Healthcare utilization patterns among adolescents with dual diagnoses of mental health and substance use disorders

The co-occurrence of substance use disorders and mental health disorders in adolescents, known as dual diagnosis, complicates treatment adherence, heightens relapse risk, and increases engagement in risky behaviors. This study contrasts these groups' healthcare utilization, interventions, and clinical profiles.

In a retrospective, longitudinal cohort study using the TriNetX Research Database, we analyzed data from 82 U.S. healthcare organizations. The study encompassed 1,757,913 adolescents aged 10 to 21 diagnosed with substance use disorders, mental health disorders, and a combination of both from 2004 to 2023. Propensity score matching was applied to adjust for demographic and clinical variables, assessing healthcare utilization, treatment initiation, and social challenges.

Among 1,757,913 adolescents, 14.0 % (n = 246,776) had a dual diagnosis. Compared with isolated MHD, adolescents with DDx had significantly higher odds of emergency department use (OR 2.64, 95 % CI 2.27-2.70) and inpatient hospitalization (OR 2.73, 95 % CI 2.69-2.77). Relative to isolated SUD, DDx also showed elevated ED use (OR 1.56, 95 % CI 1.53-1.58) and inpatient care (OR 2.55, 95 % CI 2.50-2.61). Pharmacologic treatment initiation was more common in DDx, including antidepressants (53.1 % vs. 44.8 % MHD; OR 1.40, 95 % CI 1.38-1.42) and antipsychotics (35.5 % vs. 18.9 % MHD; OR 2.36, 95 % CI 2.33-2.39). DDx also demonstrated higher rates of social and environmental problems (19.3 % vs. 8.6 % MHD and 3.9 % SUD).

Adolescents with dual diagnoses constitute a distinct demographic with intricate clinical profiles and heightened healthcare needs, emphasizing the need for integrated care approaches that address clinical symptoms and social determinants. Early identification and comprehensive interventions are crucial to improving outcomes.