Julie Hugunin receives TL-1 training grant in clinical and translational research

MD/PhD candidate Julie Hugunin received a TL1 training grant in clinical and translational research,  Her study focuses on utilization of primary care services among youth aged 16-25 with serious mental illness, and the role of primary care in their mental health care and overall health outcomes.

A serious mental illness (SMI) is a mental disorder that significantly impairs major life activities or functions and affects 4.6% of US adults. Narrowly defined SMI usually includes a diagnosis of schizophrenia, bipolar, or other psychotic disorders. Each year, $193.2 billion in lost earnings can be attributed to SMI in the United States. Persons with SMI are a vulnerable and marginalized population, with experts designating SMI as a health disparity. Compared to the general population, those with SMI are more likely to experience poverty, decreased educational attainment, and have smaller, less supportive social networks. On average, those with SMI die 8-25 years earlier than those without and experience greater than double the risk of mortality. This mortality disparity appears to primarily result from socioeconomic, clinical and healthcare risk factors.

SMI is most prevalent in the young adult population, with 7.7% of those aged 18-25 years experiencing SMI. This critical age period is when many SMI diagnoses first become apparent and when early intervention is possible. However, this age group has some of the lowest rates of mental and preventative health service use with almost half receiving no mental health services (2018). Too often, those with SMI instead experience a fragmented mental health care system, particularly transition age youths (16-25 years) as they move from pediatric to adult care.

In order to reach and treat those with SMI in a timely and holistic manner, an understanding of primary health care utilization of transition age youth with SMI is critical. Primary care involvement may be key to improving health outcomes and little is known about the care they receive.

This study employs the IBM® MarketScan® Commercial Claims and Encounters Database (01 Jan 2013 - 31 Dec 2018) to explore primary healthcare utilization in transition age youth with SMI, and the role of primary care in their mental health care and overall health outcomes. With information on over 5 million unique patients, this administrative claims database is one of the largest collections of deidentified patient-level data in the U.S. It reflects real world treatment patterns across a range of care, including inpatient, outpatient, pharmacy, and carve-out behavioral healthcare. Additionally, we will survey two groups of providers (practicing psychiatrists and primary care providers) that are part of UMass Memorial Health Care to better understand barriers and facilitators to caring for transition age youth with SMI in our local healthcare setting.

Having a SMI is a health disparity that significantly impacts long-term health outcomes. Early intervention, access to primary care, and evidence-based mental health treatment can decrease morbidity and mortality of those with SMI. This study explores how to better reach this vulnerable population to improve healthcare access and outcomes for those with SMI.

Specifically, we aim to:

1. Characterize primary healthcare utilization in transition age youth (16-25 years) with SMI and identify patient-level factors associated with primary care utilization among those included in the IBM® MarketScan® Database
2. Identify patterns of SMI treatment in transition age youth engaged in primary care among those included in the IBM® MarketScan® Database
3. Examine provider perspectives of barriers and facilitators to caring for transition age youth with serious mental illness by conducting surveys of both primary care physicians and psychiatrists