Association between alcohol and substance use disorders and psychiatric service use in patients with severe mental illness: a nationwide Danish register-based cohort study
Association between alcohol and substance use disorders and psychiatric service use in patients with severe mental illness: a nationwide Danish register-based cohort study
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DOI：
10.1017/s0033291718000223
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发表时间：
2018-11-01
影响因子：
6.9
通讯作者：
Hjorthoj, Carsten
中科院分区：
文献类型：
--
作者：
Jorgensen, Kirstine Bro;Nordentoft, Merete;Hjorthoj, Carsten
背景物质使用障碍在精神疾病患者中非常普遍，并且已知会阻碍精神病治疗。一些研究表明，服务使用率有所增加，而另一些研究则显示有所下降。由于缺乏大规模的研究，这些相互矛盾的结果进一步受到阻碍。本研究的目的是探讨精神病患者的物质使用障碍与精神科服务使用之间的关系。该研究是一项基于登记的前瞻性队列研究，包括严重精神疾病患者。主要结局是住院次数、住院天数和精神科急诊联系次数。相关性采用发病率比计算，置信区间为95%。这项研究包括了自1955年以来出生的所有精神病患者。共纳入精神分裂症患者21558例（47.54%合并物质使用障碍）、抑郁症患者80778例（28.78%合并物质使用障碍）、双相情感障碍患者10560例（40.08%合并物质使用障碍）和人格障碍患者69252例（39.18%合并物质使用障碍）。与无此类疾病的患者相比，患有共病物质使用障碍的患者的住院率、卧床天数和精神科急诊接触率显著增加（p < 0.001）。物质使用障碍与住院次数、卧床天数和精神科急诊科接触次数的增加有关，其中大部分物质都与此有关。
Background. Substance use disorder is highly prevalent in people with psychiatric disorders, and known to impede the psychiatric treatment. Some studies show increased rates of service use, while others show a decrease. These conflicting results are further hampered by a lack of large-scale studies. The aim of this study was to investigate the association between substance use disorder and psychiatric service use in psychiatric patients.Methods. The study was a prospective registry-based cohort study including patients with severe mental illness. The primary outcome was the number of hospitalisations, bed days and the number of psychiatric emergency department contacts. The association was calculated with incidence rate ratio with 95% confidence intervals.Results. The study included all psychiatric patients born since 1955. In total, 21 558 patients with schizophrenia (47.54% with substance use disorder), 80 778 patients with depression (28.78% with substance use disorder), 10 560 patients with bipolar affective disorder (40.08% with substance use disorder) and 69 252 patients with a personality disorder (39.18% with substance use disorder) were included. Patients with comorbid substance use disorder had significantly increased rates of hospitalisations, bed days and psychiatric emergency department contacts (p < 0.001) for the majority of the included substances, compared with patients without such disorders.Conclusion. Substance use disorder was associated with an increased number of hospitalisations, bed days and increased number of psychiatric emergency department contacts for the majority of the included substances.