Dual Diagnosis Patients First Admitted to a Psychiatric Ward for Acute Psychiatric Patients: 2-Year Period 2003–2004 versus 2013–2014

Abstract

Dual diagnosis (DD) is the coexistence of severe mental illness (SMI) and substance use disorder (SUD). The increase of DD observed in recent years has important implications for mental health services organization. The aim of this study is to assess the prevalence and features of DD over a decade, comparing the periods 2003-2004 and 2013-2014. We performed a retrospective study retrieving sociodemographic and clinical data from the medical records of patients at their first admission to the Psychiatric Ward of University Hospital "Maggiore della Carità" in Novara, Italy. Patients with SMI and comorbid SUD (SMI-SUD) and patients with SMI without comorbidity (SMI) were compared in the two periods, 2003-2004 versus 2013-2014. SMI-SUD patients in both 2-year periods were more likely to be male, younger, unemployed, living with parents (or alone, for the 2013-2014 period) rather than with a family of their own, and single (or divorced, in 2003-2004). The 2003-2004 patients were more frequently diagnosed with a personality disorder, whereas the 2013-2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods as well: in both periods, male gender was associated with an increased risk of DD, whereas age >61 years was associated with decreased risk. Only in the first period (2003)(2004) was having a university degree associated with a decreased risk of DD, whereas the diagnosis of a personality disorder was associated with an increased risk of DD; on the contrary, in the second period (2013)(2014), living in a protective environment was associated with a decreased risk of DD. The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors that may be the target of prevention and treatment approaches.