Psychiatric care of patients with depression and comorbid substance use disorders

Background: The goal of this study was to describe the sociodemographic and clinical characteristics and routine psychiatric care of depressed patient s with or without substance use disorders (SUDs) and to assess the associat ion between the presence of comorbid SUD and the psychiatric management of patients with depression. Method: Each of a sample of 531 psychiatrists participating in the Practice Research Network (PRN) of the American Psychiatric Institute for Research and Education was asked to provide information about 3 randomly chosen pati ents. Data were collected using a self-administered questionnaire, which ge nerated detailed diagnostic and clinical data on 1228 psychiatric patients. Weighted data were analyzed using the SUDAAN software package. Multivariat e logistic regression was used to compare depressed patients with and witho ut SUD. Results: A total of 595 patients (48.4%) were diagnosed with depression (DS M-IV criteria). The prevalence of SUD (excluding nicotine dependence) in th is group was 18.1%. The group with SUD had a significantly larger proportio n of males, young adults, patients seen in public general hospitals, and no n-managed care public plans. No significant group differences were found fo r primary payer, locus of care, length of treatment, type of current or pas t treatment, and prescription of medications. Only 2.2% of SUD patients wer e prescribed with an anti-SUD medication (i.e., disulfiram and naltrexone). Conclusion: Concomitant SUDs have little effect on the routine psychiatric care of depressed patients. Efforts should be made to improve the identific ation and management of depressed patients with SUD.