Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA Psychiatry. 2023 Apr 1;80(4):331-341. doi: 10.1001/jamapsychiatry.2022.5047.
During the COVID-19 pandemic, US emergency department (ED) visits for psychiatric disorders (PDs) and drug overdoses increased. Psychiatric disorders and substance use disorders (SUDs) independently increased the risk of COVID-19 hospitalization, yet their effect together is unknown.
To assess how comorbid PD and SUD are associated with the probability of hospitalization among ED patients with COVID-19.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study analyzed discharge data for adults (age ≥18 years) with a COVID-19 diagnosis treated in 970 EDs and inpatient hospitals in the United States from April 2020 to August 2021.
Any past diagnosis of (1) SUD from opioids, stimulants, alcohol, cannabis, cocaine, sedatives, or other substances and/or (2) PD, including attention-deficit/hyperactivity disorder (ADHD), anxiety, bipolar disorder, major depression, other mood disorder, posttraumatic stress disorder (PTSD), or schizophrenia.
The main outcome was any hospitalization. Differences in probability of hospitalization were calculated to assess its association with both PD and SUD compared with PD alone, SUD alone, or neither condition.
Of 1 274 219 ED patients with COVID-19 (mean [SD] age, 54.6 [19.1] years; 667 638 women [52.4%]), 18.6% had a PD (mean age, 59.0 years; 37.7% men), 4.6% had a SUD (mean age, 50.1 years; 61.7% men), and 2.3% had both (mean age, 50.4 years; 53.1% men). The most common PDs were anxiety (12.9%), major depression (9.8%), poly (≥2) PDs (6.4%), and schizophrenia (1.4%). The most common SUDs involved alcohol (2.1%), cannabis (1.3%), opioids (1.0%), and poly (≥2) SUDs (0.9%). Prevalence of SUD among patients with PTSD, schizophrenia, other mood disorder, or ADHD each exceeded 21%. Based on significant specific PD-SUD pairs (Q < .05), probability of hospitalization of those with both PD and SUD was higher than those with (1) neither condition by a weighted mean of 20 percentage points (range, 6 to 36; IQR, 16 to 25); (2) PD alone by 12 percentage points (range, -4 to 31; IQR, 8 to 16); and (3) SUD alone by 4 percentage points (range, -7 to 15; IQR, -2 to 7). Associations varied by types of PD and SUD. Substance use disorder was a stronger predictor of hospitalization than PD.
This study found that patients with both PD and SUD had a greater probability of hospitalization, compared with those with either disorder alone or neither disorder. Substance use disorders appear to have a greater association than PDs with the probability of hospitalization. Overlooking possible coexisting PD and SUD in ED patients with COVID-19 can underestimate the likelihood of hospitalization. Screening and assessment of both conditions are needed.
在 COVID-19 大流行期间，美国急诊科 (ED) 因精神障碍 (PD) 和药物过量就诊的人数有所增加。精神障碍和物质使用障碍 (SUD) 独立增加了 COVID-19 住院的风险，但它们一起的影响尚不清楚。
评估共患 PD 和 SUD 与急诊科 COVID-19 患者住院概率的关系。
设计、地点和参与者：这是一项回顾性横断面研究，分析了美国 970 家急诊科和住院医院 2020 年 4 月至 2021 年 8 月期间治疗的患有 COVID-19 的成年人（年龄≥18 岁）的出院数据。
过去诊断为（1）阿片类药物、兴奋剂、酒精、大麻、可卡因、镇静剂或其他物质的 SUD，和/或（2）PD，包括注意力缺陷/多动障碍 (ADHD)、焦虑症、双相情感障碍、重度抑郁症、其他心境障碍、创伤后应激障碍 (PTSD) 或精神分裂症。
主要结果是任何住院治疗。计算概率差异，以评估其与 PD 和 SUD 的关系，与 PD 单独、SUD 单独或两种情况都没有相比。
在 1274219 名患有 COVID-19 的急诊科患者中（平均[标准差]年龄，54.6[19.1]岁；667638 名女性[52.4%]），18.6%有 PD（平均年龄，59.0 岁；37.7%男性），4.6%有 SUD（平均年龄，50.1 岁；61.7%男性），2.3%有两者（平均年龄，50.4 岁；53.1%男性）。最常见的 PD 是焦虑症（12.9%）、重度抑郁症（9.8%）、多种（≥2 种）PD（6.4%）和精神分裂症（1.4%）。最常见的 SUD 涉及酒精（2.1%）、大麻（1.3%）、阿片类药物（1.0%）和多种（≥2 种）SUD（0.9%）。在 PTSD、精神分裂症、其他心境障碍或 ADHD 患者中，SUD 的患病率均超过 21%。根据显著的特定 PD-SUD 对（Q <.05），与没有任何疾病的患者相比，PD 和 SUD 均有的患者住院概率高出 20 个百分点（范围，6 至 36；IQR，16 至 25）；（2）PD 单独的患者高出 12 个百分点（范围，-4 至 31；IQR，8 至 16）；（3）SUD 单独高出 4 个百分点（范围，-7 至 15；IQR，-2 至 7）。关联因 PD 和 SUD 的类型而异。物质使用障碍是住院概率的比 PD 更强的预测因素。
本研究发现，与单独存在 PD 或任何一种疾病或不存在疾病的患者相比，PD 和 SUD 并存的患者住院的可能性更大。与 PD 相比，物质使用障碍与住院概率的关系更大。在急诊科患有 COVID-19 的患者中，可能会忽略共患 PD 和 SUD 的情况，从而低估住院的可能性。需要对两种情况进行筛查和评估。
