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

自1990年以来，全球双相情感障碍（BD）的患病率增加了59.3% （GBD精神障碍合作者，2019年）。在所有精神障碍中，双相障碍是青少年残疾调整生命年的第三大原因，在整个生命周期中排名前五（GBD精神障碍合作者，2019年）。全球40-70%的双相障碍患者患有共病性酒精使用障碍（AUD） （Grunze et al., 2021），其合并症高于其他精神障碍（Puddephatt et al., 2021）。共病性AUD会严重影响双相障碍的临床结果（saloum & Brown, 2017），增加自杀风险（Oquendo等人，2010），降低治疗依从性（Manwani等人，2007）。AUD与双相障碍之间的关系可能是双向的，双相障碍的抑郁阶段会增加对酒精的渴望，而酒精使用会加剧双相障碍的躁狂和抑郁症状（Grunze等人，2021）。对于同时出现问题的人来说，在获得护理和治疗经验方面存在既定的不平等（Harris & Edlund, 2005）。然而，即使有人接受治疗，通常也只针对情绪症状或酒精使用结果（例如，Schmitz等人，2002；Weiss等人，2007）。事实上，没有现有的社会心理干预措施能够持续地对双相障碍和药物使用症状患者同时受益（Gold et al., 2018）。社会不平等加剧了上述问题，社会经济地位较低的人不成比例地承受着与酒精相关的危害，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 et al., 2020）。具体而言，英格兰北部报告的精神健康状况（包括双相障碍）比例过高，与贫困、预期寿命缩短和自杀风险增加有关（英国公共卫生部，2019年）。然而，以英格兰南部为中心的研究（英国临床研究合作，2015年；MQ， 2019年）对双相障碍治疗有效性的证据存在偏见，并且关于共病性AUD和双相障碍的健康不平等仍未被探索。因此，有必要回顾国家记录，以进一步了解AUD和BD合并症患者可能经历的不平等，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.