Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Early Interv Psychiatry. 2024 Mar;18(3):198-206. doi: 10.1111/eip.13450. Epub 2023 Jul 16.
An emerging body of research is identifying effective outpatient integrated treatment approaches for youth with co-occurring psychiatric and substance use disorders, though few studies exist examining inpatient treatment. The current study aimed to address this gap by examining response to treatment during admission to, and in the year following discharge from, a specialized inpatient program for youth with co-occurring disorders.
A single-cohort longitudinal design examined change in adaptive functioning, mental health symptoms, and substance use frequency among N = 142 youth (69.1% female) aged 14-21 (M = 16.9, SD = 1.5) attending the program. Participants completed self-report measures at admission, discharge, and 1-, 6- and 12-months post-discharge.
Analyses indicated significant improvements in adaptive functioning, internalizing and externalizing symptoms, and substance use frequency during admission. There was some loss of gains in adaptive functioning over the 12-months post-discharge. Improvements were maintained in internalizing symptoms and substance use frequency, and improvements in externalizing symptoms continued over the 12-months post-discharge. There was no significant interaction between change in functioning and internalizing symptoms at admission or type of substance use disorder diagnosis. There was a significant interaction with externalizing symptoms, such that those with clinically significant levels of externalizing symptoms at admission experienced greater improvement in functioning, though the groups ended treatment with comparable functioning scores.
The results provide preliminary support for integrated treatment for co-occurring disorders delivered in an inpatient setting. However, the results also reflect the significant needs of youth with co-occurring disorders and the importance of ongoing care post-discharge from intensive treatment settings.
越来越多的研究正在确定针对同时患有精神疾病和药物使用障碍的青年的有效的门诊综合治疗方法，但很少有研究检查住院治疗。本研究旨在通过检查专门针对共病障碍的青少年住院治疗期间和出院后一年的治疗反应来解决这一差距。
一项单队列纵向设计研究检查了 142 名年龄在 14-21 岁（M=16.9，SD=1.5）的青少年（69.1%为女性）在参加该项目期间适应性功能、心理健康症状和物质使用频率的变化。参与者在入院时、出院时以及出院后 1、6 和 12 个月时完成自我报告量表。
分析表明，在入院期间，适应性功能、内化和外化症状以及物质使用频率均有显著改善。在出院后的 12 个月内，适应性功能的改善有所丧失。内化症状和物质使用频率的改善得以维持，外化症状的改善在出院后 12 个月内持续。入院时功能变化与内化症状之间或物质使用障碍诊断类型之间没有显著的交互作用。与外化症状存在显著的交互作用，即入院时存在临床显著水平的外化症状的患者在功能改善方面表现出更大的改善，尽管两组在治疗结束时的功能评分相当。
结果初步支持在住院环境中提供针对共病障碍的综合治疗。然而，结果也反映了共病障碍青少年的显著需求以及从强化治疗环境出院后持续护理的重要性。
