The acute appendicitis syndrome: Psychological aspects of the inflamed and non-inflamed appendix

Prevalence of Diagnosed Mental Disorders Among Florida Adult Appendectomy Patients: Implications for Medical Cost Offset with Mental Health Treatment

“…Differences in age, gender, race/ethnicity, length of stay, total hospital charges, and principal payer were found between patients with and without a diagnosed mental disorder and between mental health diagnosis groups. Negative appendectomy, irritable bowel syndrome, and ill-defined right-lower abdominal pain were found to be associated with certain mental health diagnosis groups, consistent with findings of an association between psychopathology and functional abdominal pain in hospital-based clinical studies (8,(14)(15)(16)(17)(18)(19)(20) . Being publicly insured was also found to be associated with certain mental health diagnosis groups, as well as longer hospital stays and higher charges, suggesting a potential psychiatric offset effect in which some sort of mental health treatment could offset these longer stays and/or higher charges.…”

“…Bivariate and multivariate analyses of Florida adult appendectomy patient variables by diagnosed mental disorders revealed significant differences between patients with and without a mental health diagnosis. In particular, variables found to be associated with psychopathology in previous studies (8,(14)(15)(16)(17)(18)(19)(20) were also found to be associated with certain mental disorders in this study. (30) .…”

“…Finally, no patient follow-up was possible in this study, nor were linkages possible to records of care provided in outpatient settings. Nevertheless, despite these limitations, the statistical associations found in this secondary analysis of hospital discharge administrative data were remarkable for their consistency with hospital-based clinical studies that indicated an association between psychopathology and functional abdominal pain (8,(14)(15)(16)(17)(18)(19)(20) .…”

“…In contrast to hospital-based clinical studies, which enrolled a relatively small series of appendectomy patients and evaluated their mental health status (8,(14)(15)(16)(17)(18)(19)(20) , this study was based on a secondary analysis of appendectomy patient records abstracted from a large, population-based hospital discharge administrative data set. Most states collect hospital discharge data for the primary purpose of billing insurers to reimburse hospitals for charges incurred by patients during inpatient hospitalization (31) .…”

“…An analysis of Epidemiologic Catchment Area data collected by the US National Institute of Mental Health found significantly elevated lifetime rates of almost every DSM-III Axis I psychiatric disorder among those who indicated experiencing during their lifetimes two or more functional gastrointestinal symptoms commonly associated with irritable bowel syndrome, including abdominal pain (13) . In a series of hospital-cased clinical studies, conducted by researchers in Australia (14) , Italy (15) , New Zealand (16) , and the United Kingdom (17)(18)(19)(20) , the relationship between mental health status and diagnosis of acute appendicitis leading to subsequent appendectomy was investigated. Through interviews of appendectomy patients and pathological examinations of resected appendices, these researchers found that severe life events, usually involving personal losses that posed a long-term threat to the patient, were associated with the onset of nonorganic, functional abdominal pain that closely mimicked acute appendicitis, thereby indicating a psychogenic origin in these particular cases of abdominal pain (14)(15)(16)(17)(18)(19)(20) .…”