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SO080

Psychiatric multimorbidity around the first diagnosis of substance use disorder in adolescents and young adults: a nationwide Swedish register study

PSYCHIATRIC MULTIMORBIDITY SURROUNDING THE FIRST SUBSTANCE USE DISORDER DIAGNOSIS AMONG ADOLESCENTS AND YOUNG ADULTS: A NATIONWIDE SWEDISH REGISTER STUDY

Approximately half of young people receive their first substance use disorder diagnosis in isolation, but psychiatric multimorbidity increases markedly within the two years following diagnosis, with internalizing disorders becoming increasingly prominent.

The study aimed to examine how psychiatric multimorbidity develops and how diagnoses overlap around the first recorded diagnosis of substance use disorder (SUD) in young people. Using nationwide Swedish register data (1980-2022), all individuals born between 1980 and 2000 who received their first SUD diagnosis between the ages of 10 and 25 were identified (n = 129,455); diagnoses were defined using ICD-10 codes (SUD = F10-F19, other psychiatric diagnoses = F00-F09 and F20-F99). Multimorbidity states were defined across four observation windows relative to the first SUD diagnosis: the pre-index year (t - 365 days), the index day (first SUD diagnosis), the first post-index year (t + 1 day to t + 365 days), and the second post-index year (t + 366 days to t + 730 days); associations between sociodemographic variables and membership in the most common trajectories and diagnostic overlaps were examined using logistic regression. In the pre-index year, 79.3% of individuals had no healthcare encounters, while 11.7% received a single non-SUD F-code diagnosis and 9.0% received two or more non-SUD F-code diagnoses; on the index day, 78.6% had SUD only, 12.5% had one SUD and one other F-code diagnosis, 3.9% had one SUD and two or more other F-code diagnoses, and 3.8% had two or more SUD diagnoses. In the first post-index year, the proportion with no healthcare encounters fell to 59.0%, while 7.9% had one SUD and one other F-code diagnosis, 6.2% had two or more SUD diagnoses, and 10.2% had one SUD and two or more other F-code diagnoses; in the second post-index year, the proportion with no healthcare encounters rose to 72.0%, with rates of 8.0%, 6.3%, and 4.4% observed in the remaining groups. Key findings included the presence of distinct developmental trajectories, an increase in internalizing disorders following SUD diagnosis, and variation in developmental pathways by SUD type, sex, age, and socioeconomic status (SES); the most common co-occurrence was alcohol use disorder with neurotic/stress-related disorders, and these patterns were not associated with migration background. In conclusion, the first SUD diagnosis may represent a critical opportunity for comprehensive psychiatric screening, early identification of vulnerable individuals, and targeted follow-up within youth mental health services; the poster recommends early screening, longitudinal monitoring, and holistic treatment.

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