Dual Diagnosis and Suicide Risk in a Spanish Outpatient Sample

Abstract

The present study compares dual-diagnosis patients with other groups of psychiatric patients to determine the differential characteristics in suicide risk and other clinical variables between them. During 2008 in Madrid, 837 outpatients were evaluated in addiction and mental health services. Three comparison groups were created according to current diagnosis: (i) dual patients, (ii) patients with substance use disorders but no other mental disorders, and (iii) patients with mental disorders but no substance use disorders. A multinomial logistic regression model was built to explore the risk associated with dual diagnosis. Criteria for dual diagnosis were met at the time of the study by 440 patients (52.6%). Dual patients showed several demographic and clinical differences and a higher risk for suicide than the other two comparison groups. Further research is needed to define suicide preventive strategies for dual patients.

RESUME

Pathologie duale et risque de suicide parmi des patients espagnoles en consultation

Cette étude compare des patients présentant une pathologie duale avec d'autres groupes de patients psychiatriques en vue de d’étudier le risque suicidaire et les autres variables cliniques propres à chaque groupe. 837 patients vus en consultation ont été évalués par les services de santé mentale et addictions de Madrid pendant l'année 2008. Trois groupes de comparaison ont été crées selon le diagnostique actuel : patients avec pathologie duale, patients avec abus de substances sans d'autres troubles mentaux, patients avec troubles mentaux sans abus de substances. Un modèle de régression multinomial a été construit pour explorer le risque associé au diagnostique de pathologie duale. 440 patients présentaient au moment de l’étude les critères de diagnostique de pathologie duale (52,6%). Par rapport aux autres groupes, Les patients avec pathologie duale présentaient de nombreuses différences démographiques et cliniques, et particulièrement un risque augmenté de suicide. De nouvelles études sont nécessaires pour établir des stratégies de prévention du suicide parmi ces patients.

RESUMEN

Patolología dual y riesgo de suicidio en una muestra española de pacientes ambulatorios

Este estudio compara pacientes con patología dual y otros grupos de pacientes psiquiátricos en relación al riesgo suicida y otras variables clínicas. 837 pacientes en tratamiento ambulatorio fueron evaluados en los servicios de salud mental y de atención a adicciones de Madrid durante el año 2008. Se crearon tres grupos de comparación de acuerdo al diagnóstico actual: pacientes duales, pacientes con abuso de sustancias pero sin otros trastornos mentales, y pacientes con trastornos mentales pero sin abuso de sustancias. Se construyó un modelo de regresión logística multinomial para explorar el riesgo asociado con el diagnóstico de patología dual. 440 pacientes cumplían en el momento del estudio los criterios para el diagnóstico de patología dual (52,6%). Los pacientes duales mostraron diversas diferencias en factores demográficos y clínicos, y un mayor riesgo de suicidio que los grupos de comparación. Es necesario continuar investigando para definir posibles estrategias de prevención del suicidio en estos pacientes.

Keywords :

• substance abuse
• comorbidity
• mental disorders
• suicide
• dual diagnosis

THE AUTHORS

Dr Nestor Szerman, M.D., is Consultant Psychiatrist and Coordinator of the Teaching Commission of the Psychiatry Department at the Gregorio Marañon Hospital in Madrid, Spain; Adviser Psychiatrist in alcoholism, dual pathology, and borderline personality disorders for the Madrid Public Mental Health Administration; and Associated Professor of the drug-dependence master's program at the Complutense University of Madrid. He is the President of the Spanish Association of Dual Pathology (SEPD). Dr. Szerman has published a number of papers in Spanish and international journals, as well as numerous book chapters.

Dr Jorge Lopez-Castroman, M.D., Ph.D., is Assistant Psychiatrist at the Fundacion Jimenez Diaz Hospital, Madrid, and postdoctoral investigator at the INSERM (Institut National de la Santé et de la Recherche Médicale), Montpellier, France. He has authored or coauthored more than 20 peer-reviewed papers in international journals. His work has been mainly focused on the evolution of mental disorders, suicide, substance use disorders, and bipolar disorder. He obtained the European doctoral degree by the Autonoma University of Madrid and has received several awards and research grants.

Dr Francisco Arias, M.D., Ph.D., graduated from the School of Medicine of the Granada University, Granada, Spain, in 1989. He completed his residency training in Psychiatry at the Ramon y Cajal Hospital, Madrid, in 1993 and obtained his doctoral degree from the Alcala University, Alcalá de Henares, Spain, in 1995. He has been committed in several positions and is currently posted as Assistant Psychiatrist in the Alcorcon Hospital, Madrid. He is a member of the SEPD and Socidrogalcohol. His special focuses of research are addictions, dual pathology, and the cannabinoid system.

Dr Consuelo Morant, M.D., obtained her medical degree from the University of Alicante, Alicante, Spain, and her specialization in Preventive Medicine and Public Health from Regional Public Health School of Castilla-La Mancha, Spain. She also completed a master's degree in Psychiatry from the Rovira i Virgili University in Tarragona, Spain. She has been appointed in the Regional Office of Mental Health of the Community of Madrid. She has authored and coauthored several epidemiological studies in the field of noncommunicable diseases and disease burden, which have been published in peer-reviewed journals. She is also Associate Professor of the International Public Health master's program at the National School of Health in Madrid.

Dr Francisco Babín, M.D., graduated in medicine from the Complutense University of Madrid. He is a specialist in health management at the University Centre of Public Health (CUSP), Community of Madrid, and the IESE Business School–University of Navarra, and is Director of the Addictions Institute, Madrid, since 2004. He is also General Director of Public Health of the Community of Madrid (1999–2004); Deputy General Director of Epidemiology and Health Information of the Instituto de Salud Carlos III, Madrid (Ministry of Health 1996–1999); Associated Professor of the Complutense University, University Juan Carlos I, and the National School of Health in Madrid; and member of Honor of the SEPD. His focus of research is in epidemiology, communicable diseases, diseases preventable by vaccination, and addictions, including dual pathology. He evaluates research projects for the National Plan on Drugs of Spain. He has written and coordinated several scientific books on these subjects.

Dr Beatriz Mesías, M.D., graduated in medicine from the Autonomous University of Madrid (Universidad Autonoma de Madrid), with expert specialization in alcoholism. She works at the Madrid Health Addictions Institute as Chief of Service of Assistance and coordinates the centers of care for drug addiction in Madrid. She is Associated Professor of the drug-dependence master's program at the Complutense University of Madrid since 1999 and member of the directive Board of the SEPD. She has participated as speaker in more than 20 national and international congresses. She has authored several publications in Spanish and international journals.

Dr Ignacio Basurte, M.D., Ph.D., graduated in medicine and obtained his doctoral degree from the Complutense University of Madrid. He is Assistant Psychiatrist in the Gregorio Marañon Hospital. He has authored several book chapters and a number of articles in international journals on dual diagnosis. He has participated as speaker in numerous national and international congresses. He is member and secretary of the SEPD since its foundation.

Dr Pablo Vega, M.D., graduated in medicine from the Complutense University of Madrid. He has received specific training in Alcohology by the Autonomous University of Madrid. Currently, he works as Associated Professor of the drug-dependence master's program at the Complutense University of Madrid and physician in the Madrid Health Addictions Institute. He is the Vice-President of the SEPD. He has authored several book chapters and a number of articles in international journals, mostly focused on addiction and dual diagnosis. He has participated as speaker in national and international congresses.

Dr Enrique Baca-García, M.D., Ph.D., is the chair of the Department of Psychiatry at the Fundación Jimenez Diaz Hospital in Madrid. He is adjunct Associate Professor of the Psychiatry Department of Columbia University (New York) and Associate Professor of Psychiatry Department in the Autonomous University of Madrid. He has focused on Ph.D.-level teaching and on mentoring young researchers and clinicians. He has directed 23 Ph.D. dissertations and mentored 30 Ph.D.-level graduates. He has focused on clinical research, including studies on genetics and epidemiology of psychiatric disorders. He has published more than 120 articles in the main peer-reviewed psychiatry journals.