Healthcare use, interventions and longer term outcomes in people with co-occurring bipolar and alcohol use disorders

自1990年以来，双相情感障碍(BD)的全球患病率增加了59.3%(GBD精神障碍合作者，2019年)。在所有精神障碍中，BD是青少年残疾调整寿命年数的第三大原因，在整个生命周期中排在前五位(GBD精神障碍合作者，2019年)。全球40%-70%的被诊断为BD的人患有共病酒精使用障碍(AUD)(Grunze等人，2021年)，其共病发病率高于其他精神障碍(Puddephatt等人，2021年)。在BD中，合并AUD会影响临床结果(Salloum&Brown，2017)，增加自杀风险(Oquendo等人，2010)，并降低治疗依从性(Manwani等人，2007)。AUD和BD之间的关系可能是双向的，BD的抑郁阶段增加了对酒精的渴望，酒精的使用加剧了BD的躁狂和抑郁症状(Grunze等人，2021年)。然而，即使有人接受治疗，它通常也只针对情绪症状或酒精使用结果(例如，Schmitz等人，2002年；Weiss等人，2007年)。事实上，现有的心理社会干预措施没有一种能够同时有利于BD和共生疾病患者的物质使用症状(Gold等人，2018年)。社会不平等加剧了上述问题，社会经济地位较低的人格外背负与酒精有关的伤害，包括死亡率(Collins，2016)，以及包括BD在内的严重精神疾病的患病率增加(Lee等人，2020年)。具体地说，英格兰北部报告了不成比例的更高的精神健康状况，包括与剥夺、预期寿命缩短和自杀风险增加相关的BD(公共卫生英格兰，2019年)。然而，BD治疗有效性的证据因以英格兰南部为中心的研究而存在偏见(英国临床研究合作组织，2015；MQ，2019年)，关于AUD和BD共病的健康不平等仍未得到探索。因此，有必要审查国家记录，以进一步了解患有澳门氏症和BD的人可能经历的不平等，并调查治疗途径和结果可能受到的影响。

Since 1990, the global prevalence of bipolar disorder (BD) has increased by 59.3% (GBD Mental Disorder Collaborators, 2019). Across all mental disorders, BD is the third highest cause of disability-adjusted-life years for adolescents and in the top five across the entire lifespan (GBD Mental Disorder Collaborators, 2019). 40-70% of people diagnosed with BD globally suffer from comorbid alcohol use disorder (AUD) (Grunze et al., 2021) with a higher comorbidity than for other mental disorders (Puddephatt et al., 2021). Comorbid AUD problematically influences the clinical outcomes (Salloum & Brown, 2017), increases suicide risk (Oquendo et al., 2010) and lowers treatment adherence (Manwani et al., 2007) in BD. The relationship between AUD and BD is likely bidirectional, with the depressive stages of BD increasing alcohol craving, and alcohol use exacerbating both mania and depression symptoms of BD (Grunze et al., 2021).There are established inequalities in access to care and treatment experience for people with co-occurring problems (Harris & Edlund, 2005). However, even when someone accesses treatment it typically only targets either mood symptoms or alcohol use outcomes (e.g., Schmitz et al., 2002; Weiss et al., 2007). Indeed, no existing psychosocial interventions consistently benefit both BD and substance use symptoms for patients with co-occurring disorders (Gold et al., 2018).The above issues are compounded by social inequalities and people of lower socioeconomic status are disproportionately burdened with alcohol-related harms, including mortality (Collins, 2016), and an increased prevalence of severe mental illness, including BD (Lee et al., 2020). Specifically, the North of England reports disproportionately higher rates of mental health conditions, including BD, associated with deprivation, reduced life expectancy and increased suicide risk (Public Health England, 2019). However, evidence for BD treatment effectiveness is biased by research centred around the South of England (UK Clinical Research Collaboration, 2015; MQ, 2019), and health inequalities regarding comorbid AUD and BD remain unexplored. Resultingly, there is a need to review national records to further understand the inequalities that may be experienced by people with comorbid AUD and BD and to investigate how treatment pathways and outcomes may be impacted.