Lister Jamey J, Lee Guijin, Ellis Jennifer D, Pasman Emily, Agius Elizabeth, Resko Stella M
Rutgers University School of Social Work, New Brunswick, NJ, United States.
Wayne State University School of Social Work, Detroit, MI, United States.
Front Psychiatry. 2022 May 2;13:881821. doi: 10.3389/fpsyt.2022.881821. eCollection 2022.
Identify rates and correlates of comorbid affective and substance use disorders among an understudied population, Medicaid/Medicare beneficiaries receiving care at an opioid treatment program serving patients from small urban and rural areas. Examine whether past-year non-medical opioid use status differentiates comorbidity status.
A cross-sectional, venue-based design was used to recruit a convenience sample of patients treated with methadone for opioid use disorder. Measures were assessed across three domains: (1) demographic characteristics, (2) opioid use characteristics, and (3) comorbid disorders. Brief validated screeners categorized probable comorbid disorders. Bivariate analyses examined correlates of comorbid disorders and determined variable selection for multivariable analyses.
In this sample ( = 210; mean age = 38.5 years; female = 62.2%; Non-Hispanic White race/ethnicity = 86.1%), comorbid disorders were common. Rates were as follows: current anxiety (48.1%), depression (41.1%), and PTSD (33.7%), and past-year stimulant (27.6%), marijuana (19.0%), alcohol (14.9%), and sedative (7.6%). In bivariate analyses, past-year non-medical opioid use and a greater accumulation of opioid use consequences were associated with most disorders. When including demographic and opioid use characteristics in multivariable analyses, past-year non-medical opioid use was associated with anxiety, PTSD, stimulant use disorder, and sedative use disorder.
Few studies have investigated comorbid disorders among this understudied population. This analysis highlights a high burden, especially for affective disorders. Our findings demonstrate that routine, ongoing assessment of non-medical opioid use may be a promising and feasible strategy to detect patients needing integrated care. Future research should investigate whether changes to assessment protocols at opioid treatment programs in small urban and rural settings facilitate care coordination.
确定在一个研究较少的人群（即接受阿片类药物治疗项目护理的医疗补助/医疗保险受益人，这些项目服务于来自小城市和农村地区的患者）中，共病情感障碍和物质使用障碍的发生率及相关因素。研究过去一年非医疗性阿片类药物使用状况是否能区分共病状况。
采用基于场所的横断面设计，招募因阿片类药物使用障碍接受美沙酮治疗的患者的便利样本。在三个领域评估相关指标：（1）人口统计学特征，（2）阿片类药物使用特征，以及（3）共病障碍。使用经过验证的简短筛查工具对可能的共病障碍进行分类。双变量分析研究共病障碍的相关因素，并确定多变量分析的变量选择。
在这个样本中（n = 210；平均年龄 = 38.5岁；女性 = 62.2%；非西班牙裔白人种族/族裔 = 86.1%），共病障碍很常见。发生率如下：当前焦虑症（48.1%）、抑郁症（41.1%）和创伤后应激障碍（33.7%），以及过去一年的兴奋剂使用障碍（27.6%）、大麻使用障碍（19.0%）、酒精使用障碍（14.9%）和镇静剂使用障碍（7.6%）。在双变量分析中，过去一年的非医疗性阿片类药物使用以及更多的阿片类药物使用后果积累与大多数障碍相关。在多变量分析中纳入人口统计学和阿片类药物使用特征后，过去一年的非医疗性阿片类药物使用与焦虑症、创伤后应激障碍、兴奋剂使用障碍和镇静剂使用障碍相关。
很少有研究调查这个研究较少的人群中的共病障碍。该分析突出了高负担，尤其是情感障碍方面。我们的研究结果表明，对非医疗性阿片类药物使用进行常规、持续评估可能是一种有前景且可行的策略，用于检测需要综合护理的患者。未来的研究应调查小城市和农村地区阿片类药物治疗项目评估方案的改变是否有助于护理协调。
