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Association between alcohol and substance use disorders and psychiatric service use in patients with severe mental illness: a nationwide Danish register-based cohort study

Published online by Cambridge University Press:  12 February 2018

Kirstine Bro Jørgensen ,
Merete Nordentoft  and
Carsten Hjorthøj
Kirstine Bro Jørgensen*
Affiliation:
Copenhagen University Hospital, Mental Health Center Copenhagen, Copenhagen, Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Copenhagen and Aarhus, Denmark
Merete Nordentoft
Affiliation:
Copenhagen University Hospital, Mental Health Center Copenhagen, Copenhagen, Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Copenhagen and Aarhus, Denmark
Carsten Hjorthøj
Affiliation:
Copenhagen University Hospital, Mental Health Center Copenhagen, Copenhagen, Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Copenhagen and Aarhus, Denmark
*
Author for correspondence: Kirstine Bro Jørgensen, Kirstine.Bro.Joergensen@regionh.dk
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Abstract

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.

Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 15 , November 2018 , pp. 2592 - 2600
Copyright
Copyright © Cambridge University Press 2018 

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References

Bradley, CJ and Zarkin, GA (1996). Inpatient stays for patients diagnosed with severe psychiatric disorders and substance abuse. Health Services Research 31, 387–408.Google Scholar
Hansen, SS, Munk-Jorgensen, P, Guldbaek, B, Solgard, T, Lauszus, KS, Albrechtsen, N et al. (2000). Psychoactive substance use diagnoses among psychiatric in-patients. Acta Psychiatrica Scandinavica 102, 432–438.Google Scholar
Herr, BE, Abraham, HD and Anderson, W (1991). Length of stay in a general hospital psychiatric unit. General Hospital Psychiatry 1, 68–70.Google Scholar
Hjorthøj, C, Østergaard, MLD, Benros, ME, Toftdahl, NG, Erlangsen, A, Andersen, JT et al. (2015). Association between alcohol and substance use disorders and all-cause and cause-specific mortality in schizophrenia, bipolar disorder, and unipolar depression: a nationwide, prospective, register-based study. The Lancet Psychiatry 2, 801–808.Google Scholar
Kildemoes, HW, Sørensen, HT and Hallas, J (2011). The Danish national prescription registry. Scandinavian Journal of Public Health 39, 38–41.Google Scholar
Large, M, Mullin, K, Gupta, P, Harris, A and Nielssen, O (2014). Systematic meta-analysis of outcomes associated with psychosis and co-morbid substance use. The Australian and New Zealand Journal of Psychiatry 48, 418–432.Google Scholar
Leon, SC, Lyons, JS, Christopher, NJ and Miller, SI (1998). Psychiatric hospital outcomes of dual diagnosis patients under managed care. The American Journal on Addictions 7, 81–86.Google Scholar
Lynge, E, Sandegaard, JL and Rebolj, M (2011). The Danish National Patient Register. Scandinavian Journal of Public Health 39, 30–33.Google Scholar
McCrone, P, Menezes, PR, Johnson, S, Scott, H, Thornicroft, G, Marshall, J et al. (2000). Service use and costs of people with dual diagnosis in South London. Acta Psychiatrica Scandinavica 101, 464–472.Google Scholar
Menezes, PR, Johnson, S, Thornicroft, G, Marshall, J, Prosser, D and Bebbington, PKE (1996). Drug and alcohol problems among individuals with severe mental illnesses in South London. British Journal of Psychiatry 168, 612–619.Google Scholar
Mors, O, Perto, GP and Mortensen, PB (2011). The Danish Psychiatric Central Research Register. Scandinavian Journal of Public Health 39, 54–57.Google Scholar
Patel, R, Wilson, R, Jackson, R, Ball, M, Shetty, H, Broadbent, M et al. (2016). Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study. BMJ Open 6, e009888.Google Scholar
Pedersen, CB, Gøtzsche, H, Møller, JØ and Mortensen, PB (2006). The Danish Civil Registration System. A cohort of eight million persons. Danish Medical Bulletin 53, 441–449.Google Scholar
Picci, RL, Versino, E, Oliva, F, Giaretto, RM, Ostacoli, L, Trivelli, F et al. (2013). Does substance use disorder affect clinical expression in first-hospitalization patients with schizophrenia? Analysis of a prospective cohort. Psychiatry Research 210, 780–786.Google Scholar
Ries, RK, Russo, J, Wingerson, D, Snowden, M, Comtois, K, Srebnik, D et al. (2000). Shorter hospital stays and more rapid improvement among patients with schizophrenia and substance disorders. Psychiatric Services 51, 210–215.Google Scholar
Sara, GE, Burgess, PM, Malhi, GS, Whiteford, HA and Hall, WC (2014). Stimulant and other substance use disorders in schizophrenia: prevalence, correlates and impacts in a population sample. Australian and New Zealand Journal of Psychiatry 48, 1036–1047.Google Scholar
Toftdahl, NG, Nordentoft, M and Hjorthøj, C (2016). Prevalence of substance use disorders in psychiatric patients: a nationwide Danish population-based study. Social Psychiatry and Psychiatric Epidemiology 51, 129–140.Google Scholar
Wobrock, T, Falkai, P, Schneider-Axmann, T, Hasan, A, Galderisi, S, Davidson, M et al. (2013). Comorbid substance abuse in first-episode schizophrenia: effects on cognition and psychopathology in the EUFEST study. Schizophrenia Research 147, 132–139.Google Scholar
Wright, S, Gournay, K, Glorney, E and Thornicroft, G (2000). Dual diagnosis in the suburbs: prevalence, need, and in-patient service use. Social Psychiatry and Psychiatric Epidemiology 35, 297–304.Google Scholar
Wu, HE, Mohite, S, Ngana, I, Burns, W, Shah, N, Schneider, L et al. (2015). Hospital length of stay in individuals with schizophrenia with and without cocaine-positive urine drug screens at hospital admission. The Journal of Nervous and Mental Disease 203, 33–36.Google Scholar