Persistence of impaired functioning and psychological distress after medical hospitalization for men with co-occurring psychiatric and substance use disorders

OBJECTIVE: To measure the persistence of impaired health-related quality of life (HRQL) and psychological distress associated with co-occurring psychi atric and substance use disorders in a longitudinal sample of medically hos pitalized male veterans. DESIGN:A random sample followed observationally for 1 year after study enro llment. SETTING: Inpatient medical and surgical wards at three university-affiliate d Department of Veterans Affairs Medical Centers. PATIENTS/PARTICIPANTS: A random sample of 1,007 admissions to medical and s urgical inpatient services, excluding women and admissions for psychiatric reasons, A subset of participants (n = 736) was designated for longitudinal follow-up assessments at 3 and 12 months after study enrollment. This subs et was selected to include all possible participants with study-administere d psychiatric diagnoses (52%) frequency-matched by date of study enrollment to approximately equivalent numbers of participants without psychiatric di agnoses (48%). MEASUREMENTS AND MAIN RESULTS: All participants were administered a compute rized, structured psychiatric diagnostic interview for 13 psychiatric disor ders (including substance use) and received longitudinal assessments at 3 a nd 12 months on a multidimensional measure of HRQL, the SF-36, and a measur e of psychological distress, the Symptom Checklist, 90-item version. On ave rage, HRQL declined and psychological distress increased over time (P < .05 ). Psychiatric disorders were associated with significantly greater impairm ents in functioning and increased distress on all measures (P < .001) excep t physical functioning (p < .05). These results were replicated in the pati ents (n = 130) who received inpatient or outpatient mental health or substa nce abuse services. CONCLUSIONS: General medical physicians need to evaluate the mental health status of their hospitalized and seriously ill patients. Effective mental h ealth interventions can be initiated posthospitalization, either immediatel y in primary care or through referral to appropriate specialty care, and sh ould improve health functioning over time.