Decker Kathleen P, Peglow Stephanie L, Samples Carl R, Cunningham Tina D
Department of Mental Health & Behavioral Sciences, Hampton VAMC, 100 Emancipation Drive, Hampton, VA 23667.
Department of Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510.
Mil Med. 2017 Jan;182(1):e1589-e1595. doi: 10.7205/MILMED-D-15-00560.
A cohort of 207 veterans admitted to a residential substance use treatment program was followed for 5 years following discharge to determine factors associated with reduced relapse or mortality following discharge. Subsequent utilization of medical and psychiatric hospitalization and emergency room utilization was also examined. Retrospective chart review was conducted using demographic, diagnostic, and prior treatment as independent variables. Dependent variables included aftercare compliance and subsequent morbidity as measured by relapse, emergency room visits, subsequent hospitalizations, and mortality. Cox proportional hazards models were used to examine factors associated with relapse and mortality. Aftercare attendance was higher in those who completed treatment (p < 0.01). Factors associated with higher risk of relapse included comorbid disorders, failure to complete the index residential substance use treatment program, and psychiatric rehospitalization. Factors associated with higher mortality included failure to complete residential substance use treatment, longer medical rehospitalization, and nicotine dependence. Longer psychiatric rehospitalization was associated with a lower risk of mortality. Comorbid psychiatric conditions and failure to complete residential substance use treatment were associated with higher relapse. Limitations include that this population has severe substance use disorder, that subjective report of symptom severity was not assessed and that attendance at Alcoholics Anonymous aftercare was not surveyed.
对207名入住住院物质使用治疗项目的退伍军人进行了队列研究，在出院后随访5年，以确定与出院后复发减少或死亡率降低相关的因素。还检查了随后的医疗和精神科住院利用情况以及急诊室利用情况。使用人口统计学、诊断和既往治疗作为自变量进行回顾性病历审查。因变量包括后续护理依从性以及通过复发、急诊室就诊、随后的住院和死亡率衡量的后续发病率。使用Cox比例风险模型来检查与复发和死亡率相关的因素。完成治疗的患者的后续护理出勤率更高（p < 0.01）。与复发风险较高相关的因素包括共病障碍、未完成索引住院物质使用治疗项目以及精神科再次住院。与较高死亡率相关的因素包括未完成住院物质使用治疗、较长时间的医疗再次住院以及尼古丁依赖。较长时间的精神科再次住院与较低的死亡风险相关。共病精神状况和未完成住院物质使用治疗与较高的复发率相关。局限性包括该人群患有严重的物质使用障碍，未评估症状严重程度的主观报告，且未调查戒酒互助会后续护理的出勤率。
