The role of depression in healthcare service utilization and opioid agonist treatment among persons with co-occurring opioid use and depressive disorders
Embargo until
2021-12-01
Date
2020-08-25
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Johns Hopkins University
Abstract
Background: Depression is the most common co-occurring mental health disorder among persons with opioid use disorder (OUD). Psychiatric comorbidity can impact healthcare utilization, particularly emergency department visits and hospitalizations, as well as continuity of treatment for opioid use disorder. The objectives of this dissertation are to enhance understanding of characteristics and health conditions among persons with co-occurring OUD and depression, and to explore the role depression plays in healthcare utilization and continuity of buprenorphine treatment.
Methods: Data were obtained from the Geisinger Health System (GHS), and included electronic health records for all healthcare encounters that occurred at any of the GHS facilities before the fall of 2019. In addition to electronic health records, ordered and dispensed prescription records were used. Adults 18 years old or older included in each of the study samples were recruited from one of Geisinger’s outpatient addiction treatment clinics and all had at least one recorded OUD diagnosis in their electronic health record. Differences in characteristics and other diagnoses between persons with and without depression were assessed by multivariable logistic regression. Propensity score weighted Cox regression survival analysis for recurrent events was used to assess the association between OUD with prior depression and healthcare utilization. Propensity score weighted logistic regression was used to estimate odds of 180-day retention and any treatment discontinuation, and propensity score weighted Cox proportional hazards regression was implemented to estimate the hazard of treatment gaps or discontinuation for those with and without prior depression.
Results: Forty-nine percent of adults with OUD had a lifetime depression diagnosis. Persons with co-occurring depression were more likely to be female and have other common medical conditions, as well as other mental health and substance use disorders, and/or at least one overdose or suicide attempt or ideation. Compared to OUD without prior depression, OUD with prior depression was associated with increased risk of emergency department visits that included a substance use disorder, suicidal ideation or suicide attempt and/or mental health disorder code. Any prior or past year depression was associated with increased risk of treatment gap and/or discontinuation and past year depression was associated with decreased odds of 180-day buprenorphine treatment retention.
Conclusions: This dissertation highlights the complex healthcare needs of persons with co-occurring opioid use and depressive disorders, and the particular importance of the integration of depression care into medical care and treatment for opioid use disorder.
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Keywords
opioid use disorder, co-occurring opioid use and depression disorder, psychiatric comorbidity, opioid agonist treatment, healthcare service utilization