perfect health by 34% (OR=0.66, 95%CI=0.59,0.73).  In the second-stage, linear model, among adults reporting less-than-perfect health (EQ-5D score<1.0), the presence of a child or adult with a mental health condition in the household reduced their EQ-5D score by 0.02 (95%CI =-0.03,-0.01 for both).  In comparison, chronic non-mental health conditions among children and adults in the household reduced co-habiting adults’ odds of reporting perfect health by 12-13% (95%CI for child= 0.81,0.94, for adult=0.82,0.92), and among those reporting less-than-perfect health, a child with non-mental health condition had no spillover effect on adults and an adult reduced others’ EQ-5D score by 0.01 (95%CI=-0.01,0).   

Conclusion: In a US national sample, all health conditions produced spillover disutility on household members, but mental disorders more substantially affected parents, spouses and other adults in the household.  Benefits of mental health interventions may be more accurately captured by including the spillover effects of these conditions on family members.