Last-Resort Behavioral Health Care Utilization in Individuals With Spina Bifida

Emily C Hacker; Nathan VanderVeer-Harris; Debbie Goldberg; Lindsay A Hampson; Hillary L Copp

doi:10.1016/j.apmr.2025.12.011

Last-Resort Behavioral Health Care Utilization in Individuals With Spina Bifida

Arch Phys Med Rehabil. 2025 Dec 28:S0003-9993(25)01127-X. doi: 10.1016/j.apmr.2025.12.011. Online ahead of print.

Authors

Emily C Hacker¹, Nathan VanderVeer-Harris², Debbie Goldberg¹, Lindsay A Hampson¹, Hillary L Copp³

Affiliations

¹ Department of Urology, University of California, San Francisco, San Francisco, CA.
² Department of Urology, Tulane University School of Medicine, New Orleans, LA.
³ Department of Urology, University of California, San Francisco, San Francisco, CA. Electronic address: Hillary.Copp@ucsf.edu.

PMID: 41461278
DOI: 10.1016/j.apmr.2025.12.011

Abstract

Objective: To examine the differences in last-resort behavioral health care (LRBH) utilization for mental health and substance use between individuals with spina bifida (SB) and matched non-SB controls.

Design: We analyzed data from the California Department of Health Care Access and Information (2005-2017) to compare inpatient and emergency department (ED) behavioral health utilization between individuals with SB and non-SB controls (1:5 ratio). Multivariable logistic regression was used to assess the likelihood of LRBH use, adjusting for demographic, socioeconomic, and clinical variables.

Setting: ED and inpatient hospitalizations across all practice types in a large health care system.

Participants: We queried the California Department of Health Care Access and Information database from 2005 to 2017, (N=116,364). We created a cohort by frequency-matching those with SB 1:5 by birth year and facility (inpatient or ED) to a randomly generated control sample without SB.

Interventions: Not applicable.

Main outcome measures: Encounters per patient with a primary behavioral health diagnosis.

Results: The cohort included 19,394 individuals with SB and 96,970 controls. Individuals with SB had a higher mean Charlson Comorbidity Index (2.0 vs 1.1) and more LRBH encounters (5.1 vs 2.7 per patient). SB was independently associated with increased risk of ≥1 encounter (adjusted odds ratio [aOR], 1.49; 95% CI, 1.42-1.56). Within the SB group, increased Charlson Comorbidity Index (aOR, 1.04), women (aOR, 1.12), and nonprivate insurance (aOR, 2.48) predicted higher utilization. Asian/Pacific Islander race (aOR, 0.32), Hispanic ethnicity (aOR, 0.41), and those residing in lower socioeconomic advantage areas (aOR, 0.92) were associated with decreased odds of behavioral health care encounters.

Conclusions: Individuals with SB are at significantly higher risk of LRBH utilization compared with non-SB controls. SB independently predicted nearly 50% increased odds of requiring such services. Our analysis identifies significant sociodemographic predictors of LRBH care within the SB population, which should be further explored as potential targets for preventive behavioral health intervention.

Keywords: Mental health; Rehabilitation; Spina bifida; Substance use disorders.