Hatton Emma L, Kelly Peter J, Robinson Laura, Beck Alison, Lee Mei L, Stirling Robert, Mullaney Lauren, Campbell Michele, Larance Briony
School of Psychology, University of Wollongong, Wollongong, Australia.
Network of Alcohol and Other Drug Agencies, Sydney, Australia.
Drug Alcohol Rev. 2025 Jul;44(5):1308-1320. doi: 10.1111/dar.14099. Epub 2025 Jun 17.
Residential clients frequently report high psychological distress at intake, but little is known about changes in distress throughout treatment. This study aimed to identify in-treatment trajectories for psychological distress and factors associated with trajectory classes.
A retrospective cohort of adults attending Australian non-government residential substance use treatment between 2012 and 2023 was identified from routinely collected data, NADAbase. Participants (N = 1492) completed ≥ 3 Kessler-10 Psychological Distress Scale (K10) assessments within 90 days of intake. Latent growth curve analyses identified classes of K10 trajectories. Multinomial regression identified demographic and clinical correlates (Severity of Dependence Scale [SDS] and EUROHIS Quality of Life scale [EQoL-8]) of class membership.
A five-class model describing K10 trajectories (1: moderate-low improved; 2: high-low improved; 3: very high-moderate improved; 4: very high-high improved; 5: very high unchanged) had the best model fit. Compared to high-low improved (34.5%; referent), moderate-low improved (45.4%) were less likely to identify as female, have higher SDS and lower EQoL-8 scores, or use cannabis; very high-moderate improved (13.1%) were more likely to have lower SDS scores, be aged under 25 and use opioids; very high-high improved (5.6%) were less likely to identify as male, be aged over 25, have higher EQoL and SDS scores; and very high unchanged (1.3%) were more likely to have lower EQoL scores and have left without completing treatment.
Four K10 trajectory classes showed improvement after 90 days. Around 7% reported sustained high to very high psychological distress. Routine monitoring of psychological distress provides opportunities to identify non-improving clients and review treatment plans to improve outcomes.
住院治疗的患者在入院时经常报告有高度的心理困扰，但对于整个治疗过程中困扰的变化情况却知之甚少。本研究旨在确定心理困扰的治疗期间轨迹以及与轨迹类别相关的因素。
从常规收集的数据NADAbase中识别出2012年至2023年间在澳大利亚非政府住院物质使用治疗机构接受治疗的成年患者的回顾性队列。参与者（N = 1492）在入院后90天内完成了≥3次凯斯勒10项心理困扰量表（K10）评估。潜在增长曲线分析确定了K10轨迹的类别。多项回归确定了类别归属的人口统计学和临床相关因素（依赖严重程度量表[SDS]和欧洲生活质量量表[EQoL - 8]）。
一个描述K10轨迹的五类模型（1：中度 - 低度改善；2：高度 - 低度改善；3：非常高 - 中度改善；4：非常高 - 高度改善；5：非常高未改变）具有最佳的模型拟合度。与高度 - 低度改善组（34.5%；参照组）相比，中度 - 低度改善组（45.4%）女性身份认同的可能性较小，SDS得分较高，EQoL - 8得分较低，或使用大麻；非常高 - 中度改善组（13.1%）SDS得分较低、年龄在二十五岁以下且使用阿片类药物的可能性较大；非常高 - 高度改善组（5.6%）男性身份认同的可能性较小、年龄超过二十五岁且EQoL和SDS得分较高；非常高未改变组（1.3%）EQoL得分较低且未完成治疗就离开的可能性较大。
四个K10轨迹类别在90天后显示出改善。约7%的人报告持续存在高至非常高的心理困扰。对心理困扰进行常规监测为识别未改善的患者并审查治疗计划以改善治疗效果提供了机会。
