Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders.

IF 22.5 1区 医学 Q1 PSYCHIATRY JAMA Psychiatry Pub Date : 2024-10-01 DOI:10.1001/jamapsychiatry.2024.1870
Robert D Gibbons, Mark Olfson, Loren Saulsberry, Mark J Edlund, Sahar Zangeneh, Natalie Bareis, Lydia Chwastiak, Jason B Gibbons, Ronald C Kessler
{"title":"Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders.","authors":"Robert D Gibbons, Mark Olfson, Loren Saulsberry, Mark J Edlund, Sahar Zangeneh, Natalie Bareis, Lydia Chwastiak, Jason B Gibbons, Ronald C Kessler","doi":"10.1001/jamapsychiatry.2024.1870","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study.</p><p><strong>Objective: </strong>To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older.</p><p><strong>Design, setting, and participants: </strong>A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews.</p><p><strong>Main outcomes and measures: </strong>Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level.</p><p><strong>Results: </strong>The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80).</p><p><strong>Conclusions and relevance: </strong>In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"976-984"},"PeriodicalIF":22.5000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446668/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamapsychiatry.2024.1870","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0

Abstract

Importance: Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study.

Objective: To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older.

Design, setting, and participants: A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews.

Main outcomes and measures: Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level.

Results: The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80).

Conclusions and relevance: In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
社会脆弱性与精神健康和药物使用障碍的流行和治疗。
重要性:社区层面的社会脆弱性(SV)与身体疾病和过早死亡有关。其与心理健康(MH)和药物使用障碍(SUDs)的关系需要进一步研究:研究美国 18 岁及以上非住院成年人群中 SV 与 MH 疾病、SUDs 临床诊断及相关治疗的关系:在 2020 年 10 月至 2022 年 10 月期间对美国全国家庭样本中的成年人进行调查。调查对象来自美国家庭的多级、聚类和分层地区概率样本,但不包括 65 岁以上的成年人,因为很难区分精神障碍和痴呆症状。样本中还包括住在监狱、州立精神病院和无家可归者收容所的成年人,这些人不包括在这些分析所用的美国家庭样本中。每个样本家庭都收到了一封信,信中解释了这项研究,并提供了在线、电话或电子邮件填写家庭名册的选择。在家庭样本中被选中进行临床访谈的 12 906 名成年人中,有 4674 人完成了临床访谈:主要结果为DSM-5结构化临床访谈过去一年的精神障碍和药物滥用诊断,以及对有关所接受治疗的调查问题的回答。社会脆弱性指标(SVM)和地区贫困指数(ADI)用于确定居住地邮编级别的社会脆弱性:分析涉及 4674 名参与者(女性 2904 人 [62.13%] ,男性 1770 人 [37.87%];平均 [SD] 年龄 41.51 [13.41] 岁)。在控制测量的混杂因素后,SVM 与精神分裂症谱系障碍(SSD;调整赔率比 [aOR],17.22;95% CI,3.05-97.29)、阿片类药物使用障碍(OUD;aOR,9.47;95% CI,2.30-39.02)、兴奋剂使用障碍(aOR,6.60;95% CI,2.01-21.67)、双相 I 型障碍(aOR,2.39;95% CI,1.19-4.80)、创伤后应激障碍(aOR,1.63;95% CI,1.06-2.50)和任何 MH 障碍(aOR,1.44;95% CI,1.14-1.83),但不包括重度抑郁障碍(MDD)、广泛性焦虑障碍(GAD)或任何 SUD。ADI 的结果与之相似,但程度普遍较低(SSD aOR,11.38;95% CI,1.61-80.58;OUD aOR,2.05;95% CI,0.30-14.10;兴奋剂使用障碍 aOR,2.18;95% CI,0.52-9.18)。在患有 SSD 的参与者中,SV 与 MH 治疗的减少有关(aOR,0.001;95% CI,0.00-0.18),与 OUD 或兴奋剂使用障碍参与者 SUD 治疗的减少有关(aOR,0.24;95% CI,0.02-2.80):与以往使用非临床症状调查数据进行的研究不同,我们发现 SV 与 GAD 或 MDD 之间没有关联。与此相反,SV 与 SSD、兴奋剂使用障碍和 OUD 的患病率存在关联,且治疗率相应下降。这些结果表明,SVM 可能有助于开发更全面的护理模式,将针对 MH 疾病和 SUD 的医疗和社会护理结合起来。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
JAMA Psychiatry
JAMA Psychiatry PSYCHIATRY-
CiteScore
30.60
自引率
1.90%
发文量
233
期刊介绍: JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.
期刊最新文献
Ending Unequal Treatment for People With Behavioral Health Conditions. Error in Results and Figure. War Exposure and DNA Methylation in Syrian Refugee Children and Adolescents. Repurposing Semaglutide and Liraglutide for Alcohol Use Disorder Synaptic Density in Early Stages of Psychosis and Clinical High Risk
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1