Mental Health and Substance Use Comorbidity Among Adolescents in Psychiatric Inpatient Hospitals: Prevalence and Covariates

Prevalence of Dual Diagnoses among Children and Adolescents with Mental Health Conditions

BACKGROUND

The World Health Organisation defines dual diagnosis as the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder. Children and adolescents with dual diagnoses represent a significant public health burden in social and financial terms.

AIMS

The objective of the present paper is to provide a review of studies dealing with dual diagnoses and their prevalence among children and adolescents whose primary treatment involves psychiatric conditions.

METHODS

The PRISMA was used to conduct a systematic search. Articles published between January 2010 and May 2022 were searched for analysis.

RESULTS

Eight articles were eventually found eligible for the final content analysis. The analysis of the articles identified the prevalence of dual diagnoses among children and adolescents treated primarily for psychiatric conditions, the gender-specific occurrence of dual diagnoses, methods used to diagnose psychiatric and substance use disorders, types of psychiatric diagnoses involved in dual diagnoses, and prevalence differences contingent on the type of service provision as the main thematic areas. The prevalence of dual diagnoses among the target population ranged from 18.3% to 54% (mean 32.7%). Boys were more likely to experience dual diagnoses and affective disorders were the most frequent psychiatric diagnoses.

CONCLUSION

The importance of the issue and the high prevalence of dual diagnoses make it imperative that this type of research is pursued.

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

OBJECTIVES

Child and adolescent psychiatric (CAP) inpatient admissions have increased since 2009 and the clinical profile of these patients has become more complex. Unrecognized dual diagnosis, that is, comorbid substance use or substance use disorder (SUD) may contribute to this problem, but the prevalence of dual diagnosis in this population is inadequately understood. The goal of this scoping review was to summarize the range and content of research on this topic.

METHODS

MEDLINE, EMBASE, and PsychINFO databases were systematically searched for studies published from 2008 to 2019 containing information on rates of comorbid substance use or SUD in CAP inpatients.

RESULTS

A total of 23,326 abstracts were located. After removing duplicates, screening abstracts and full-text papers, and extracting data with full-text reviews, fourteen studies meeting our criteria remained. Rates of substance use or SUD ranged from 0.9% to 54.8%, differing on the basis of: (1) type of outcome; (2) type of data source; and (3) whether samples had a specific diagnostic focus or not. Rates of any type of SUD were reported in approximately 25% of samples from administrative databases, in 17.7% to 38.5% of chart reviews, and in 55% of studies with data from clinical research examinations. The highest rates of substance-specific substance use or SUD were for alcohol, cannabis, and nicotine.

CONCLUSIONS

We located 14 studies, but methodologic heterogeneity precluded quantitative calculation of a single estimate for the prevalence of dual diagnosis. However, most of the rates suggest that this is an important problem in CAP inpatients, meriting further research. We suggest ways to improve future studies.

A comparative study of socio-demographic and substance use correlates in early-onset psychosis

BACKGROUND

Comorbid substance use, particularly cannabis among adolescents with mental illness, is a major public health concern in developing countries with limited mental health resources. Better understanding of the association between cannabis use and other polysubstance use and early mental illness will provide for more targeted early interventions.

AIM

This aim of this study was to examine the socio-demographic profile and cannabis use characteristics among adolescents with first-episode early-onset psychosis (EOP) and compare with age-matched and gender-matched adolescents with first-episode non-psychotic mental illness (controls).

METHOD

Forty-five adolescents with first-episode EOP and 45 controls were assessed using a clinical interview, Positive and Negative Syndrome Scale and World Health Organization Alcohol, Smoking and Substance Involvement Screening test (ASSIST) for substance-related problems.

RESULTS

There were significant socio-demographic differences among the adolescents with EOP (73% Black, 64% from low family income, 44% from rural areas) compared with controls (24% Black, 53% from low family income, 2% from rural areas). Although there was no difference in lifetime cannabis use, EOP adolescents differed in motivation for cannabis use, had increased current cannabis use (38%, P = 0.01) and more frequent use (52%, P = 0.04) compared with controls (16% current and 18% frequent use). EOP adolescents reported more hazardous use with higher ASSIST mean cannabis-specific involvement scores (EOP 10,2; controls 2,3; P = 0.004).

CONCLUSION

The differences in socio-demographic variables may reflect the marked disparity in access to mental health care for rural Black youth. Psychotic youth may be more vulnerable to comorbid cannabis-related problems than other mentally ill adolescents. The study highlights the need for early introduction of substance use interventions among adolescents with mental illness.

Substance use in adolescents with mental illness in Durban, South Africa

Comorbid substance use in adolescents with mental illness is often an indicator of poor treatment outcome. This study aims to determine the prevalence of, and associated risk factors for, substance use in adolescents with mental illness attending a mental health service. Data was collected from hospital records of 162 adolescents, using a structured data sheet, over a two-year period. Substance use was more significant in older adolescents and those with severe mental illness. Sixty-two (38.3%) adolescents used substances. Thirty-seven (38.1%) male adolescents reported substance use compared to 25 (38.5%) female adolescents. Alcohol was the most commonly used substance (n = 48; 29.6%), followed by cannabis (n = 32; 19.8%). There were significant direct associations between substance use and history of abuse or neglect, forensic history, educational setting, admission status, and the psychiatric diagnoses of schizophrenia, other psychotic disorders, and bipolar mood disorder. Inverse associations were found between substance use and adjustment disorders, attention deficit hyperactivity disorder, and intellectual disability. The results of this study indicate an urgent need for substance misuse programmes for at risk youth, and the introduction of dual diagnosis intervention programmes in this age group.

Drug use prevention projects in schools in Vitória, Brazil: quality analysis and improvement proposals

Adolescents living in vulnerable regions are more exposed to risk factors for drug use. The prevention of such use in school is a public policy that needs evaluation. Based on technical criteria and derived from a mixed research, this article analyses the quality of school-based prevention of drug use in Vitória, state of Espírito Santo, Brazil, and proposes improvements. A checklist of quality elements was completed with data from 16 projects proposed by 99 teachers from public schools. In 10 projects (62.5%), the approximate quality index was above 0.50. The majority of projects fulfilled the requirement of theoretical foundation (81.25%) and some of the methodological (93.75%), design (75%) and implementation (62%) requirements. Other requirements were absent: the majority were not designed by the whole school community (87.5%), and the participation of the family (62.5%) or the students as mediators (62.5%) was not considered. In general, contents of life skills (87.5%), positive relationships and alternative activities to drug use (56.25%) were not included. Activities for reinforcing the content were not described in any of the projects, and evaluation activities were described in only a few (31.25%). Many projects did not describe the inclusion of the project in the school curriculum (62.5%). Although, considering all items of effectiveness, regardless of their weight, more than half of the projects had an above average quality. The present items provide quality to the projects, whereas absent items indicate shortcomings to be improved using some of the measures described in this study.

Screening, Brief Intervention, and Referral to Treatment

Screening, Brief Intervention, and Referral to Treatment is a quick, effective technique with which to manage substance use in adolescents and young adults. Use of a validated measure for detecting substance use and abuse is significantly more effective than unvalidated tools or provider intuition. There are a variety of validated tools available to use in the adolescent/young adult population, and there are opportunities to increase the efficiency and scalability of screening by using computerized questionnaires. This area continues to evolve rapidly.

Adolescent Substance Use and Comorbid Psychopathology: Emotion Regulation Deficits as a Transdiagnostic Risk Factor

Rates of substance use and comorbid psychopathology peak during adolescence, highlighting the need to identify transdiagnostic risk processes that cut across conditions and elucidate early embedded risk factors for comorbidity across development. The current review highlights emotion regulation deficits as a core transdiagnostic risk factor underlying the development of substance use, addiction, and comorbid psychopathology in adolescence. We present the dual systems model of neurological development to highlight adolescence as a critical period of increased risk for emotion regulation difficulties, corresponding risk behaviors, and psychopathology. We describe malfunction in the neurobiological regulation system underlying the relationship between emotion regulation and risk for addiction and comorbidity. We pull from two established developmental theories including both the externalizing pathway and the internalizing pathway to substance use disorders, which together highlight how early embedded risk in the form of emotion regulation deficits can explain mechanisms underlying the development of addiction and comorbid psychiatric disorders.