Psychiatric Care of Patients With Depression and Comorbid Substance Use Disorders.

Background: The goal of this study was todescribe the sociodemographic and clinical characteristics androutine psychiatric care of depressed patients with or withoutsubstance use disorders (SUDs) and to assess the associationbetween the presence of comorbid SUD and the psychiatricmanagement of patients with depression.

Method: Each of a sample of 531 psychiatristsparticipating in the Practice Research Network (PRN) of theAmerican Psychiatric Institute for Research and Education wasasked to provide information about 3 randomly chosen patients.Data were collected using a self-administered questionnaire,which generated detailed diagnostic and clinical data on 1228psychiatric patients. Weighted data were analyzed using theSUDAAN software package. Multivariate logistic regression wasused to compare depressed patients with and without SUD.

Results: A total of 595 patients (48.4%) werediagnosed with depression (DSM-IV criteria). The prevalence ofSUD (excluding nicotine dependence) in this group was 18.1%. Thegroup with SUD had a significantly larger proportion of males,young adults, patients seen in public general hospitals, andnon-managed care public plans. No significant group differenceswere found for primary payer, locus of care, length of treatment,type of current or past treatment, and prescription ofmedications. Only 2.2% of SUD patients were prescribed with ananti-SUD medication (i.e., disulfiram and naltrexone).

Conclusion: Concomitant SUDs have little effecton the routine psychiatric care of depressed patients. Effortsshould be made to improve the identification and management ofdepressed patients with SUD.