Persistence of impaired functioning and psychological distress after medical hospitalization for men with co-occurring psychiatric and substance use disorders.
OBJECTIVE
To measure the persistence of impaired health-related quality of life (HRQL) and psychological distress associated with co-occurring psychiatric and substance use disorders in a longitudinal sample of medically hospitalized male veterans.


METHODS
A random sample followed observationally for 1 year after study enrollment.


METHODS
Inpatient medical and surgical wards at 3 university-affiliated Department of Veterans Affairs Medical Centers.


METHODS
A random sample of 1,007 admissions to medical and surgical inpatient services, excluding women and admissions for psychiatric reasons. A subset of participants (n = 736) was designated for longitudinal follow-up assessments at 3 and 12 months after study enrollment. This subset was selected to include all possible participants with study-administered psychiatric diagnoses (52%) frequency-matched by date of study enrollment to approximately equivalent numbers of participants without psychiatric diagnoses (48%).


RESULTS
All participants were administered a computerized structured psychiatric diagnostic interview for 13 psychiatric (include substance use) disorders and received longitudinal assessments at 3 and 12months on a multidimensional measure of HRQL, the SF-36, and a measure of psychological distress, the Symptom Checklist, 90-item version. On average, HRQL declined and psychological distress increased over time (P <.05). Psychiatric disorders were associated with significantly greater impairments in functioning and increased distress on all measures (P <.001) except physical functioning (P <.05). These results were replicated in the patients (n = 130) who received inpatient or outpatient mental health or substance abuse services.


CONCLUSIONS
General medical physicians need to evaluate the mental health status of their hospitalized and seriously ill patients. Effective mental health interventions can be initiated posthospitalization, either immediately in primary care or through referral to appropriate specialty care, and should improve health functioning over time.
HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA. BoothBrendaM@exchange.uams.edu
B M
BM
Booth
F C
FC
Blow
C A
CA
Loveland Cook
D015897:Comorbidity; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D011897:Random Allocation; D019966:Substance-Related Disorders / Q000503:physiopathology*; D014728:Veterans / Q000523:psychology