Ecker Anthony H, Stanley Melinda A, Smith Tracey L, Teng Ellen J, Fletcher Terri L, Van Kirk Nathaniel, Amspoker Amber B, Walder Annette, McIngvale Elizabeth, Lindsay Jan A
VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.
J Cogn Psychother. 2019 Feb 1;33(1):23-32. doi: 10.1891/0889-8391.33.1.23.
Obsessive-compulsive disorder (OCD) and substance-use disorders (SUDs) co-occur at high rates, which is related to poorer psychosocial outcomes. Prior work suggests that, among veterans in the Veterans Health Administration (VHA), OCD is underdiagnosed and undertreated, which can compound negative effects of OCD and SUD co-occurrence. This study identified patterns of OCD and specific SUD co-occurrence and their effect on mental health and substance-use screening measures and mental healthcare utilization. Using VHA administrative data, we identified veterans with an OCD diagnosis from 2010 to 2016 ( = 38,157); 36.70% also had a SUD diagnosis. Specific SUD rates are alcohol-use disorder, 17.17%; cannabis-use disorder, 5.53%; opioid-use disorder, 3.60%; amphetamine-use disorder, 1.49%; cocaine-use disorder, 3.37%; and tobacco-use disorder, 26.50%. Veterans with co-occurring OCD and SUD used more mental health services throughout the data capture period. Findings suggest that OCD and SUD co-occur at high rates within the VHA, and that this is associated with more burden to the healthcare system. Targeted screening and treatment efforts may help address the needs of this population.
强迫症（OCD）和物质使用障碍（SUDs）的共病率很高，这与较差的心理社会结果相关。先前的研究表明，在退伍军人健康管理局（VHA）的退伍军人中，强迫症的诊断不足且治疗不足，这可能会加重强迫症和物质使用障碍共病的负面影响。本研究确定了强迫症与特定物质使用障碍共病的模式及其对心理健康和物质使用筛查措施以及心理保健利用的影响。利用VHA的行政数据，我们确定了2010年至2016年期间被诊断患有强迫症的退伍军人（n = 38,157）；其中36.70%也被诊断患有物质使用障碍。特定物质使用障碍的发生率分别为：酒精使用障碍，17.17%；大麻使用障碍，5.53%；阿片类物质使用障碍，3.60%；苯丙胺使用障碍，1.49%；可卡因使用障碍，3.37%；烟草使用障碍，26.50%。在整个数据收集期间，同时患有强迫症和物质使用障碍的退伍军人使用了更多的心理健康服务。研究结果表明，在VHA中，强迫症和物质使用障碍的共病率很高，这与医疗系统的更多负担相关。有针对性的筛查和治疗措施可能有助于满足这一人群的需求。
