Neuropsychiatric Symptoms and Expenditure on Complementary and Alternative Medicine

Neuropsychiatric symptoms affect more than 1 in 3 adults in the United States.1,2 This group of symptoms, including insomnia, anxiety, attention deficits, memory loss, regular headaches, excessive sleepiness, and depression, often occurs as a constellation rather than as individual symptoms.1,2 While these symptoms can be present in otherwise healthy individuals, the constellation is frequently present in those suffering from neuropsychiatric conditions including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), mild cognitive impairment (MCI), dementia, and fibromyalgia.3–5 Individual neuropsychiatric symptoms have also been shown to be independent risk factors for other chronic medical conditions such as insomnia and obesity, metabolic syndrome, cardiovascular disease, and stroke.6–9 Furthermore, they are associated with risky behaviors (eg, substance abuse, drunk driving, dangerous sexual behaviors), and decreased work productivity.10 Standard treatments for neuropsychiatric symptoms vary according to the associated disease entities, but these symptoms as a whole are often notoriously difficult to treat. Additionally, despite conventional options, including pharmacologic intervention and mental health visits, patients continue to seek other options for relief of these symptoms.1 Complementary and alternative medicine (CAM) encompasses a wide range of therapies including acupuncture, meditation, yoga, biofeedback, massage therapy, and herbal medications.11 Prior studies have estimated that Americans spend $34 billion out-of-pocket annually for CAM treatments.12 Several of these CAM treatments, with varying degrees of underlying evidence, may offer additional options to those suffering from neuropsychiatric symptoms. In our prior work,1 we reported higher prevalence of CAM use among adults with neuropsychiatric symptoms compared to those without neuropsychiatric symptoms (44% vs 30%, P < .001). The 3 modalities most likely to be used include herbal medications, deep-breathing exercises, and meditation. Mind-body therapies were the most popular subcategory.1,2 In addition, there was a positive association between the number of neuropsychiatric symptoms and CAM use, with those having more symptoms more likely to use CAM, particularly mind-body medicine.1,2 Preliminary studies13–15 with these mind-body interventions have suggested improvements in sleep dysfunction, anxiety, and attention deficits. For example, mindfulness-based stress reduction, an 8-week group yoga and meditation course, has shown improvement in anxiety, depression, insomnia, and quality of life.13–17 Studies18 with acupuncture have suggested potential benefit for cognition and sleep quality. Several studies19,20 suggest the beneficial effects of meditation for attention and memory processes. Some studies19,21–24 of meditation and yoga have also suggested beneficial changes both neurostructurally and neurophysiologically, with changes in cortical gray matter, as well as changes with γ-aminobutyric acid (GABA) and glutamate production providing a potential neural mechanistic pathway for the improvements observed. However, several studies25,26 investigating nutriceuticals or herbal therapies for individual neuropsyehiatric symptoms, such as St. John’s wort for anxiety and depression and ginkgo for memory have had equivocal results at best. Also, while many types of CAM are generally regarded as relatively safe, questions of safety and herb-drug interactions exist with supplements.27–29 Irrespective of the evidence base, with significant CAM use by the general population, significant out-of-pocket costs are assumed. However, to our knowledge, no studies have been published evaluating CAM expenditure in patients with neuropsyehiatric symptoms. Out-of-pocket expenditure represents a significant interest by the consumer, indicating a willingness to invest a finite resource beyond regular expenditures on health insurance and standard treatments. In order to inform future clinical and cost-effectiveness research, facilitate discussion among various stakeholders, and inform eventual public policy regarding CAM treatments, it is imperative to understand consumer use and expenditure of CAM, particularly in a population in which neuropsyehiatric symptoms are pervasive and span multiple important medical conditions. Thus, understanding costs associated with CAM therapies is an important indicator of consumer interest and demand. In this context, utilizing a nationally representative survey, we aimed to further analyze patterns of consumer cost and expenditure for CAM specifically in those with neuropsyehiatric symptoms.