Abstract
IntroductionMental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, in children and young people in Wales, UK.MethodsA retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11–25 between 2008 and 2017. We estimated first ever incidence of CC, plotted Kaplan–Meier survival curves and carried out Cox regression to estimate hazard ratios (HR) for risk of death by condition group (CC; MD or SUD only; NC).ResultsHigher incidence of CC in WLGP and PEDW was associated with male sex, older age and greater deprivation. Male to female IRRs (95% CI) were 1.18 (1.12–1.24) in WLGP and 1.17 (1.10–1.24) in PEDW, oldest to youngest IRRs were 24.80 (21.20–29.40) in WLGP and 4.50 (4.08–4.98) in PEDW and most to least deprived IRRs were 3.28 (3.00–3.58) in WLGP and 2.59 (2.36–2.84) in PEDW. Incidence in WLGP significantly decreased between 2008 and 2017 (IRR = 0.88, 95% CI 0.78–0.99); the greatest reduction occurred in the most deprived quintile (IRR 0.67, 95% CI 0.54–0.82). Incidence of hospital admissions remained stable (IRR = 0.95, 95% CI 0.84–1.08). Risk of death was significantly higher for CC compared with NC (HR = 8.7, 95% CI 7.5–10.0).ConclusionMale sex, older age and greater deprivation were associated with higher CC incidence, although the gap between WIMD quintiles has decreased. CC was associated with greater risk of death. Mental health and substance misuse services should be provided in ways that remove barriers, and are acceptable and accessible to all, particularly those at greatest risk, or who are less likely to engage.
Highlights
Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality
The Welsh Longitudinal General Practice dataset (WLGP) incidence cohort consisted of 923,941 individuals contributing 4,391,444 person years at risk (PYAR) and the Patient Episodes Dataset for Wales (PEDW) incidence cohort consisted of 958,603 individuals contributing 4,545,876 PYAR
About 70.4% of individuals with such as illegal drugs or alcohol (SUD) had a code for MD and 8.4% of individuals with MD had a code for SUD
Summary
Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. SUD, with 75% of drug service users and 85% of alcohol service users reporting one or more MD.[3] In the UK during the 2000s, MD and SUD were found to be strongly associated with poorer than average health and greater risk of premature death.[4] During the 1990s, prevalence of CC recorded in routine primary care data in England and Wales significantly increased.[5] A study of birth cohorts from the UK (births in 1946) and New Zealand (births in 1972–73) and survey data from the USA in the late 1990s and early 2000s suggested that at least half of adult mental disorders began in adolescence, with anxiety disorders typically presenting earlier than substance use disorders and psychotic disorders.[6] There may be long-term conse quences for children and young people with these diag noses, increasing the likelihood of poorer social, physical and mental health outcomes during the course of their lives.[7] A range of individuals and services are involved in the provision of care for children and young people with MD or SUD in Wales, including parents and carers, schools, primary care, specialist child and adolescent men tal health services (CAMHS) and children’s social care.[8]
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