Villalobos-Gallegos Luis, Marín-Navarrete Rodrigo, Roncero Calos, González-Cantú Hugo
Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
Unidad de Adicciones y Patología Dual, Servicio de Psiquiatría, Hospital Universitario Vall d'Hebrón-Agencia de Salud Pública de Barcelona (ASPB), Centro de Investigación Biomédica en Red-Área Temática de Salud Mental (CIBERSAM).
Braz J Psychiatry. 2017 Oct-Dec;39(4):286-292. doi: 10.1590/1516-4446-2016-1972. Epub 2017 Jan 9.
To identify symptom-based subgroups within a sample of patients with co-occurring disorders (CODs) and to analyze intersubgroup differences in mental health services utilization.
Two hundred and fifteen patients with COD from an addiction clinic completed the Symptom Checklist 90-Revised. Subgroups were determined using latent class profile analysis. Services utilization data were collected from electronic records during a 3-year span.
The five-class model obtained the best fit (Bayesian information criteria [BIC] = 3,546.95; adjusted BIC = 3,363.14; bootstrapped likelihood ratio test p < 0.0001). Differences between classes were quantitative, and groups were labeled according to severity: mild (26%), mild-moderate (28.8%), moderate (18.6%), moderate-severe (17.2%), and severe (9.3%). A significant time by class interaction was obtained (chi-square [χ2[15]] = 30.05, p = 0.012); mild (χ2[1] = 243.90, p < 0.05), mild-moderate (χ2[1] = 198.03, p < 0.05), and moderate (χ2[1] = 526.77, p < 0.05) classes displayed significantly higher treatment utilization.
The classes with more symptom severity (moderate-severe and severe) displayed lower utilization of services across time when compared to participants belonging to less severe groups. However, as pairwise differences in treatment utilization between classes were not significant between every subgroup, future studies should determine whether subgroup membership predicts other treatment outcomes.
在共病障碍（COD）患者样本中识别基于症状的亚组，并分析心理健康服务利用方面的亚组间差异。
来自一家成瘾诊所的215名COD患者完成了症状自评量表90修订版。使用潜在类别剖析法确定亚组。在3年期间从电子记录中收集服务利用数据。
五类模型拟合最佳（贝叶斯信息准则[BIC]=3546.95；调整后的BIC=3363.14；自抽样似然比检验p<0.0001）。类别之间的差异是定量的，根据严重程度对组进行标记：轻度（26%）、轻中度（28.8%）、中度（18.6%）、中重度（17.2%）和重度（9.3%）。获得了显著的类别×时间交互作用（卡方[χ2[15]]=30.05，p=0.012）；轻度（χ2[1]=243.90，p<0.05）、轻中度（χ2[1]=198.03，p<0.05）和中度（χ2[1]=526.77，p<0.05）类别显示出显著更高的治疗利用率。
与症状较轻组的参与者相比，症状更严重（中重度和重度）的类别在各时间段的服务利用率较低。然而，由于各亚组之间治疗利用率的成对差异并非在每个亚组之间都显著，未来的研究应确定亚组成员身份是否能预测其他治疗结果。
