College of Nursing, Washington State University, Spokane, WA, USA.
Gen Hosp Psychiatry. 2012 Sep-Oct;34(5):500-5. doi: 10.1016/j.genhosppsych.2012.05.001. Epub 2012 Jun 14.
The objective was to determine if patients hospitalized with a primary medical diagnosis and any co-occurring serious mental illness (SMI) were more likely than patients without any co-occurring SMI diagnosis to experience a subsequent medical hospitalization.
This was a longitudinal cohort study of 925,705 adult persons (aged 18+ years). Patients hospitalized in Washington State from 2004 to 2008 were followed through 2009 (for an average of 43 months).
Compared to patients hospitalized for medical conditions without co-occurring SMI, patients with co-occurring dysthymia, bipolar and major depressive disorders were at an elevated risk for long-term subsequent hospitalization. Patients in the combined co-occurring mood disorders cohort were more likely (hazard ratio=1.13; 99% confidence interval=1.10-1.16; P<.001) than patients in the reference cohort to experience a subsequent medical hospitalization. A significant interaction between substance and mood disorders that increased risk for subsequent hospitalization was also observed.
Hospitalized patients with co-occurring mood disorders are at high risk for repeat hospitalization for a medical reason. This high-risk population, including those with substance abuse, should be a focus of research efforts to identify and address ambulatory-care-sensitive conditions amenable to strategies that decrease complications and illness leading to subsequent hospitalizations.
本研究旨在确定患有主要医疗诊断且同时伴有任何共病严重精神疾病（SMI）的患者是否比没有任何共病 SMI 诊断的患者更有可能经历随后的医疗住院治疗。
这是一项针对 925705 名成年患者（年龄≥18 岁）的纵向队列研究。2004 年至 2008 年期间在华盛顿州住院的患者通过 2009 年（平均随访 43 个月）进行随访。
与因无共病 SMI 的医疗条件住院的患者相比，同时患有心境恶劣障碍、双相和重性抑郁障碍的患者长期后续住院的风险增加。在合并共病心境障碍队列中的患者比参考队列中的患者更有可能（风险比=1.13；99%置信区间=1.10-1.16；P<.001）经历随后的医疗住院治疗。还观察到物质和心境障碍之间的显著相互作用，这增加了随后住院的风险。
同时患有心境障碍的住院患者因医疗原因再次住院的风险很高。这一高风险人群，包括有药物滥用的患者，应成为研究工作的重点，以确定和解决适合减少并发症和导致随后住院的疾病的门诊医疗敏感条件。
