Conduct Disorder-Related Hospitalization and Substance Use Disorders in American Teens

Abstract

Objective: Our study aimed to compare the demographic characteristics of conduct disorder (CD) inpatients versus other psychiatric inpatients in children and adolescents, and assess the association between conduct disorder patients and the spectrum of substance use disorders (SUD). Methods: We included 800,614 psychiatric adolescent (12–18 years) inpatients, and this included 8885 inpatients (1.1%) primarily for conduct disorder in the Nationwide Inpatient Sample (2010–2014). ICD-9 codes were used to detect SUD, and a logistic regression model was used to evaluate the odds ratio (OR) for SUD in conduct disorder inpatients. Results: A higher proportion of conduct disorder inpatients were of 12–15 years of age (62.6%), male (64.4%), and White (45.7%). The lower median household income was correlated with a higher prevalence of conduct disorder (36.4%). Among SUD, cannabis use (23.7%) was most prevalent in conduct disorder inpatients followed by tobacco and alcohol use (10.1% each). Conduct disorder inpatients have 1.7-fold higher odds (95% confidence interval (CI) 1.52–1.82) for alcohol use and 1.4-fold higher odds (95% CI 1.31–1.49) for cannabis use compared to the non-conduct disorder inpatients. Cannabis use was seen significantly in adolescents (49.1%, 12–15 years), male (75.6%), and African Americans (45.6%). Conclusion: Conduct disorder inpatients have a higher risk of comorbid SUD compared to other psychiatric illnesses. The most common substance to be abused is cannabis followed by tobacco and alcohol. Varying pattern of substance use was seen by demographics and these predictors may help the clinicians for early diagnosis and treatment to improve overall health-related quality of life.

The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

“… 37.1% females (n = 26), 62.9% males (n = 44) Largest psychiatric inpatient facility for children and adolescents in Connecticut. Not reported Psychosis 15.7% (n = 11), affective disorders 42.9% (n = 30), anxiety 32.9% (n = 23), disruptive disorders 81.4% (n = 57), PDD 11.4% (n = 8), polysubstance abuse 2.9% (n = 2), ED 2.9% (n = 2) Valproate 45.7% (n = 32), SSRI 24.3% (n = 17), stimulant 20% (n = 14), Alpha-2 agonist 20% (n = 14), neuroleptics 12.9% (n = 9) Cross-sectional (comparative study) BMI, Weight Significant weight gain associated with medicated individuals compared with non-medicated Masroor et al, (2019) [ 49 ] USA 800,614 adolescent inpatients (12-18 years) from the Nationwide Inpatient sample from 4411 hospitals and 45 states in the USA 800,614 Not reported 57.75% females (n = 462,366), 42.25% males (n = 338,248) Nationwide survey of 45 inpatient adolescent mental health facilities in the USA Not reported Conduct disorder 1.1% (n = 8885), other diagnoses not specified Not reported Cross-sectional (Retrospective cohort) Tobacco Use, Alcohol Use Significantly higher rates of tobacco and alcohol use disorders in people with conduct disorder compared with those without McCloughen et al, (2015) [ 50 ] Australia 56 young people (16–25 years) from two acute mental health units in Australia for people with a diagnosed mental illness admitted voluntarily and involuntarily 56 Not reported 35.7% females (n = 20), 62.3% males (n = 36) Two acute mental health units; one adolescent (12-17y) and one youth (17-26y) within a large Australian public general hospital for patients with acute mental and behavioral disturbances. Not reported Mood disorder 48% (n = 27), psychotic disorder 46% (n = 26), anxiety 26.8% (n = 15), developmental disorders 10.7% (n = 6), ADHD 5.4% (n = 3), personality disorder 5.4% (n = 3), ED 1.8% (n = 1) One medication 48% (n = 27), two medications 41% (n = 23); most common antidepressants 39% (n = 22), antipsychotics 70% (n = 39), anticonvulsants 14% (n = 8), mood stablisers 7% (n = 4) and combination 5% (n = 3) Cross-sectional Co-morbid Physical Health Conditions, Physical Activity, Dietary Intake, Tobacco Use, Alcohol Use Health risk behaviours (e.g.…”

“…Tobacco use was reported in 19 studies, containing 804,018 individuals [ 19 , 30 , 31 , 33 , 35 , 38 , 41 , 42 , 44 , 47 , [49] , [50] , [51] , [53] , [54] , [55] , 58 , 61 , 63 ]. Pooled prevalence rate of tobacco use was 51.5% (95% CI 32.2–70.2; N = 804,018) (see Fig 2).…”

“…Pooled prevalence rate of tobacco use was 51.5% (95% CI 32.2–70.2; N = 804,018) (see Fig 2). The sample largely comprised of one cohort containing 800,614 individuals [ 49 ]; however, removal of this study had minimal effect on the overall figure. (53%).…”

“…4.44) [ 19 ]. The overall pooled prevalence rates of people who reported alcohol abuse or alcohol dependence was 7.3% (95% CI 3.9–13.1), and ranged in individual samples from 16% to 42% [ 31 , 49 , 54 ].…”

Rates of Dual Diagnosis in Child and Adolescent Psychiatric Inpatients: A Scoping Review

“…We categorized this study as having a diagnostic focus of CD, since this was the authors' main interest. 31 Three types of methods were used to detect substance use or SUD: (1) ICD-9-coded hospital discharge diagnoses;…”