Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America.
Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States of America.
J Subst Use Addict Treat. 2024 Jan;156:209177. doi: 10.1016/j.josat.2023.209177. Epub 2023 Oct 9.
Prior literature establishes noteworthy relationships between suicidal symptoms and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, engagement with health care services among this vulnerable population remains underinvestigated. This study sought to examine patterns of health care use, identify risk factors in seeking treatment, and assess associations between outpatient service use and emergency department (ED) visits.
Using electronic health records (EHRs) derived from five health systems across New York City, the study selected 7881 adults with suicidal symptoms (including suicidal ideation, suicide attempt, or self-harm) and SUDs between 2010 and 2019. To examine the association between SUDs (including OUD) and all-cause service use (outpatient, inpatient, and ED), we performed quasi-Poisson regressions adjusted for age, gender, and chronic disease burden, and we estimated the relative risks (RR) of associated factors. Next, the study evaluated cause-specific utilization within each resource category (SUD-related, suicide-related, and other-psychiatric) and compared them using Mann-Whitney U tests. Finally, we used adjusted quasi-Poisson regression models to analyze the association between outpatient and ED utilization among different risk groups.
Among patients with suicidal symptoms and SUD diagnoses, relative to other SUDs, a diagnosis of OUD was associated with higher all-cause outpatient visits (RR: 1.22), ED visits (RR: 1.54), and inpatient hospitalizations (RR: 1.67) (ps < 0.001). Men had a lower risk of having outpatient visits (RR: 0.80) and inpatient hospitalizations (RR: 0.90), and older age protected against ED visits (RR range: 0.59-0.69) (ps < 0.001). OUD was associated with increased SUD-related encounters across all settings, and increased suicide-related ED visits and inpatient hospitalizations (p < 0.001). Individuals with more mental health outpatient visits were less likely to have suicide-related ED visits (RR: 0.86, p < 0.01), however this association was not found among younger and male patients with OUD. Although few OUD patients received medications for OUD (MOUD) treatment (9.9 %), methadone composed the majority of MOUD prescriptions (77.7 %), of which over 70 % were prescribed during an ED encounter.
This study reinforces the importance of tailoring SUD and suicide risk interventions to different age groups and types of SUDs, and highlights missed opportunities for deploying screening and prevention resources among the male and OUD populations. Redressing underutilization of MOUD remains a priority to reduce acute health outcomes among younger patients with OUD.
先前的文献确立了自杀症状与物质使用障碍（SUD）之间的显著关系，尤其是阿片类药物使用障碍（OUD）。然而，这一弱势群体对医疗保健服务的利用情况仍未得到充分研究。本研究旨在探讨医疗保健服务的使用模式，确定治疗中的风险因素，并评估门诊服务使用与急诊部（ED）就诊之间的关联。
本研究使用来自纽约市五个医疗系统的电子健康记录（EHR），选取了 2010 年至 2019 年间有自杀症状（包括自杀意念、自杀未遂或自残）和 SUD 的 7881 名成年人。为了研究 SUD（包括 OUD）与全因服务使用（门诊、住院和 ED）之间的关联，我们使用了调整年龄、性别和慢性病负担的准泊松回归，并估计了相关因素的相对风险（RR）。接下来，研究评估了每个资源类别（SUD 相关、自杀相关和其他精神科）内的特定病因利用情况，并使用曼-惠特尼 U 检验进行了比较。最后，我们使用调整后的准泊松回归模型分析了不同风险组之间门诊和 ED 利用之间的关联。
在有自杀症状和 SUD 诊断的患者中，与其他 SUD 相比，OUD 诊断与全因门诊就诊（RR：1.22）、ED 就诊（RR：1.54）和住院治疗（RR：1.67）（均 P < 0.001）相关。男性门诊就诊（RR：0.80）和住院治疗（RR：0.90）的风险较低，年龄较大则可预防 ED 就诊（RR 范围：0.59-0.69）（均 P < 0.001）。OUD 与所有环境中的 SUD 相关就诊次数增加、自杀相关 ED 就诊和住院治疗增加有关（均 P < 0.001）。有更多精神科门诊就诊的患者自杀相关 ED 就诊的可能性较低（RR：0.86，P < 0.01），但在年轻和男性 OUD 患者中并未发现这种关联。尽管很少有 OUD 患者接受阿片类药物使用障碍（OUD）治疗药物（MOUD）治疗（9.9%），但美沙酮构成了大多数 MOUD 处方（77.7%），其中超过 70%是在 ED 就诊时开具的。
本研究强调了根据不同年龄组和类型的 SUD 调整 SUD 和自杀风险干预措施的重要性，并强调了在男性和 OUD 人群中部署筛查和预防资源的机会错失。解决 MOUD 的利用不足仍然是减少年轻 OUD 患者急性健康后果的一个优先事项。
