1
|
Jackson K, Kaner E, Hanratty B, Gilvarry E, Yardley L, O'Donnell A. Understanding people's experiences of the formal health and social care system for co-occurring heavy alcohol use and depression through the lens of relational autonomy: A qualitative study. Addiction 2024; 119:268-280. [PMID: 37778755 DOI: 10.1111/add.16350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/23/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND AIMS Heavy alcohol use and depression commonly co-occur. However, health and social care services rarely provide coordinated support for these conditions. Using relational autonomy, which recognizes how social and economic contexts and relational support alter people's capacity for agency, this study aimed to (1) explore how people experience formal care provision for co-occurring alcohol use and depression, (2) consider how this context could lead to adverse outcomes for individuals and (3) understand the implications of these experiences for future policy and practice. DESIGN Semi-structured qualitative interviews underpinned by the methodology of interpretive description. SETTING North East and North Cumbria, UK. PARTICIPANTS Thirty-nine people (21 men and 18 women) with current or recent experience of co-occurring heavy alcohol use ([Alcohol Use Disorders Identification Test [AUDIT] score ≥ 8]) and depression ([Patient Health Questionnaire test ≥ 5] screening tools to give an indication of their current levels of alcohol use and mental score). MEASUREMENTS Semi-structured interview guide supported in-depth exploration of the treatment and care people had sought and received for heavy alcohol use and depression. FINDINGS Most participants perceived depression as a key factor contributing to their heavy alcohol use. Three key themes were identified: (1) 'lack of recognition' of a relationship between alcohol use and depression and/or contexts that limit people's capacity to access help, (2) having 'nowhere to go' to access relevant treatment and care and (3) 'supporting relational autonomy' as opposed to assuming that individuals can organize their own care and recovery. Lack of access to appropriate treatment and provision that disregards individuals' differential capacity for agency may contribute to delays in help-seeking, increased distress and suicidal ideation. CONCLUSIONS Among people with co-occurring heavy alcohol use and depression, lack of recognition of a relationship between alcohol use and depression and formal care provision that does not acknowledge people's social and economic context, including their intrinsic need for relational support, may contribute to distress and limit their capacity to get well.
Collapse
Affiliation(s)
- Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Cunningham R, Imlach F, Lockett H, Lacey C, Haitana T, Every-Palmer S, Clark MTR, Peterson D. Do patients with mental health and substance use conditions experience discrimination and diagnostic overshadowing in primary care in Aotearoa New Zealand? Results from a national online survey. J Prim Health Care 2023; 15:112-121. [PMID: 37390032 DOI: 10.1071/hc23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 07/02/2023] Open
Abstract
Introduction Quality of health care contributes to poor physical health outcomes for people with mental health and substance use conditions (MHSUC). AIM This study investigated experiences of people with MHSUC who sought help for a physical health condition in primary healthcare services, examining quality of care attributes. Methods An online survey of adults currently or recently accessing services for MHSUC was fielded in 2022. Respondents were recruited nationally through mental health, addiction and lived experience networks and social media. The attributes of service quality assessed were relationships (respect and being listened to), discrimination due to MHSUC, and diagnostic overshadowing (MHSUC diagnosis distracted from physical health care). Results Respondents who had used primary care services were included (n = 335). The majority of respondents reported both being treated with respect (81%) and being listened to (79%) always or most of the time. A minority of respondents reported diagnostic overshadowing (20%) or discrimination due to MHSUC (10%). People with four or more diagnoses or a diagnosis of bipolar disorder or schizophrenia had significantly worse experiences across all quality measures. Those with a diagnosis of substance use disorders had worse experiences for diagnostic overshadowing. Māori had worse experiences for respect and diagnostic overshadowing. Conclusions Although many respondents reported good experiences in primary care, this was not the case for everyone. Quality of care was affected by type and number of diagnoses and the person's ethnicity. Interventions to reduce stigma and diagnostic overshadowing for people with MHSUC are needed in primary care services in New Zealand.
Collapse
Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Fiona Imlach
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Helen Lockett
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Cameron Lacey
- Maori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand; and Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Tracy Haitana
- Maori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Mau Te Rangimarie Clark
- Maori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| |
Collapse
|
3
|
Puddephatt J, Irizar P, Jones A, Gage SH, Goodwin L. Associations of common mental disorder with alcohol use in the adult general population: a systematic review and meta-analysis. Addiction 2022; 117:1543-1572. [PMID: 34729837 PMCID: PMC9300028 DOI: 10.1111/add.15735] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/15/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Research has shown that alcohol use and common mental disorders (CMDs) co-occur; however, little is known about how the global prevalence of alcohol use compares across different CMDs. We aimed to (i) report global associations of alcohol use (alcohol use disorder (AUD), binge drinking and consumption) comparing those with and without a CMD, (ii) examine how this differed among those with and without specific types of CMDs and (iii) examine how results may differ by study characteristics. METHODS We used a systematic review and meta-analysis. Cross-sectional, cohort, prospective, longitudinal and case-control studies reporting the prevalence of alcohol use among those with and without a CMD in the general population were identified using PsycINFO, MEDLINE, PsyARTICLES, PubMed, Scopus and Web of Science until March 2020. Depression, anxiety and phobia were included as a CMD. Studies were included if they used a standardized measure of alcohol use. A random-effects meta-analysis was conducted to generate pooled prevalence and associations of AUD with CMD with 95% confidence intervals (CI). A narrative review is provided for binge drinking and alcohol consumption RESULTS: A total of 512 full-texts were reviewed, 51 included in our final review and 17 in our meta-analyses (n = 382 201). Individuals with a CMD had a twofold increase in the odds of reporting an AUD [odds ratio (OR) = 2.02, 95% CI = 1.72-2.36]. The odds of having an AUD were similar when stratified by the type of CMD (mood disorder: OR = 2.00, 95% CI = 1.62-2.47; anxiety/phobic disorder: OR = 1.94, 95% CI = 1.35-2.78). An analysis of study characteristics did not reveal any clear explanations for between-study heterogeneity (I2 > 80%). There were no clear patterns for associations between having a CMD and binge drinking or alcohol consumption, respectively. CONCLUSIONS People with common mental disorders (depression, anxiety, phobia) are twice as likely to report an alcohol use disorder than people without common mental disorders.
Collapse
Affiliation(s)
| | | | - Andrew Jones
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
| | | | - Laura Goodwin
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
4
|
Chang HM, Pan CH, Chen PH, Chen YL, Su SS, Tsai SY, Chen CC, Kuo CJ. Premature death and causes of death among patients with panic disorder and comorbid psychiatric disorders: A nationwide cohort study. J Psychiatr Res 2022; 148:340-347. [PMID: 35202994 DOI: 10.1016/j.jpsychires.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/17/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Panic disorder (PD) is associated with high psychiatric and physical comorbidity, but the cause of mortality has not been well studied. This study investigated mortality rates and causes of death in an Asian cohort with PD. METHODS We enrolled a nationwide retrospective cohort of 298,466 persons diagnosed with PD from January 1, 2001, to December 31, 2016. Each cohort member was matched with a comparison one randomly selected from the general population with the same sex, age at entry, and birth year. The data of both the PD cohort and the comparison group were linked with the national mortality database to obtain each individual's mortality status. We used mortality rate ratios (MRRs) to compare mortality risks between the patients with PD and the general population. Stratified analysis of mortality risks was performed based on sex and psychiatric comorbidities. RESULTS PD was associated with a slightly increased mortality risk (MRR, 1.14 [99% CI, 1.11-1.17]). The risk of unnatural death (MRR, 2.83 [99% CI, 2.59-3.10]) was significantly higher among the individuals with PD than among the general population, whereas the risk of overall natural death across all categories was not (MRR, 1.01 [99% CI, 0.98-1.04]). The mortality risk was the highest for suicide (MRR, 4.94 [99% CI, 4.32-5.72]) and was higher in women (MRR, 6.37 [99% CI, 5.25-7.96]) than in men (MRR, 3.77 [99% CI, 3.14-4.64]). Comorbid substance use disorders increased the risk of mortality from natural (MRR, 3.23 [99% CI, 2.59-4.14]) and unnatural (MRR, 9.45 [99% CI, 6.29-17.85]) causes. CONCLUSION PD was associated with increased all-cause mortality, especially suicide. Substance use further increased mortality risk in persons with PD. Targeted treatment for substance use and suicide prevention are essential among persons with PD.
Collapse
Affiliation(s)
- Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
| |
Collapse
|
5
|
John U, Rumpf HJ, Hanke M, Meyer C. Mental disorders and total mortality after 20 years in an adult general population sample. Eur Psychiatry 2020; 63:e30. [PMID: 32115002 PMCID: PMC7315884 DOI: 10.1192/j.eurpsy.2020.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background. General population data on associations between mental disorders and total mortality are rare. The aim was to analyze whether the number of mental disorders, single substance use, mood, anxiety, somatoform or eating disorders during the lifetime and whether treatment utilization may predict time to death 20 years later in the general adult population. Methods. We used data from the Composite International Diagnostic Interview, which includes DSM-IV diagnoses for substance use, mood, anxiety, somatoform, and eating disorders, for a sample of 4,075 residents in Germany who were 18–64 years old in 1996. Twenty years later, mortality was ascertained using the public mortality database for 4,028 study participants. Cox proportional hazards models were applied for disorders that existed at any time in life before the interview. Results. The data revealed increased hazard ratios (HRs) for number of mental disorders (three or more; HR 1.4; 95% confidence interval [CI] 1.1–1.9) and for single disorders (alcohol dependence, dysthymia, panic disorder with agoraphobia, and hypochondriasis), with the reference group being study participants who had not suffered from any of the mental disorders analyzed and with adjustments made for age, sex, and education. Among individuals with any mental disorder during their lifetimes, having been an inpatient in treatment for a mental disorder was related to a higher HR (2.2; CI 1.6–3.0) than was not having been in any treatment for a mental disorder. Conclusions. In this sample of adults in the general population, three or more mental disorders, alcohol dependence, dysthymia, panic disorder with agoraphobia, and hypochondriasis were related to premature death.
Collapse
Affiliation(s)
- Ulrich John
- Department of Social Medicine and Prevention, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Greifswald, Germany
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Lübeck, Lübeck, Germany
| | - Monika Hanke
- Department of Social Medicine and Prevention, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christian Meyer
- Department of Social Medicine and Prevention, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Greifswald, Germany
| |
Collapse
|