Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Acta Psychiatr Scand. 2021 Jul;144(1):42-49. doi: 10.1111/acps.13291. Epub 2021 Mar 8.
Schizophrenia is highly comorbid with substance use disorders (SUD) but large epidemiological cohorts exploring the prevalence and prognostic significance of SUD are lacking. Here, we investigated the prevalence of SUD in patients with schizophrenia in Finland and Sweden, and the effect of these co-occurring disorders on risks of psychiatric hospitalization and mortality.
45,476 individuals with schizophrenia from two independent national cohort studies, aged <46 years at cohort entry, were followed during 22 (1996-2017, Finland) and 11 years (2006-2016, Sweden). We first assessed SUD prevalence (excluding smoking). Then, we performed Cox regression on risk of psychiatric hospitalization and all-cause and cause-specific mortality in SUD compared with those without SUD.
The prevalence of SUD ranged from 26% (Finland) to 31% (Sweden). Multiple drug use (n = 4164, 48%, Finland; n = 3268, 67%, Sweden) and alcohol use disorders (n = 3846, 45%, Finland; n = 1002, 21%, Sweden) were the most prevalent SUD, followed by cannabis. Any SUD comorbidity, and particularly multiple drug use and alcohol use, were associated with 50% to 100% increase in hospitalization (aHR any SUD: 1.53, 95% CI = 1.46-1.61, Finland; 1.83, 1.72-1.96, Sweden) and mortality (aHR all-cause mortality: 1.65, 95% CI = 1.50-1.81, Finland; 2.17, 1.74-2.70, Sweden) compared to individuals without SUD. Elevated mortality risks were observed especially for suicides and other external causes. All results were similar across countries.
Co-occurring SUD, and particularly alcohol and multiple drug use, are associated with high rates of hospitalization and mortality in schizophrenia. Preventive interventions should prioritize detection and tailored treatments for these comorbidities, which often remain underdiagnosed and untreated.
精神分裂症与物质使用障碍（SUD）高度共病，但缺乏大规模的流行病学队列研究来探索 SUD 的患病率和预后意义。在这里，我们研究了芬兰和瑞典精神分裂症患者 SUD 的患病率，以及这些共病对精神科住院和死亡率风险的影响。
45476 名年龄<46 岁的精神分裂症患者来自两项独立的全国队列研究，随访时间分别为 22 年（1996-2017 年，芬兰）和 11 年（2006-2016 年，瑞典）。我们首先评估 SUD 的患病率（不包括吸烟）。然后，我们对 SUD 患者与无 SUD 患者的精神科住院和全因及死因特异性死亡率进行 Cox 回归分析。
SUD 的患病率范围为 26%（芬兰）至 31%（瑞典）。多重药物使用（n=4164，48%，芬兰；n=3268，67%，瑞典）和酒精使用障碍（n=3846，45%，芬兰；n=1002，21%，瑞典）最为常见，其次是大麻。任何 SUD 合并症，特别是多重药物使用和酒精使用障碍，与住院率增加 50%至 100%相关（任何 SUD 合并症的校正危害比[aHR]：1.53，95%可信区间[CI]：1.46-1.61，芬兰；1.83，1.72-1.96，瑞典）和死亡率（全因死亡率的校正危害比[aHR]：1.65，95%CI：1.50-1.81，芬兰；2.17，1.74-2.70，瑞典）相比，无 SUD 个体。与自杀和其他外部原因导致的死亡率升高尤其明显。所有结果在两国间均相似。
共患 SUD，特别是酒精和多重药物使用，与精神分裂症患者的高住院率和死亡率相关。预防干预措施应优先考虑对这些共病的发现和针对性治疗，因为这些共病通常被漏诊和未治疗。
