TY - JOUR
AU - S. Sandelich
AU - C. Buresh
AU - S. Axson
AU - B. Linn
AU - M. Mareboina
A1 - 
AB - PURPOSE: 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. METHODS: 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. RESULTS: 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). DISCUSSION: 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.
AD - Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America; Penn State College of Medicine, Hershey, PA, United States of America. Electronic address: ssandelich@pennstatehealth.psu.edu.; Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America.; Ross and Carol Nese College of Nursing, University Park, PA, United States of America.; Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America.; Penn State College of Medicine, Hershey, PA, United States of America.
AN - 41352628
BT - J Affect Disord
C5 - Opioids & Substance Use; Healthcare Disparities
DA - Mar 1
DO - 10.1016/j.jad.2025.120808
DP - NLM
ET - 20251204
JF - J Affect Disord
LA - eng
N2 - PURPOSE: 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. METHODS: 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. RESULTS: 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). DISCUSSION: 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.
PY - 2026
SN - 0165-0327
SP - 120808
ST - Healthcare utilization patterns among adolescents with dual diagnoses of mental health and substance use disorders
T1 - Healthcare utilization patterns among adolescents with dual diagnoses of mental health and substance use disorders
T2 - J Affect Disord
TI - Healthcare utilization patterns among adolescents with dual diagnoses of mental health and substance use disorders
U1 - Opioids & Substance Use; Healthcare Disparities
U3 - 10.1016/j.jad.2025.120808
VL - 396
VO - 0165-0327
Y1 - 2026
ER -