Healthcare resource utilisation and suicidal ideation amongst adolescents in the US with posttraumatic stress disorder, major depressive disorder, and substance use disorders using electronic health records

• Published in: Journal of affective disorders 2024-11, Vol.365, p.73-79
• Main Authors: Chan, Kelly M.Y., Low, Li Tong, Wong, Joshua G., Kuah, Sherwin, Rush, A. John
• Format: Article
• Language: English
• Subjects: EHR; HCRU; MDD; PTSD; Real-world evidence; SUD
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2024.08.055

While PTSD is commonly associated with multiple comorbidities, studies have yet to quantify the impact of these comorbidities on key clinical outcomes and HCRU. This study explored risks of emergency room (ER) visits, inpatient admissions (IA), suicidal ideation (SI), and treatment follow-up duration (FU), amongst PTSD patients with comorbid MDD and/or SUD. Using real-world data (RWD) generated by electronic health records accessed from the NeuroBlu database, a cohort of adolescent patients (12-17 yrs) was examined over a one-year study period following PTSD diagnosis. 5794 patients were included in the cohort. Compared to patients with only PTSD (n = 3061), those with comorbid MDD (n = 1820) had greater odds of ER (4.5 times), IA (1.6 times), and FU (4.3 times). Those with comorbid SUD (n = 653) had greater odds of IA (4.5 times), shorter FU (34 days), and lower odds of ER (0.5 times). Both comorbidities (n = 260) had greater odds of ER (3.8 times), IA (2.6 times), SI (3.6 times), and shorter FU (12 days). These RWD had a high proportion of missingness. Health records of patients who changed service providers could not be accounted for in this study. Both MDD and SUD substantially elevated the risk of HCRU and suicidal ideation for PTSD patients. •Limited literature studying the cumulative effects of major depressive disorder (MDD) and substance use disorder (SUD) on adolescents diagnosed with PTSD.•Comorbid MDD and SUD was respectively present in 31 % and 11 % of the 5794 adolescents diagnosed with PTSD.•Minimally, the odds of inpatient admission is at least 40 % higher in patients with comorbid MDD or SUD present, with the odds of patients with comorbid SUD being admitted to the hospital being 4.5 times higher than those with PTSD only.•Patients with both MDD and SUD were not observed to develop worse outcomes.•Screening for comorbid MDD and SUD may substantially improve prognosis of PTSD in adolescents.