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Quality of Outpatient Depression Treatment in Patients With Comorbid Substance Use Disorder.
Coughlin LN, Pfeiffer P, Ganoczy D, Lin LA. Quality of Outpatient Depression Treatment in Patients With Comorbid Substance Use Disorder. The American journal of psychiatry. 2021 May 1; 178(5):414-423.
Clinical practice guidelines recommend concurrent treatment of co-occurring depression and substance use disorders; however, the degree to which patients with substance use disorders receive guideline-concordant treatment for depression is unknown. The authors investigated the provision of guideline-concordant depression treatment to patients with and without substance use disorders in a large integrated health care system.
In a retrospective cohort study of 53,034 patients diagnosed with a depressive disorder in fiscal year 2017 in the U.S. Veterans Health Administration, the authors assessed the association of comorbid substance use disorders with guideline-concordant depression treatment, including both medication and psychotherapy, while adjusting for patient demographic and clinical characteristics.
Guideline-concordant depression treatment was lower across metrics for patients with co-occurring depression and substance use disorders compared to those without substance use disorders. Consistent findings emerged in covariate-adjusted models of antidepressant treatment, such that patients with substance use disorders had 21% lower odds of guideline-concordant acute treatment (adjusted odds ratio = 0.79, 95% CI = 0.73, 0.84) and 26% lower odds of continuation of treatment (adjusted odds ratio = 0.74, 95% CI = 0.69, 0.79). With regard to psychotherapy, patients with co-occurring depression and substance use disorders had 13% lower odds (adjusted odds ratio = 0.87, 95% CI = 0.82, 0.91) of adequate acute-phase treatment and 19% lower odds (adjusted odds ratio = 0.81; 95% CI = 0.73, 0.89) of psychotherapy continuation.
Despite the availability of effective treatments for depression, patients with co-occurring substance use disorders are less likely to receive guideline-concordant depression treatment. Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment.