Background/Purpose: Youth with systemic lupus erythematosus (SLE) have high health care utilization, which may be exacerbated by psychiatric disorders, a common comorbidity in this group. We examined the impact of psychiatric diagnoses on utilization of medical services in youth with SLE.

Methods : We conducted a retrospective cohort study using administrative claims for 2000 to 2013 from Clinformatics^TM DataMart (OptumInsight, Eden Prairie, MN), a large US database of privately insured enrollees. We included youth ages 10-24 years with an incident diagnosis of SLE (³3 International ClassiÞcation of Diseases, Ninth Revision codes for SLE 710.0, each >30 days apart, with ≥ 1 year of preceding continuous enrollment without a code for SLE). We categorized mutually exclusive groups of youth with SLE as those with: 1) no psychiatric diagnosis, 2) a psychiatric diagnosis in the 12 months preceding SLE diagnosis, and 3) an incident psychiatric diagnosis in the 12 months after SLE diagnosis. We calculated mean ambulatory, emergency and inpatient visits for medical services in the year after SLE diagnosis, and used Poisson regression to compare the number of visits among the 3 groups, adjusting for demographic and disease variables.

Results :  We identified 650 youth with an incident diagnosis of SLE, with mean age of 18.4 years (SD 3.7), composed of 88% females and 25% with nephritis. Depression was diagnosed in 144 (22%), anxiety in 93 (14%), and other psychiatric disorders in 210 (32%). A psychiatric diagnosis was present preceding SLE diagnosis in 122 (19%) and diagnosed in the year after SLE diagnosis in 105 (16%); 423 (65%) had no psychiatric diagnosis. In adjusted models, mean ambulatory visits in the year after SLE diagnosis were higher for those with preceding (14.4, SD 11.7, p=0.01) and incident (18.1, SD 14.6, p<0.0001) psychiatric diagnoses than among those without a psychiatric diagnosis (11.6, SD 9.9) (Figure). Those with an incident psychiatric diagnosis had more acute care visits compared to those without a psychiatric diagnosis: 9.5 (10.9) vs 5.1 (8.6) for emergency (p=0.0001), and 4.9 (10.7) vs 2.8 (7.8) for inpatient (p=0.03). Those with a preceding psychiatric diagnosis had 6.9 (13.1) mean emergency and 3.5 (8.2) mean inpatient visits, which were not significantly statistically different from the other groups.

Conclusion : In youth with SLE, psychiatric comorbidity is associated with higher utilization of medical services in ambulatory settings in the year after SLE diagnosis, and those with a new psychiatric diagnosis during this period had higher utilization of acute medical care. Interventions to address existing and newly identified psychiatric disorders may decrease health care burden for youth with SLE.