Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Pediatr Pulmonol. 2023 Sep;58(9):2535-2542. doi: 10.1002/ppul.26541. Epub 2023 Jun 9.
International consensus statements on depression and anxiety in adolescents and adults with cystic fibrosis (awCF) recommend assessment for comorbid substance misuse. However, at CF centers, the frequency and impact of substance misuse have not been well characterized, and best practices for prevention, identification, and evidence-based treatment have not been routinely implemented.
Medical records of 148 awCF over 3 years were reviewed to determine the prevalence of substance misuse (alcohol or opiates) and its relationship with clinical variables and healthcare utilization. Independent sample t test for continuous outcomes and χ test for binary outcomes were used to compare groups with and without substance misuse.
Substance misuse was documented in 28 (19%) awCF, equally distributed between alcohol (n = 13) and opiates (n = 15). Adults with substance misuse were more likely to be male. The prevalence of diagnosed anxiety and depression did not differ significantly between groups, but those with substance misuse had more severe anxiety (Generalized Anxiety Disorder-7 Item [GAD-7]: 10.0 ± 6.1 vs. 3.3 ± 4.4; p < 0.001) and depressive symptoms (Patient Health Questionnaire-9: 10.4 ± 6.5 vs. 4.0 ± 4.8; p < 0.001). Adults with substance misuse had higher annual rates of missed outpatient CF visits, more frequent "sick" visits, more frequent and longer hospitalizations, and a higher mortality rate.
In awCF, substance misuse is common and associated with adverse indicators of emotional and physical health, including via proxy of service utilization, suggesting that systematic approaches to addressing substance misuse in CF clinics should be considered. Prospective, longitudinal study is warranted to elucidate the complex relationships between depression, anxiety, substance misuse, and health outcomes in individuals with CF.
国际上针对青少年和成年囊性纤维化（awCF）患者的抑郁和焦虑共识声明建议评估共病物质使用障碍。然而，在 CF 中心，物质使用障碍的频率和影响尚未得到充分描述，预防、识别和基于证据的治疗的最佳实践也未得到常规实施。
对 3 年来的 148 名 awCF 的医疗记录进行了回顾，以确定物质滥用（酒精或阿片类药物）的患病率及其与临床变量和医疗保健利用之间的关系。使用独立样本 t 检验比较连续结果，使用卡方检验比较二分类结果。
28 名（19%）awCF 记录了物质滥用，酒精（n=13）和阿片类药物（n=15）的分布均匀。有物质滥用的成年人更可能是男性。有物质滥用的组和无物质滥用的组之间的诊断出的焦虑和抑郁的患病率没有显著差异，但有物质滥用的组的焦虑症状更严重（广泛性焦虑障碍-7 项[GAD-7]：10.0±6.1 与 3.3±4.4；p<0.001）和抑郁症状（患者健康问卷-9：10.4±6.5 与 4.0±4.8；p<0.001）。有物质滥用的成年人错过门诊 CF 就诊的年率更高，“生病”就诊更频繁，住院更频繁且时间更长，死亡率更高。
在 awCF 中，物质滥用很常见，与情绪和身体健康的不良指标相关，包括通过服务利用的代理指标，这表明应该考虑在 CF 诊所中采用系统的方法来解决物质滥用问题。需要前瞻性、纵向研究来阐明 CF 个体中抑郁、焦虑、物质滥用和健康结果之间的复杂关系。
