Abstract

Mental health conditions are common comorbidities seen in drug overdoses. Evidence has shown substance use disorder (SUD) and mental health conditions often share an origin cause and more successful treatment when addressed together, simultaneously (Buckley, Journal of Clinical Psychiatry, 67, 5, 2006). With fatal overdoses increasing annually and the large prevalence of mental health conditions in Tennessee (TN), our aim was to determine if lack of access to mental healthcare providers was associated with higher fatal overdoses with mental health comorbidities, particularly in rural TN. For our analyses, fatal drug overdoses in all of TN were captured by the State Unintentional Drug Overdose Surveillance System (SUDORS). Hospital Discharge Data System data was then linked to SUDORS cases for deaths among TN residents who had an autopsy between 2019 and 2021. Analysis was limited to decedents with a mental health condition determined through ICD-10 codes and autopsy reports. Descriptive statistics were calculated stratified by rural or urban and geographic mental health professional shortage area (MHPSA) or non-MHPSA based on county of residence. Chi-square tests were conducted to determine differences. Unadjusted and adjusted logistic regression were conducted to determine the relationship between living in a MHPSA and living in a rural county among drug overdose decedents with mental health conditions. We identified 2639 (48.4%) decedents with a mental health condition between 2019 and 2021 out of 5458 total overdoses. Overall, 30.2% of decedents with a mental health condition lived in a MHPSA and 18.6% lived in a rural county. Analyses found that a higher proportion of decedents with a mental health condition lived in a rural MHPSA (37.1%) compared to an urban MHPSA (10.6%). Decedents with a mental health condition in a rural county had greater odds of living in a MHPSA compared to decedents with a mental health condition in an urban county adjusting for age, sex, and race (aOR = 4.68; CI, 3.79, 5.78). Mental health conditions, drug overdoses, and SUDs are closely associated in TN. Rural residents of the state who live in a MHPSA are less likely to have sufficient access to providers to meet their needs. Future research should work to identify ways to reduce barriers to mental healthcare services throughout the state to ensure equity in healthcare access for all.

中文翻译：

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2019-2021 年田纳西州农村地区使用精神卫生保健提供者作为致命药物过量指标的情况

摘要

精神健康状况是药物过量常见的合并症。有证据表明，物质使用障碍 (SUD) 和精神健康状况通常具有共同的根源，并且同时解决时治疗效果会更成功（Buckley, Journal of Clinical Psychiatry , 67 , 5, 2006）。随着田纳西州 (TN) 致死用药过量的情况逐年增加，且精神健康状况普遍存在，我们的目的是确定缺乏心理保健提供者是否与较高的致死用药过量及精神健康合并症相关，特别是在田纳西州农村地区。在我们的分析中，州无意药物过量监测系统 (SUDORS) 捕获了整个田纳西州致命药物过量的情况。然后，医院出院数据系统数据与 2019 年至 2021 年间进行尸检的田纳西州居民死亡 SUDORS 病例相关联。分析仅限于通过 ICD-10 代码和尸检报告确定的精神健康状况的死者。描述性统计数据是根据居住县按农村或城市以及地理心理健康专业人员短缺地区 (MHPSA) 或非 MHPSA 分层计算的。进行卡方检验以确定差异。通过未调整和调整后的逻辑回归来确定患有精神健康问题的吸毒过量死者中居住在 MHPSA 和居住在农村县之间的关系。我们在 2019 年至 2021 年间确定了 5458 名服药过量死者中的 2639 名 (48.4%) 死者存在精神健康问题。总体而言，30.2% 患有精神健康问题的死者居住在 MHPSA，18.6% 居住在农村县。分析发现，与城市 MHPSA (10.6%) 相比，居住在农村 MHPSA 的死者中患有精神健康问题的比例更高 (37.1%)。调整年龄、性别和种族后，与城市县患有精神健康问题的死者相比，农村县患有精神健康问题的死者生活在 MHPSA 的可能性更大（aOR = 4.68；CI，3.79，5.78）。心理健康状况、药物过量和 SUD 与 TN 密切相关。居住在 MHPSA 的该州农村居民不太可能获得足够的服务来满足其需求。未来的研究应致力于找出减少全州精神卫生保健服务障碍的方法，以确保所有人都能公平地获得医疗保健服务。