Nehlin Christina, Arinell Hans, Dyster-Aas Johan, Jess Kari
a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden.
b Division of Psychiatry , Uppsala University Hospital , Uppsala , Sweden.
J Dual Diagn. 2017 Oct-Dec;13(4):247-253. doi: 10.1080/15504263.2017.1347307. Epub 2017 Jun 30.
It is common for persons with psychiatric disorders to also have alcohol problems. Studies in the general population as well as in clinical samples have found hazardous or harmful alcohol habits to be particularly prevalent in the presence of psychiatric disorders. This study sought to explore the relationships between drinking habits and health care utilization (psychiatric as well as general medical) in persons seeking psychiatric treatment and to investigate the associations among age, sex, and type or number of diagnoses and health care use and costs. For the planning of targeted interventions, we also sought to identify subgroups with a high prevalence of hazardous drinking habits.
From a psychiatric clinic for affective disorders at a university hospital in Sweden, patients who had been screened for hazardous drinking (N = 609) were selected. Patients with primary psychosis or substance use disorder receive treatment at other clinics and did not participate. Medical records data were grouped and compared. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used for diagnoses and the Alcohol Use Disorders Identification Test for screening. Patients were grouped by drinking habits and sex, age, and diagnosis group, and their psychiatric as well as general medical health care use was compared.
Abstainers used psychiatric care more than all other drinking groups (p < .001). Psychiatric health care costs were higher in abstainers and low-risk drinkers (1.64 to 1). No differences in general medical care could be identified between drinking groups. Specific subgroups with higher rates of hazardous drinking could not be identified (44% of all males and 34% of all females reported such habits). Inconclusive results from previous research are most likely due to different methods used to classify drinking problems.
Abstainers and low-risk drinkers used psychiatric health care to a higher cost than the other drinking groups. Possible explanations are discussed from a clinical and scientific perspective. This study clarifies the need for uniform measures when classifying alcohol use in studies of relationships between alcohol use and health care use. There is also a need to separate former drinkers from abstainers in future studies.
患有精神疾病的人同时存在酒精问题很常见。在普通人群以及临床样本的研究中发现，在患有精神疾病的情况下，危险或有害的饮酒习惯尤为普遍。本研究旨在探讨寻求精神治疗的人群中饮酒习惯与医疗保健利用（精神科以及普通医疗）之间的关系，并调查年龄、性别、诊断类型或数量与医疗保健使用及费用之间的关联。为了规划有针对性的干预措施，我们还试图识别具有高危险饮酒习惯患病率的亚组。
从瑞典一家大学医院的情感障碍精神科诊所中，选取了接受过危险饮酒筛查的患者（N = 609）。患有原发性精神病或物质使用障碍的患者在其他诊所接受治疗，未参与本研究。对病历数据进行分组并比较。使用《国际疾病和相关健康问题统计分类》第10版（ICD - 10）进行诊断，并用酒精使用障碍识别测试进行筛查。患者按饮酒习惯、性别、年龄和诊断组进行分组，并比较他们的精神科以及普通医疗保健使用情况。
戒酒者比所有其他饮酒组更多地使用精神科护理（p <.001）。戒酒者和低风险饮酒者的精神科医疗保健费用更高（比例为1.64比1）。饮酒组之间在普通医疗护理方面未发现差异。无法识别出危险饮酒率较高的特定亚组（所有男性中有44%，所有女性中有34%报告有此类习惯）。先前研究结果不明确很可能是由于用于对饮酒问题进行分类的方法不同。
戒酒者和低风险饮酒者使用精神科医疗保健的成本高于其他饮酒组。从临床和科学角度讨论了可能的解释。本研究阐明了在酒精使用与医疗保健使用关系研究中对酒精使用进行分类时采用统一措施的必要性。未来研究中也需要将既往饮酒者与戒酒者区分开来。
