Family Intervention and Health Care Costs for Kansas Medicaid Patients with Schizophrenia

By Christenson, Jacob D.; Crane, D. Russell et al. | Journal of Marital and Family Therapy, July 2014 | Go to article overview

Family Intervention and Health Care Costs for Kansas Medicaid Patients with Schizophrenia


Christenson, Jacob D., Crane, D. Russell, Bell, Katherine M., Beer, Andrew R., Hillin, Harvey H., Journal of Marital and Family Therapy


Schizophrenia is one of the most disorienting, debilitating, and disruptive mental disorders (Dickerson & Lehman, 2006; Lindstreuroom & Bingefors, 2000) and has a profound effect on the life of the patient, their family, and society (Miklowitz, 2004; National Collaborating Centre for Mental Health, 2010). The disorder affects approximately 24 million people worldwide (World Health Organization, n.d.) and accounts for more hospital admissions than any other psychiatric disorder (Murray & Lopez, 1996). Moreover, it has been estimated that the overall cost of treatment and lost productivity amounts to between $62 billion and $65 billion a year in the United States alone (Wu et al., 2005; Wyatt, Henter, Leary, & Taylor, 1995). As a result of these high social and economic costs, there has been significant interest in developing treatments that are both clinically and fiscally effective.

Although pharmacotherapy continues to be the most preferred component of treatment (e.g., Csernansky & Schuchart, 2002; Lindstreuroom & Bingefors, 2000), there are also a number of family interventions that have been shown to be effective when included in the treatment of schizophrenia (e.g., Leff, Kuipers, Berkowitz, & Sturgeon, 1985; McFarlane et al., 1995; Randolph et al., 1994). However, family interventions continue to be used infrequently (Dixon et al., 2001) and virtually no attention has been paid to the relationship between family interventions and healthcare costs (Mihalopoulos, Magnus, Carter, & Vos, 2004). In the current study, two structural models of Kansas Medicaid claims data were used to address this gap in the schizophrenia literature.

SCHIZOPHRENIA AND FAMILY DYNAMICS

Despite the proven efficacy of pharmacotherapy, there remains a high relapse rate and risk of suicide among patients with schizophrenia (e.g., Kaplan & Harrow, 1999; Nuechterlein, Snyder, & Mintz, 1992). Furthermore, many psychiatric patients who are on medication continue to have severe impairments that significantly affect functioning in work and society (Coryell et al., 1993). Miklowitz (2004) notes that the episodic nature of such disorders, even when medication is taken consistently "suggests that the popular concept of 'brain disease' is overly static and reductionistic. There is substantial evidence that genetic, biological, psychological, and social variables are 'moving targets,' which are mutually influential in the onset and course of psychiatric illnesses" (p. 668). Research has shown that family dynamics are especially important to consider when evaluating the influence of psychosocial variables on schizophrenia (e.g., Falloon et al., 1985; Kuipers, 2006; Marsh & Lefly, 2003; Miklowitz, 2004).

Early research on the effect of family dynamics on schizophrenia found that patients who lived with their spouse or parents tended to have higher hospital readmission rates than those who did not (Brown, Carstairs, & Topping, 1958). As a result of such findings, a theory of how expressed emotion (EE) interacts with the illness was developed (Berglund, Vahlne, & Edman, 2003). EE is typically defined by the amount of criticism, hostility, and emotional overinvolvement demonstrated during family interactions. Vaughn and Leff(1976) were among the first to investigate the effect of EE on schizophrenia patients and found that relapse was associated with high EE in caregivers. As this seminal study, a number of researchers have found similar results (e.g., Bertrando et al., 2006; Butzlaff& Hooley, 1998; Leff& Vaughn, 1985; McFarlane, Dixon, Luken, & Lucksted, 2002; Rockland, 2010).

It should be noted that high EE may develop as a consequence of the onset of schizophrenia, instead of being a preexisting characteristic of the family. As an example, Hooley and Richters (1995) showed that parents whose child was diagnosed 3-5 years earlier exhibited an average of 15 critical comments during an assessment interview, while those whose child was diagnosed less than 1 year earlier exhibited an average of only 4. …

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