SUBSTANCE-ABUSE, COMMUNITY-SERVICE USE, AND SYMPTOM SEVERITY OF URBANAND RURAL RESIDENTS WITH SCHIZOPHRENIA

Objective: This study examined the relationships of substance abuse, u se of community-based services, and symptom severity among rural and u rban residents with schizophrenia in the six months after discharge fr om short-term inpatient care. Methods: At baseline and six-month follo w-up, symptom severity of 139 subjects was assessed using the Brief Ps ychiatric Rating Scale (BPRS), and substance abuse status was determin ed using the Structured Clinical Interview for DSM-III-R (SCID), Subje cts' reports of mental health service use were confirmed by record rev iew Results: Although, on average, BPRS scores indicated symptom impro vement between baseline and follow-up, symptoms worsened for 27 percen t of subjects, Multivariate analysis, adjusted for baseline symptom se verity: indicated poorer outcomes for rural residents, substance abuse rs, and subjects who did not use community services, Symptoms of rural substance abusers who used no community services were worse at follow -up than those of any other subgroup, Nearly half of all subjects had less than monthly contact with community services. The greater likelih ood of symptom worsening among rural residents was attributed to their less frequent use of community services. Conclusions: The findings re inforce the importance of ensuring involvement in community-based serv ices for individuals with comorbid schizophrenia and substance use dis orders. Promotion of service use by persons with a dual diagnosis may be particularly critical to the well-being of rural residents with sch izophrenia.