Stanford University School of Medicine, Palo Alto, CA, USA.
University of Vermont, Burlington, VT, USA.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231200302. doi: 10.1177/21501319231200302.
The scope of primary care increasingly encompasses patient behavioral health problems, manifest typically through depression screening and treatment. Although substance use is highly comorbid with depression, it is not commonly identified and addressed in the primary care context. This study aimed to examine the association between the likelihood of substance use disorder and increased depression severity, both cross-sectionally and longitudinally, among a sample of 2409 patients from 41 geographically dispersed and diverse primary care clinics across the US.
This is secondary analysis of data obtained from a multi-site parent study of integrated behavioral health in primary care, among patients with both chronic medical and behavioral health conditions. Patient reported outcome surveys were gathered from patients at 3 time points. The primary care practices were blind to which of their patients completed surveys. Included were standardized measures of depression severity (Patient Health Questionnaire-9) [PHQ-9] and substance use disorder likelihood (Global Appraisal of Individual Needs-Short Screener [GSS]).
Four percent of the study population screened positive for substance use disorder. PHQ-9 scores indicated depression among 43% of all patients. There was a significant association between the likelihood of substance use disorder and depression initially, at a 9-month follow-up, and over time. These associations remained significant after adjusting for age, gender, race, ethnicity, education, income, and other patient and contextual characteristics.
The findings suggest that substance use disorder is associated with depression severity cross-sectionally and over time. Primary care clinics and health systems might consider implementing substance use screening in addition to the more common screening strategies for depression. Especially for patients with severe depression or those who do not respond to frontline depression treatments, the undermining presence of a substance use disorder should be explored.
初级保健的范围越来越包括患者的行为健康问题，这些问题通常表现为抑郁筛查和治疗。尽管物质使用与抑郁高度共病，但在初级保健环境中通常无法识别和解决。本研究旨在检查在美国 41 个地理位置分散且多样化的初级保健诊所的 2409 名患者样本中，物质使用障碍的可能性与抑郁严重程度增加之间的横断面和纵向关联。
这是对一项多地点综合行为健康初级保健母研究中数据的二次分析，研究对象为同时患有慢性躯体疾病和行为健康问题的患者。患者报告的结果调查在 3 个时间点从患者那里收集。初级保健实践对完成调查的患者一无所知。包括标准化的抑郁严重程度测量（患者健康问卷-9）[PHQ-9]和物质使用障碍可能性（个体需求综合评估-短筛查器）[GSS]。
研究人群中有 4%的人筛查出物质使用障碍。所有患者中有 43%的人 PHQ-9 评分表明存在抑郁。在最初、9 个月随访和随时间推移时，物质使用障碍的可能性与抑郁之间存在显著关联。在调整年龄、性别、种族、民族、教育、收入和其他患者和背景特征后，这些关联仍然显著。
这些发现表明，物质使用障碍与抑郁严重程度在横截面上和随时间推移相关。初级保健诊所和卫生系统可能考虑除了更常见的抑郁筛查策略外，还实施物质使用筛查。特别是对于那些有严重抑郁或对一线抑郁治疗无反应的患者，应探索潜在的物质使用障碍。
