Rush Brian, Koegl Christopher J
Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Ontario.
Can J Psychiatry. 2008 Dec;53(12):810-21. doi: 10.1177/070674370805301207.
To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.
Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.
Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm.
The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems.
采用标准方法，在一个全面的心理健康服务系统中，研究同时患有精神障碍和物质使用障碍的人群的患病率及特征，涉及众多人口统计学、诊断及需求相关变量。
收集了从专科三级住院部、专科门诊部及社区心理健康项目中抽取的病例（n = 9839）的数据。共病状况基于科罗拉多客户评估记录中记录的物质使用障碍诊断及药物滥用测量。在每个护理级别中，对有或无共病的组的人口统计学和需求特征进行了比较。
总体而言，共病的患病率为18.5%，在接受专科三级住院护理的患者中最高（28%），在特定亚人群中如年轻人（55%）和患有精神障碍的人（34%）中也较高。在专科住院项目中，基于共病的组间差异很少。对于门诊和社区环境，患有共病的患者的需求特征更受损且复杂，更可能年轻、单身、男性且受教育程度低。在所有护理级别中，患有共病与反社会和具有挑战性的行为、法律介入以及自杀或自我伤害风险密切相关。
共病的患病率估计可能代表了一个服务于大量城乡混合人口的多层次护理系统。结果强调了需要关注特定亚人群和部门，以寻求对其心理健康和成瘾问题进行更综合的治疗和支持。
