A recent study has found that patients who have both systemic lupus erythematous (SLE) and major depressive disorder (MDD) are more likely to have issues with substance use disorder (SUD) including alcohol, tobacco, opioids, and cannabis. The study, led by Xiaofeng Yan, MD, PhD, aimed to investigate the prevalence of SUD diagnoses amongst patients with comorbid MDD in SLE patients, as well as whether SUD is higher amongst those with SLE.
Previous research has already shown that patients with SLE have a higher prevalence of MDD and are more likely to drink alcohol. This study utilised data from I2B2, a de-identified dataset from the electronic medical record (EMR) of a university-affiliated hospital, including data from inpatient and outpatient settings. Researchers used ICD10 codes to guide the search and identified 743 patients with SLE and 37,623 patients with MDD. Out of the comorbid MDD group, 317 patients had SLE. The majority of patients were female (88%) and aged between 50-60 years (26%).
The study found that 42.66% of the patient population with SLE also had MDD, but only 132 were treated with antidepressants (41.64%). Patients with comorbid MDD were more likely to have diagnoses of tobacco, alcohol, opioid, cannabis, stimulant, hallucinogen, sedative-hypnotic, and anxiolytic use disorders compared to patients with only SLE. Tobacco was found to be the most common SUD, while sedative, hypotonic, and anxiolytic use disorders were the least common.
The authors of the study concluded that there is a consistently higher rate of SUD diagnoses amongst patients diagnosed with SLE and comorbid MDD compared to SLE alone. They recommend that clinicians screen for substance use disorders when patients have comorbid MDD to improve clinical care and outcomes.
In another study, a symptom checklist was developed to help primary care physicians better diagnose and assess the severity of patients with SUD. Led by Thomas E. Matson, PhD, MPH, Kaiser Permanente Washington Health Research Institute, the study evaluated the psychometric properties of the Substance Use Symptom Checklist used in primary care among patients who report daily cannabis use and/or other drug use.
SUDs are often under-recognised in primary care settings as structured clinical interviews can be infeasible. However, a brief, standardised substance use symptom checklist could help assess SUD. The study involved 23,304 individuals with a mean age of 38.2 years, of whom 16,140 reported daily cannabis use only, 4791 reported other drug use only, and 2373 reported daily cannabis and other drug use.
The results showed that 26.3% of patients in the daily cannabis use only group endorsed two or more items on the symptom checklist consistent with DSM-5 SUD, compared to 30.2% of the other drug use group and 51.8% of the daily cannabis and other drug use group. This symptom checklist could enable primary care physicians to better diagnose and assess the severity of patients with SUD.
In summary, these studies highlight the need for clinicians to screen for substance use disorders in patients with comorbid SLE and MDD and demonstrate the usefulness of symptom checklists in assessing SUDs in primary care settings. Early diagnosis and treatment of substance use disorders can lead to better clinical care and outcomes.
