Lisa R Fortuna1, Benjamin Cook2, Michelle V Porche3, Ye Wang4, Ana Maria Amaris5, Margarita Alegria6. 1. Boston University Medical School, Boston Medical Center, Child and Adolescent Psychiatry, 850 Harrison Avenue, Dowling 7, Boston, MA, 02118, USA. Electronic address: lisa.fortuna@bmc.org. 2. Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, 2(nd) Floor, Cambridge, MA, 02141, USA; Department of Psychiatry, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02139, USA. Electronic address: bcook@cha.harvard.edu. 3. School of Education, Boston University, 2 Silber Way, Boston, MA, 02215, USA. Electronic address: mporche@bu.edu. 4. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St., 8(th) Floor, Boston, MA, 02114, USA. Electronic address: ywang75@mgh.harvard.edu. 5. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St., 8(th) Floor, Boston, MA, 02114, USA. Electronic address: ama485@mail.harvard.edu. 6. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St., 8(th) Floor, Boston, MA, 02114, USA; Departments of Medicine and Psychiatry, Harvard Medical School, 50 Staniford Street, 8th Floor, Boston, MA, 02114, USA. Electronic address: malegria@mgh.harvard.edu.
Abstract
BACKGROUND: Sleep Disturbances (SDs) are a symptom common to mental health disorders (MHD) and substance use disorders (SUD). We aimed to identify the value of SD as a predictor for subsequent treatment of illicit drug and alcohol use disorders (SUDs) in primary care and relative to the predictive value of mental health disorders (MHDs). METHODS: We used electronic health records data from ambulatory primary care in a safety net Boston area healthcare system from 2013 to 2015 (n = 83,920). SUD (separated into illicit drug use disorder and alcohol use disorder) and MHD were identified through ICD-9 codes and medical record documentation. We estimated Cox proportional hazard models to examine the risk of SUD across four comparison groups (SD only, SD and MHD, MHD only, and neither SD nor MHD). RESULTS: Compared to patients with no sleep or MHD, patients with SD had a greater risk for subsequent SUD treatment. Approximately one-fifth of patients with SD were treated for an illicit drug use disorder and approximately 12% were treated for alcohol use disorder. Risk for SUD treatment, estimated at over 30% by the end of the study, was greatest for patients with a MHD, either alone or comorbid with SD. Risk was greater for older patients and men, and lower for minority patients. CONCLUSIONS: SD and MHD, individually and comorbid, significantly predict subsequent treatment of illicit drug and alcohol use disorder in primary care. Screening and evaluation for SD should be a routine practice in primary care to help with identifying potential SUD risk.
BACKGROUND:Sleep Disturbances (SDs) are a symptom common to mental health disorders (MHD) and substance use disorders (SUD). We aimed to identify the value of SD as a predictor for subsequent treatment of illicit drug and alcohol use disorders (SUDs) in primary care and relative to the predictive value of mental health disorders (MHDs). METHODS: We used electronic health records data from ambulatory primary care in a safety net Boston area healthcare system from 2013 to 2015 (n = 83,920). SUD (separated into illicit drug use disorder and alcohol use disorder) and MHD were identified through ICD-9 codes and medical record documentation. We estimated Cox proportional hazard models to examine the risk of SUD across four comparison groups (SD only, SD and MHD, MHD only, and neither SD nor MHD). RESULTS: Compared to patients with no sleep or MHD, patients with SD had a greater risk for subsequent SUD treatment. Approximately one-fifth of patients with SD were treated for an illicit drug use disorder and approximately 12% were treated for alcohol use disorder. Risk for SUD treatment, estimated at over 30% by the end of the study, was greatest for patients with a MHD, either alone or comorbid with SD. Risk was greater for older patients and men, and lower for minority patients. CONCLUSIONS:SD and MHD, individually and comorbid, significantly predict subsequent treatment of illicit drug and alcohol use disorder in primary care. Screening and evaluation for SD should be a routine practice in primary care to help with identifying potential SUD risk.
Authors: Joshua L Gowin; Matthew E Sloan; Bethany L Stangl; Vatsalya Vatsalya; Vijay A Ramchandani Journal: Am J Psychiatry Date: 2017-08-04 Impact factor: 18.112
Authors: Laura K Barger; Rowan P Ogeil; Christopher L Drake; Conor S O'Brien; Kim T Ng; Shantha M W Rajaratnam Journal: Sleep Date: 2012-12-01 Impact factor: 5.849
Authors: Rong Guo; Dylan Thomas Vaughan; Ana Lourdes Almeida Rojo; Yanhua H Huang Journal: Neuropsychopharmacology Date: 2022-06-16 Impact factor: 7.853