An investigation of the multimorbidity of mental disorders and alcohol attributable conditions

酒精是年轻人死亡的主要原因。2017年，英格兰各年龄段有近6000人死于酒精，约五分之一的人口饮酒量超过了政府指导方针的建议。我们知道，饮酒过量的人也更容易出现精神健康问题，但我们对同时患有这两种疾病的人的未来健康状况知之甚少，特别是酒精引起的身体疾病在这一群体中是否更常见。我们确实知道，有酒精和精神健康问题的人可能并不总是能够获得他们需要的治疗，而且全科医生目前并不经常询问患有抑郁症和焦虑症的人他们的饮酒情况。这项工作将帮助我们了解哪些疾病在这群人中更常见，以及如何最好地治疗它们。多重疾病指的是人们同时患有至少两种健康状况，了解这些多重状况如何相互作用影响一个人的整体健康是很重要的。这项工作将调查最常见的多病模式，包括精神健康问题，这取决于某人是否过度饮酒。我们知道，人们可以用酒精来帮助应对心理健康问题，相反，饮酒过多会使心理健康恶化。因此，除了就业、住房、吸烟和身体健康方面的其他信息外，我们还将研究酒精和心理健康问题的排序是否会影响人们是否过早死亡。我们的研究将使用全国调查、队列研究（跟踪人们的一生）和电子医疗记录（包括你看全科医生或住院时的数据）。我们将使用统计方法来更多地了解与酒精和心理健康有关的多重发病，并确定经历过类似健康状况的不同人群。我们还将与医护人员开展研讨会，询问他们我们的发现是否反映了他们在实践中看到的情况。然后，我们将确定那些在生活中经历过许多不利因素的人，以及那些有其他行为风险因素（如吸烟和不良饮食）的人，是否更有可能经历多重疾病，以及他们是否在更年轻的时候患上这些疾病。我们将跟踪那些已经患有酒精引起的疾病而入院的人，看看他们是否更有可能经历特殊的多重疾病模式，以及这些人中哪些人使用的卫生服务和治疗最多，因此可能需要在早期阶段得到支持。然后，我们将利用我们对多重疾病的模式和途径的发现来思考我们治疗过度饮酒或有精神健康问题的人的方式的变化可能对这些患者的结果产生什么影响，以及这可能对NHS产生的影响。我们的工作可能表明，我们需要做更多的工作，以确保酒精和心理健康服务比目前更好地结合起来。我们工作的进一步影响将是开发网络工具，全科医生可以使用这些工具来了解哪些病人可能会有最差的结果，并为他们的病人选择最佳的治疗方案。我们还可以帮助为政府政策的制定提供信息，并选择提供哪些治疗和服务，以避免有精神健康问题的个人因饮酒而遭受更多伤害。

Alcohol is the main cause of death in young people. In England in 2017 there were almost 6000 deaths across all age groups caused by alcohol, with around a fifth of the population drinking more alcohol than is recommended by government guidelines. We know that individuals who drink too much are also more likely to have a mental health problem, but we know less about the future health of people who have both of these problems and specifically whether physical diseases caused by alcohol are more common in this group. We do know that individuals with both alcohol and mental health problems may not always be able to access the treatments they need and that GPs currently do not routinely ask people with depression and anxiety about their drinking. This work will help us to understand what diseases are more common in this group of people and how best to treat them.Multimorbidity refers to people having at least two health conditions at the same time and it is important we understand how these multiple conditions interact to affect someone's overall health. This work will investigate the most common patterns of multimorbidity, including mental health problems, depending on whether someone does or does not drink excessively. We know that people may use alcohol to help cope with mental health problems and conversely that drinking too much can make mental health worse. We will therefore look at whether the ordering of the alcohol and mental health problem, in addition in addition to other information regarding employment, housing, smoking, and physical health affects whether people die earlier than they should. Our research will use national surveys, cohort studies (which follow people throughout their lives) and electronic healthcare records (which include data from when you visit your GP or are admitted to hospital). We will use statistical methods to understand more about multimorbidity in relation to alcohol and mental health and to identify different groups of individuals who have experienced similar types of health conditions. We will also conduct workshops with healthcare staff to ask them whether our findings reflect what they see in their practice. We will then determine whether individuals who have experienced many disadvantages in their lives and those with other behavioural risk factors (e.g. smoking and poor diet) are more likely to experience multimorbidity and whether they develop these conditions at a younger age.We will follow individuals who have been admitted to hospital who already have a disease caused by alcohol to look at whether they are more likely to experience particular patterns of multimorbidity, and which of these people use the most health services and treatments and so may require support at an earlier stage. We will then use what we have discovered about the patterns and pathways of multimorbidity to think about what effect that changes in the way we treat people who drink excessively or have mental health problems might have on outcomes for those patients and the impact this might have on the NHS.Our work may show that we need to do more to ensure that alcohol and mental health services are better joined up than they currently are. Further impacts of our work will be in developing web-tools that can be used by GPs to understand which patients are likely to have the poorest outcomes and in selecting the best treatment options for their patients. We can also help inform the development of government policies and in selecting which treatments and services to provide, to avoid individuals with mental health problems experiencing more harms as a result of their drinking.