Anxiety, substance use, adherence to treatment and level of functioning in specialized psychiatric care patients

Research output: ThesisDoctoral ThesisCollection of Articles


A high proportion of patients with mental disorders experience concurrent anxiety symptoms and substance abuse, which impacts the course and outcome of principal psychiatric disorders and increases the risk of physical morbidity and suicide. Another prominent problem that worsens outcome and increases healthcare costs, is poor adherence to psychiatric treatment. As a consequence of severe course and poor treatment adherence, mental disorders are highly disabling. Because of methodological variations in the studies on anxiety and substance use comorbidity, adherence, and functioning, it remains unclear whether such conditions share similar characteristics across schizophrenia spectrum and mood disorders. The Helsinki University Psychiatric Consortium Study was performed in the metropolitan area of Helsinki between 12.01.2011 and 20.12.2012, covering specialized psychiatric care units. For this study, patients were divided into three subgroups: schizophrenia or schizoaffective disorder (SSA, n=113), bipolar disorder (BD, n=99), and depressive disorder (DD, n=188). Anxiety symptoms were measured with the Overall Anxiety Severity and Impairment Scale; substance use was assessed with recorded substance use disorder diagnoses, Alcohol Use Disorders Identification Test, and original questionnaires; treatment adherence was assessed with patients´ self-reports; subjective level of functioning was assessed with the Sheehan Disability Scale; and data on objective work status were gathered from medical records. Nearly half of all patients felt severe anxiety frequently, but SSA patients less often than mood disorders peers. High neuroticism, symptoms of depression and borderline personality disorder were associated with co-occurring anxiety within all diagnostic groups. Almost half of the patients reported hazardous alcohol use or were daily smokers. Symptoms of anxiety and borderline personality disorder were associated with self-reported alcohol consumption. Outpatients were significantly more adherent than current inpatients. Non-adherence to outpatient visits was strongly associated with hospital setting and substance use disorder. Nearly one-third of mood disorder patients were employed, while in SSA patients this proportion was only 5.3%. Severe course of disease and current depressive symptoms were likely to affect work status and perceived functional impairment, respectively. Careful detection and treatment of harmful substance use and affective symptoms are necessary to enhance treatment adherence, and functional level of patients with mood or schizophrenia spectrum disorders.
Original languageEnglish
  • Isometsä, Erkki, Supervisor
  • Joffe, Grigori, Supervisor
Place of PublicationHelsinki
Print ISBNs978-951-51-4066-1
Electronic ISBNs978-951-51-4067-8
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Bibliographical note

M1 - 108 s. + liitteet

Fields of Science

  • Affective Symptoms
  • Alcohol-Related Disorders
  • Anxiety
  • Anxiety Disorders
  • +epidemiology
  • Bipolar Disorder
  • Borderline Personality Disorder
  • Cigarette Smoking
  • Comorbidity
  • Depression
  • Depressive Disorder
  • Health Status
  • Mental Disorders
  • Mood Disorders
  • Neuroticism
  • Psychotic Disorders
  • Schizophrenia
  • Schizophrenia Spectrum and Other Psychotic Disorders
  • Self Efficacy
  • Substance-Related Disorders
  • Suicide
  • Treatment Adherence and Compliance
  • 3124 Neurology and psychiatry

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