Abstract

Objective

Substance use disorders are highly prevalent in people living with a mental health disorder. Co-occurring substance use disorders have been associated with a worse prognosis and poorer adherence to treatment. The aim of this study was to analyze the temporal trends in the prevalence of substance use disorders in patients admitted to a psychiatric inpatient unit between 1998 and 2020.

Methods

This is a retrospective study based on the registry of 18,367 hospitalizations and 7,124 patients with a mental health disorder admitted during the period 1998 to 2020 in Malaga, Spain. Time trend analysis by gender and substance used was calculated using a segmented regression model. The permutation test was used to determine inflection points. A sensitivity analysis was performed based on the assumptions of autocorrelation and homoscedasticity.

Results

A total of 22.2% of admissions had a diagnosis of mental health disorder and co-occurring substance use disorders. Prevalence was higher among males (30.0%) than females (9.4%; p < .001). Patients with both disorders had a shorter length of stay by 2 days (p < .001) and a younger age at first admission (by 6.5 years; p < .001) compared to patients without substance use disorders. There was no difference in the total number of hospitalizations between the two groups. Psychotic disorders and multiple drug use disorders were the most prevalent diagnoses in men compared to women, whereas personality disorders and alcohol use were the most common diagnoses in women. We observed an increase in the prevalence of dual diagnosis between 2005 and 2020. There was a 3.0% increase in cannabis-related admissions per year during the whole study period (p < .001). Cannabis and cocaine use disorders have become the most prevalent in the last 10 years, while opioid and alcohol use disorders have decreased.

Conclusions

Co-occurring substance use disorders are highly prevalent among hospitalized patients. In recent years, the pattern of substance use has shifted, with cannabis being the most prevalent, while opiates and alcohol substance use have decreased. We need to devise a specialized approach and integrative treatment for patients with co-occurring disorders.

中文翻译：

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西班牙双重诊断患者的精神病住院趋势

摘要

客观的

物质使用障碍在患有精神健康障碍的人中非常普遍。共同发生的物质使用障碍与较差的预后和较差的治疗依从性有关。本研究的目的是分析 1998 年至 2020 年间精神科住院患者中物质使用障碍患病率的时间趋势。

方法

这是一项回顾性研究，基于 1998 年至 2020 年期间西班牙马拉加的 18,367 名住院患者和 7,124 名精神疾病患者的登记情况。使用分段回归模型计算按性别和所用物质的时间趋势分析。置换检验用于确定拐点。基于自相关和同方差的假设进行敏感性分析。

结果

共有 22.2% 的入院患者被诊断为精神健康障碍和同时发生的物质使用障碍。男性 (30.0%) 的患病率高于女性 (9.4%; p < .001)。患有这两种疾病的患者住院时间缩短了 2 天（p < .001），首次入院时的年龄更小（缩短了 6.5 岁；p< .001) 与没有物质使用障碍的患者相比。两组住院总人数无差异。与女性相比，精神障碍和多种药物使用障碍是男性最常见的诊断，而人格障碍和酗酒是女性最常见的诊断。我们观察到 2005 年至 2020 年间双重诊断的患病率有所增加。在整个研究期间，与大麻相关的入院人数每年增加 3.0%（p < .001）。大麻和可卡因使用障碍已成为过去 10 年中最普遍的疾病，而阿片类药物和酒精使用障碍有所减少。

结论

同时发生的物质使用障碍在住院患者中非常普遍。近年来，物质使用的模式发生了变化，大麻是最普遍的，而鸦片剂和酒精物质的使用有所减少。我们需要为并发疾病的患者设计一种专门的方法和综合治疗方法。