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Substance misuse and psychiatric illness: prospective observational study using the general practice research

Martin Frisher1, Ilana Crome, John Macleod

  • 1Department of Medicines Management, Keele University, Staffordshire ST5 5BG, UK. m.frisher@mema.keele.ac.uk

Journal of Epidemiology and Community Health
|September 17, 2005
PubMed
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Psychiatric illness is linked to substance misuse, but a larger proportion of substance misuse cases are linked to prior psychiatric illness. This suggests psychiatric conditions may precede and contribute to substance use disorders.

Area of Science:

  • Public Health
  • Psychiatry
  • Epidemiology

Background:

  • Substance misuse and psychiatric illness frequently co-occur.
  • Understanding the directionality of this relationship is crucial for effective public health interventions.

Purpose of the Study:

  • To quantify the relationship between substance misuse and psychiatric illness in the UK general practice population.
  • To determine the relative risk and attributable proportion of each condition given prior exposure to the other.

Main Methods:

  • A population-based prospective observational study was conducted using the General Practice Research Database (GPRD) from 1993 to 1998.
  • Data from 1.4 million patients across 230 general practices in England and Wales were analyzed.
  • Relative risk (RR) and population attributable risk (PAR) were calculated to assess the association.

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Main Results:

  • The prevalence of psychiatric illness was 15% and substance abuse was 0.3%.
  • Individuals with substance misuse had a 1.54 times higher risk of developing psychiatric illness (RR=1.54).
  • Individuals with psychiatric illness had a 2.09 times higher risk of developing substance misuse (RR=2.09), with 14.2% of substance misuse cases attributable to psychiatric illness.

Conclusions:

  • A small proportion of psychiatric illness is attributable to substance misuse.
  • A substantial proportion of substance misuse is attributable to psychiatric illness.
  • The findings do not support the hypothesis that comorbidity is primarily driven by substance misuse.