Goldstein Benjamin I, Levitt Anthony J
Mood Disorders Program, Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Clin Psychiatry. 2006 Jun;67(6):925-32. doi: 10.4088/jcp.v67n0609.
This study compares health service utilization by individuals with comorbid lifetime bipolar I disorder and lifetime alcohol use disorders (AUD) to that of individuals with either diagnosis alone, using nationally representative data.
The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with bipolar I disorder only (BD-only; N = 636), AUD only (N = 11,068), and comorbid bipolar I disorder and AUD (BD-AUD; N = 775). Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The 3 groups were compared with respect to self-reported health service utilization.
For both men and women, respondents in the BD-AUD group were significantly more likely than AUD-only respondents to report any alcohol-related service utilization (p < .001). BD-AUD respondents were significantly more likely to report bipolar disorder-related hospital admissions as compared with BD-only respondents among males only (p = .009). Within the BD-AUD group, males reported significantly greater utilization of AUD treatment only (p < .001), and females reported significantly greater utilization of bipolar disorder treatment only (p < .001) and significantly greater likelihood of utilizing mental health services overall (p < .001). There was no gender difference in the proportion of respondents who utilized both AUD and bipolar disorder services.
As expected, individuals with comorbid bipolar I disorder and AUD utilize significantly more mental health services than individuals with either disorder alone. The primary original finding is that among those with comorbid bipolar I disorder and AUD, bipolar I disorder is more likely to go untreated among males and AUD is more likely to go untreated among females. Gender may be an important factor to consider in future health service planning for comorbid bipolar I disorder and AUD.
本研究使用具有全国代表性的数据，比较患有共病终生双相I型障碍和终生酒精使用障碍（AUD）的个体与仅患有其中一种诊断的个体的医疗服务利用情况。
使用2001 - 2002年全国酒精及相关状况流行病学调查来确定仅患有双相I型障碍（仅BD；N = 636）、仅患有AUD（N = 11,068）以及患有共病双相I型障碍和AUD（BD - AUD；N = 775）的受访者。诊断依据美国国立酒精滥用与酒精中毒研究所的酒精使用障碍及相关残疾访谈表 - DSM - IV版得出。比较这三组在自我报告的医疗服务利用方面的情况。
对于男性和女性，BD - AUD组的受访者报告任何与酒精相关的服务利用的可能性均显著高于仅患有AUD的受访者（p < 0.001）。仅在男性中，BD - AUD受访者报告与双相情感障碍相关的住院治疗的可能性显著高于仅患有BD的受访者（p = 0.009）。在BD - AUD组中，男性仅报告AUD治疗的利用率显著更高（p < 0.001），女性仅报告双相情感障碍治疗的利用率显著更高（p < 0.001），且总体上利用心理健康服务的可能性显著更高（p < 0.001）。在同时利用AUD和双相情感障碍服务的受访者比例上没有性别差异。
正如预期的那样，患有共病双相I型障碍和AUD的个体比仅患有其中一种障碍的个体显著更多地利用心理健康服务。主要的原始发现是，在患有共病双相I型障碍和AUD的个体中，双相I型障碍在男性中更有可能未得到治疗，而AUD在女性中更有可能未得到治疗。在未来针对共病双相I型障碍和AUD的医疗服务规划中，性别可能是一个需要考虑的重要因素。
