A Change in Perspective: From Dual Diagnosis to Multimorbidity.

OBJECTIVE

There has been increasing interest within psychiatry in the concept of multimorbidity because psychiatric patients typically present with multiple concurrent disorders, these disorders mutually exacerbate one another, and their interaction shapes treatment options. Metrics have not been developed to document multimorbidity in psychiatric clinical practice.

METHODS

Four classes of indicators relevant to multimorbidity were defined and evaluated among veterans treated in mental health specialty clinics nationally in the Veterans Health Administration (VHA) in fiscal year 2012.

RESULTS

Of the 843,583 veterans with at least three visits to a specialty mental health clinic, 94.6% had more than one general medical or mental disorder and 77.6% had more than one mental disorder, compared with 30.6% with co-occurring psychiatric and substance use disorders.

CONCLUSIONS

Real-world psychiatric care is more accurately approached from the multimorbidity perspective than from the perspective of principal, dual, or comorbid diagnoses.