Demographic, socioeconomic, and clinical trends of dual diagnosis admissions

Abstract

Background – Present literature has identified factors that correlate with increased numbers of hospital admissions in dual diagnosis patients. These generally correlate to young, single, male adults with poor education levels, homelessness, and both financial and legal problems. Nevertheless, across both foreign and local studies, there is still a dearth of literature which has not yet been explored extensively, related to the demographic, socioeconomic, and clinical factors which lead to the admission of dual diagnosis patients. Aim - To explore possible potential demographic, socioeconomic, and clinical variables leading to admission in Dual Diagnosis Units (DDU) in Malta. Participants – 568 admissions to the DDUs over a 3-year period between 2018 and 2020, of which 287 were males and 281 were females. Design – A retrospective document analysis of hospital documentation was conducted enabling the collection of demographic, socioeconomic, and clinical trends which potentially relate to the admission of individuals admitted to the DDUs. Setting – This study took place at the Dual Diagnosis Units (DDUs) of the local state psychiatric hospital. All data collection conducted by the researcher was performed in a private room within the same hospital setting. Results – There were several demographic, socioeconomic, and clinical factors which led to the admission of DDU patients. Moreover, there were several significant differences between the male and female DDU patients. FDDU patients had more severe drug dependence, severe clinical, psychological, and social problems, lower socioeconomic and demographic backgrounds, compared to MDDU patients. Furthermore, a considerable number of trends changed over the years of admission, alas this was majorly due to the effects of the COVID-19 pandemic in 2020. Conclusion – Several factors (single, unemployment, homelessness, poor income, living with parents, childhood abuse, relationship breakup, prostitution, early onset of drug abuse and living in the southern harbour) were identified as prevalent factors of DDU admissions. Additionally, several significant differences were identified between male and female patients at the DDUs. Female patients had more severe drug dependence, psychosocial problems, and came from lower socioeconomic and demographic backgrounds, compared to male patients. Moreover, across the years of admission, several shifts in trends were identified. In the year 2020, an increase in admissions of individuals who were of elder age, foreign, homeless, unemployed, diagnosed with BPAD and PTSD, had a drug dependence of over 20 years, used 3+ grams and over €100 daily, and had a history of suicide/parasuicide was identified, possibly due to the economic and psychosocial effects of the COVID-19 pandemic. This study signifies the importance and need to provide the MDDU and FDDU patients with individualised care. Moreover, better awareness, campaigns and support are needed in the community, to prevent and manage possible contributing factors from early childhood.