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A Change in Perspective: From Dual Diagnosis to Multimorbidity
Ish P Bhalla1, Robert A Rosenheck1
1The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Psychiatric Services (Washington, D.C.)
|October 17, 2017
Summary
Psychiatric patients often have multiple disorders that worsen each other. A multimorbidity approach is better for real-world psychiatric care than focusing on single diagnoses.
Area of Science:
- Psychiatry
- Health Services Research
Background:
- Growing interest in psychiatric multimorbidity due to concurrent disorders exacerbating each other and influencing treatment.
- Lack of established metrics for documenting multimorbidity in psychiatric clinical practice.
Purpose of the Study:
- To define and evaluate indicators for documenting multimorbidity in psychiatric care.
- To assess the prevalence of multimorbidity among veterans in mental health specialty clinics.
Main Methods:
- Defined four classes of indicators relevant to multimorbidity.
- Evaluated these indicators among veterans in the Veterans Health Administration (VHA) mental health specialty clinics.
- Analyzed data from fiscal year 2012.
Main Results:
- 94.6% of 843,583 veterans with ≥3 mental health visits had multiple general medical or mental disorders.
- 77.6% had more than one mental disorder.
- 30.6% had co-occurring psychiatric and substance use disorders.
Conclusions:
- The multimorbidity perspective offers a more accurate approach to real-world psychiatric care.
- This perspective is superior to focusing on principal, dual, or comorbid diagnoses alone.