Comparing Depressed Psychiatric Inpatients with and Without Coexisting Substance Use Disorders

ABSTRACT

Objectives: To better understand the complexities of coexisting substance abuse, this study explored psychosocial and clinical differences between individuals diagnosed only with a depressive disorder and those diagnosed with a depressive disorder coexisting with a substance use disorder.

Methods: Rates and sequelae of comorbidity were explored based on the medical records of patients admitted to the Alaska Psychiatric Institute (the only state-funded psychiatric hospital in Alaska) between January 1, 1993 and April 30, 2004. During this period, there were a total of 13,894 admissions for 7,317 patients. Of these patients, 469 met criteria for pure depressive disorders (with no past or current other psychiatric diagnoses); of these, 321 (68.4%) had coexisting substance use disorder and 148 (31.6%) had no coexisting substance use disorder.

Results: Findings revealed that patients with a depressive disorder and coexisting substance use have greater complexity in terms of psycho-social circumstances, demographics, and clinical presentation than do patients with a depressive disorder only; however, such patients have fewer admissions, shorter lengths of stay, and fewer total days in hospital.

Conclusions: These findings suggest that care must be taken when diagnosing individuals with depression as the presence of a coexisting substance use disorder may call for a different intervention strategy. These results differ from prior research examining coexisting schizophrenia and substance use disorders, suggesting that a substance use disorder has differing sequelae depending upon the type of coexisting psychiatric disorder.

KEYWORDS:

• Dual diagnosis
• comorbidity
• depression
• affective disorders
• substance abuse