title: Substance use disorders as risk factors for psychiatric hospitalization in bipolar disorder.
abstract: OBJECTIVE
  This study developed risk profiles of psychiatric hospitalization for veterans diagnosed as having bipolar disorder.
  
  
  METHODS
  This study included 2,963 veterans diagnosed as having bipolar disorder (types I, II, or not otherwise specified) during the 2004 fiscal year. Data were derived from the Veterans Affairs administrative database. Risk profiles for psychiatric hospitalization were generated with an iterative application of the receiver operating characteristic.
  
  
  RESULTS
  In this sample 20% of the patients with bipolar disorder were hospitalized psychiatrically during the one-year study period. Patients diagnosed as having both an alcohol use disorder and polysubstance dependence and who also were separated from their spouse or partner had a 100% risk of psychiatric hospitalization; risk of psychiatric hospitalization decreased to 52% if the patients were not separated from their partner. Patients who were not diagnosed as having alcohol use disorders or polysubstance dependence and who were not separated from their partners exhibited the lowest risk of psychiatric hospitalization (12%). Among patients with a psychiatric hospitalization, 41% had longer lengths of stay (<14 days), with the strongest predictor of a longer length of stay being an age older than 77 years, which conferred a 77% risk.
  
  
  CONCLUSIONS
  Alcohol use and polysubstance dependence can significantly affect the course of bipolar disorder, as evidenced by their associations with psychiatric hospitalizations. Increased focus on substance abuse among older adults with bipolar disorder may decrease length of psychiatric hospitalization. Our findings suggest that implementing substance treatment programs early in the course of bipolar disorder could reduce health service use.
authors.affiliation: Palo Alto Veterans Affairs Health Care System, Palo Alto, California, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hoblyn
authors.forename: Steve L
authors.initials: SL
authors.lastname: Balt
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Woodard
authors.forename: John O
authors.initials: JO
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D019966:Substance-Related Disorders; D014481:United States