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Research consistently demonstrates that prison inmates are more likely than the general population to suffer from both mental disorders and substance abuse. The current study explored the relationship between diagnoses of mental disorders and maladaptive substance use among state and federal prison inmates. Linear regression analysis was used to ascertain the prevalence of comorbidity of substance abuse and mental disorder, and multiple models were constructed to determine the direction of relationship between the two disorders. Overall, mental disorders and substance use were positively related within the sample, though mixed conclusions were drawn regarding the exact nature of their relationship. Recommendations for future study and improvements to the specificity of mental disorders and substance use measures are made.

Background. In-hospital mortality is a measure recognized by US Agency for Healthcare Quality to represent quality of care within hospitals, that accounts for mortality based on three indicators: 1. select medical conditions and procedures; 2. procedures linked with questions of use (misuse, over/under use); 3. high volume procedures traditionally associated with lower mortality rates. Understanding how different comorbidity models measure in-hospital mortality is essential not only for determining patient health status in the hospital setting, but also help to regulating mortality risk and mortality risk predictions. One of the most widely used discriminatory models is the Charlson model, which predicts the risk of mortality within one year of hospitalization of patients with various comorbidities using CCSR codes for ICD-10 diagnoses which is quantified by the c-statistics, represented by the area under the curve (AUC). Objectives. To adapt a comorbidity index model to the National Inpatient Sample (NIS) database of 2020 to predict 1-year mortality for patients admitted with select ICD-10 codes of diagnoses. Methods Our study analysis examined mortality with comorbidity using the Charlson model in a sample population of estimated 5,533,477 adult inpatients (individuals ≥18 years of age). A multivariate logistic regression model was constructed with in-hospital mortality as the outcome variable and identifying predictor variables as defined by the Clinical Classifications Software Refined Variables (CCSR) codes for selected ICD-10 diagnoses (Table 3). Descriptive statistics and the base logistic regression analyses were conducted using SAS statistical software version 9.4. To avoid overpowering and avoid variables attaining statistical significance while only marginally changing the outcome, a subsample (n=100,000) was randomly selected from the original data set. Ultimately, 20 CCSR variables with p-values <0.20 from the base simple logistic regression models were included in the subsequent backward stepwise logistic regression analysis. Results Table 1 shows the prevalence of the selected diagnoses for our analysis. Anemia (28.32%), pulmonary disease (asthma, COPD, pneumoconiosis;21.88%), and diabetes without complications (19.47%) were the three most prevalent conditions among hospitalized patients. Table 2 shows the results of the base logistic regression analysis conducted, which excluded connective tissue/rheumatologic disorders, peptic ulcer disease, anemia, diabetes with complications, and human immunodeficiency as predictors of inpatient mortality. Results of the backward stepwise regression analysis revealed that severe liver disease/hepatic failure ([adjusted odds ratio (aOR): 10.50, (CI: 10.40-10.59)], acute myocardial infarction ([2.85, (2.83-2.87)] and malnutrition ([2.15, (2.14-2.16)] were three most important risk factors and had the highest impact on inpatient mortality (p-value <0.0001). However, smoking history, obesity, and liver disease were negatively associated with inpatient mortality. The c-statistic or the area under the curve (AUC) for the final model was 0.752. Conclusion Our findings, based on Charlson modeling procedures, indicate that independent variables representative of comorbidity with the strongest 1-year risk of mortality were among patients with ICD-10 codes relating to: severe liver disease/hepatic failure, acute myocardial infarction, and malnutrition. Hence, relevant stakeholders (patients, family members, and healthcare providers) can utilize this knowledge to advance models of care and prevention strategies that limit disease progression and improve patient outcomes.

Background: E-cigarettes, also known as electronic nicotine delivery systems (ENDS), are the second most used tobacco product in the US. Cigarette smoking, alcohol, and tobacco use, which contribute to a large portion of disease burden caused by substance use disorders (SUDs), have all been shown to be associated with ENDS use. The co-occurrence of mental disorders and SUDs is well established despite unclear causality. Understanding the associations between e-cigarette use, substance use, and mental health disorders is imperative to understanding the full impact of ENDS use. The aim of our study is to examine these associations in Tennessee, where the prevalence of cigarette smokers and drug overdose deaths is higher than the national average. Methods: We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults aged 18 years, and extracted data for Tennessee (n=4,788). Logistic regression analysis was conducted to test the association between cigarette use, substance use, depression, and ENDS use. We controlled for income, race, educational status, health insurance status, race/ethnic minority status, and age. Results: Overall, 6.7% (n=320) of participants in our sample reported ENDS use. Results of our logistic regression model revealed that cigarette use (OR=2.58, 95% CI, 1.99,3.44), depression (OR=2.33, 95% CI, 1.82, 2.98), alcohol use (OR =2.50, 95% CI, 1.96, 3.20), male gender (OR =1.30, 95% CI, 1.02, 1.60), and no health insurance (OR =1.48, 95% CI, 1.02, 2.15) were associated with ENDS use, while race/ethnic minority status, low income, and non-completion of high school were not associated with ENDS use. Conclusion: Our results showed that cigarette use, alcohol use, and depression were associated with ENDS use in Tennessee after controlling for common confounders. Our results corroborate other studies that show a strong association between ENDS use, co-occurring substance use disorders, and mental disorders. This cross-sectional study from a sample in Tennessee can serve as the basis for future longitudinal research in this population.

Background: The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization ofmental health care in the host countries. Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization. Material and Methods: Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale – Short Form (SSMIS-SF), consisting of four subscales (Stereotype awareness, Stereotype agreement, Application to self, Harm to self-esteem), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales. Results: On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on Application to self to 28.3 (SD = 7.5) points on Stereotype awareness. Results showed higher scores on Application to self for individuals who were younger (t =2.65, p=0.009) and single (F = 5.70, p = 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher Application to self stigma ( = 0.18, p = 0.044), controlling for sociodemographic covariates. Discussion: Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.

Introduction: Attention deficit hyperactivity disorder (ADHD) is a common disease in childhood and adolescence. In about 60% of pediatric patients, the symptoms persist into adulthood. Treatment guidelines for adult ADHD patients suggestmultimodal therapy consisting of psychostimulants and psychotherapy.Many adult ADHD patients also suffer frompsychiatric comorbidities, among others obsessive–compulsive disorder (OCD). The treatment of the comorbidity of ADHD and OCD remains challenging as the literature is sparse. Moreover, the impact of psychostimulants on obsessive–compulsive symptoms is still unclear. Case Presentation: Here, we report on a 33-year-old patient with an OCD who was unable to achieve sufficient remission under long-term guideline-based treatment for OCD. The re-examination of the psychological symptoms revealed the presence of adult ADHD as a comorbid disorder. The patient has already been treated with paroxetine and quetiapine for the OCD. Due to the newly established diagnosis of ADHD, extendedrelease methylphenidate (ER MPH) was administered in addition to a serotonin reuptake inhibitor. After a dose of 30mg ER MPH, the patient reported an improvement in both the ADHD and the obsessive–compulsive symptoms. After discharge, the patient reduced ER MPH without consultation with a physician due to subjectively described side effects. The discontinuation of medication led to a renewed increase in ADHD and obsessive– compulsive symptoms. The readjustment to ER MPH in combination with sertraline and quetiapine thereafter led to a significant improvement in the compulsive symptoms again. Conclusion: The present case shows that in ADHD and comorbid obsessive–compulsive disorder, treatment with psychostimulants can improve the obsessive–compulsive symptoms in addition to the ADHD-specific symptoms. To our knowledge, this is only the second case report describing a treatment with ER MPH for an adult patient with OCD and ADHD comorbidity in the literature. Further research, especially randomized controlled trials, is needed to standardize treatment options.

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In 2023, medication for opioid use disorder (MOUD), including methadone and buprenorphine, remains the most effective intervention for preventing overdose death among people who consume opioids. Yet, among those seeking treatment for opioid use disorder (OUD), there are disparities in access, quality of care, and treatment outcomes. Those disparities are related to attributes of people who use opioids, the circumstances of use, the nature of opioid use as a disease, and the design of services to treat the disease. The complex relationships between these attributes are not well articulated or understood. Health services research recognizes the biopsychosocial nature of the health conditions but research to improve treatment for OUD calls for a comprehensive, integrative, transdisciplinary approach. This dissertation presents such an approach by focusing on the biological and psychosocial implications of trauma and traumatic stress disorders in the etiology, presentation, and treatment of OUD. Aim 1 was to leverage a preclinical animal model in neuroscience to investigate how a fear memory cue may trigger recurrence of drug-seeking. Aim 2 was to examine how primary care clinicians incorporate principles of Trauma-Informed Care into OUD treatment based on qualitative interview accounts of their practices. Aim 3 was to leverage a longitudinal retrospective analysis of linked medical records and claims data to estimate the effect of post-traumatic stress disorder (PTSD) diagnosis on health services utilization and explores effect moderation by race and gender. The findings from the three studies inform each other, and the dissertation helps to clarify the significance of trauma in effectively and equitably serving people with OUD. Theoretically, the dissertation incorporates the tenets of Nancy Krieger’s Ecosocial Theory in its explication of OUD treatment. Ecosocial theory builds on the biopsychosocial approach in its inclusion of societal arrangements of power and structural oppression as shaping the pathways of embodiment. Many people with OUD incorporate lived experience of trauma. Utilization of formal OUD treatment settings can shape pathways of embodiment and may be yet another adverse exposure. The socially produced determinants of traumatic stress disorders and associated OUD should encourage health scientists to think critically and systematically about the connections between our biological, social, and psychological existence to be able to effectively respond to OUD as a complex biopsychosocial phenomenon. / 2025-08-23T00:00:00Z

Background: Mental illness affects about one in eight people and is seen to increase in society. Patients diagnosed with mental illness also often suffer from physical illness and are in a large extent in need of hospital care. A litterature review containing healthcare professionals experience of caring for patients with mental and physical comorbidity in other healthcare facilities than psychiatry, may be of importance to create an understanding of experiences of caring for patients with mental and physical comorbidity. Aim: To describe healthcare professionals experiences of providing care to patients with mental and physical comorbidity in other facilities than psychiatry. Methods: This study contains eight empirical studies from the databases Cinahl and Pubmed with qualitative approach that were reviewed, analyzed and compiled. Results: The analysis resulted in two main categories ”To experience organizational flaws” and ”Negative attitudes and feelings complicates the healthcare” Conclusion: The litterature study and previous research indicate the importance of ensuring that the care environment is adapted and that the collaboration between psychiatric care and somatic care should be strengthened. The litterature study and previous research also show that increased knowledge about mental illnesses among healthcare professionals could contribute to reduce stigma and provide conditions for a better care to patients with mental and physical comorbidity / Bakgrund: Psykisk sjukdom drabbar ungefär en av åtta personer och ses öka i samhället. Patienter som är diagnosticerade med psykisk sjukdom lider även ofta av fysiska sjukdomar och är i stor utsträckning i behov av sjukhusvård. En litteraturstudie innehållande vårdpersonals erfarenheter av att vårda patienter med psykisk och fysisk samsjuklighet utanför psykiatrin, kan vara av vikt för att skapa förståelse kring erfarenheter av att vårda patienter med samsjuklighet. Syfte: Att beskriva vårdpersonals erfarenheter av att vårda patienter med psykisk och fysisk samsjuklighet utanför psykiatrin. Metod: Studien baserades på åtta empiriska studier från databaserna Cinahl och Pubmed med kvalitativ ansats som granskades, analyserades och sammanställdes. Resultat: Analysen resulterade i två huvudkategorier: “Att uppleva organisatoriska brister” och “Negativa attityder och känslor försvårar vården”. Konklusion: Litteraturstudiens resultat och tidigare forskning pekar på att det är av vikt att säkerställa att vårdmiljön anpassas och att samarbetet mellan psykiatrin och somatiken bör stärkas. Litteraturstudiens resultat och tidigare forskning visar även att ökad kunskap hos vårdpersonal om psykiska sjukdomar skulle kunna bidra till minskad stigmatisering och ge förutsättningar för att ge bättre vård till patienter med psykisk och fysisk samsjuklighet

Comorbidity of mental illness and substance abuse has become increasingly common, this study examines social factors that can influence the stability of comorbidity and also aims to identify themes linked to comorbidity in relation to social work. By applying a systematic literature study a search was conducted through various databases and  a total of 14 articles were reviewed. The method for analysis was a qualitative thematic analysis and the results are based on the themes that were identified, these were; treatment (motives, engagement and results), trauma (childhood trauma) and social factors (including social support, age and gender). The results show that several factors have been identified. Factors that can influence treatment outcome and stability of comorbidity are not single independent factors. These can be a combination of several factors that can be influenced by several circumstances. The results also show that information about abuse motives can be predicting to treat the comorbidity. To have access to social support during the treatment is also predicting for the treatment outcomes, social support can be given by family, friends, group members from the treatment setting or from the treatment therapists. Traumatic experiences among individuals with substance abuse is very common and it has shown that many clients use substances to relieve the symptoms that occur as a consequence of trauma. Other factors can also influence the stability of comorbidity such as demographic characteristics. Most of the articles show that age and gender can affect the treatment outcome. It has shown that where the clients are a majority in the characteristics (either gender or age) the treatment result is better for them compared to the minority group. Finally the author discusses the relevance of social work and the conclusions from the analysis.