Background: Mental health and substance use disorders typically onset during youth and commonly co-occur. Integrated treatment of two or more co-existing mental health and substance use disorders (i.e., concurrent disorders) is increasingly prevalent in real-world clinical settings. However, the depth of the evidence base on best practices remains unclear.
Objectives: This scoping review aimed to identify, map and summarize peer-reviewed studies of interventions for concurrent disorders in youth.
Methods: Six electronic health databases were systematically searched, in addition to a hand search of the reference lists of relevant systematic reviews. Only peer-reviewed studies of interventions treating concurrent disorders (i.e., simultaneous treatment of two or more disorders) in youth (10-29 years old) were eligible. Two independent reviewers conducted screening and data extraction. Results were charted according to studies employing pharmacological and non-pharmacological interventions.
Results: Thirty peer-reviewed studies were included, 19 (63.3%) were randomized controlled trials (RCTs). Most studies enrolled participants with an unspecified substance use disorder (n=17, 56.7%), while alcohol use was the primary substance use disorder in seven (23.3%) studies, followed by cannabis use disorder in six (20.0%) studies. Mood disorders (e.g., depression, dysthymia) were the most common concurrent mental health disorders comprising 15 (50%) studies, followed by nine (30.0%) studies of behavioural disorders (e.g., ADHD) and five (16.7%) studies of unspecified psychiatric disorders. Eighteen (60.0%) studies (n=1,699 participants) investigated the effectiveness of various non-pharmacological interventions, while 12 (40.0%) studies examined pharmacotherapies (n=765 participants).
Conclusion: Although several RCTs were identified, substantial clinical and methodological heterogeneity was evident among the studies (e.g., patients with multiple disorders, and multi-faceted interventions). Smaller systematic reviews focused on specific interventions (e.g., behavioural therapies) and concurrent disorders (e.g., depression and substance use) may be warranted. Due to considerable heterogeneity, more RCTs are needed before conducting larger systematic reviews or meta-analyses.
Contexte: Les troubles de santé mentale et les troubles liés à l'usage de substances psychoactives apparaissent généralement pendant la jeunesse et sont souvent concomitants. Le traitement intégré de deux ou plusieurs troubles coexistants de santé mentale et liés à l'usage de substances psychoactives (c.-à-d. troubles concomitants) est de plus en plus prévalent dans le milieu clinique réel. Toutefois, la profondeur de la base de connaissances sur les meilleures pratiques reste peu claire.
Objectifs: Cette étude de la portée visait à recenser, cartographier et résumer les études évaluées par des pairs portant sur les interventions relatives aux troubles concomitants chez les jeunes.
Méthodologie: Six bases de données électroniques sur la santé ont fait l'objet d'une recherche systématique, en plus d'une recherche manuelle des listes de référence des revues systématiques pertinentes. Seules les études évaluées par des pairs et portant sur des interventions destinées à traiter des troubles concomitants (c.-à-d. le traitement simultané de deux troubles ou plus) chez les jeunes (10 à 29 ans) étaient retenues. Deux examinateurs indépendants ont procédé à la sélection et à l'extraction des données. Les résultats ont été classés en fonction des études utilisant des interventions pharmacologiques et non pharmacologiques.
Résultats: Trente études évaluées par des pairs ont été incluses, dont 19 (63,3 %) étaient des essais cliniques randomisés (ECR). La plupart des études ont recruté des participants souffrant d'un trouble lié à l'usage de substances psychoactives non spécifié (n = 17, 56,7 %), tandis que la consommation d'alcool était le principal trouble lié à l'usage de substances psychoactives dans sept études (23,3 %) suivi par le trouble lié à l'usage du cannabis dans six études (20,0 %). Les troubles de l'humeur (p. ex., dépression, dysthymie) étaient les troubles mentaux concomitants les plus fréquents, avec 15 études (50 %), suivies de neuf études (30 %) consacrées aux troubles du comportement (p. ex., TDAH) et de cinq études (16,7 %) portant sur des troubles psychiatriques non spécifiés. Dix-huit études (60 %) (n = 1 699 participants) ont examiné l'efficacité de diverses interventions non pharmacologiques, tandis que 12 études (40 %) s'intéressaient aux pharmacothérapies (n = 765 participants).
Conclusion: Bien que plusieurs ECR aient été recensés, une grande hétérogénéité clinique et méthodologique a été constatée entre les études (p. ex., patients souffrant de troubles multiples et interventions à volets multiples). Des revues systématiques plus restreintes, axées sur des interventions particulières (p. ex., thérapies comportementales) et sur des troubles concomitants (p. ex., dépression et toxicomanie), pourraient être justifiées. En raison de l'hétérogénéité considérable, davantage d'ECR sont nécessaires avant de procéder à des revues systématiques ou à des méta-analyses de plus grande envergure.
Keywords: adolescent; co-occurring disorders; concurrent disorders; interventions; substance use disorders; substance-related disorders; treatment modalities; young adult; young people; youth.
Evidence-based interventions for youth with concurrent mental health and substance use disorders: A scoping reviewPlain Language SummaryWhy was the study done?This study aimed to explore the treatment of concurrent mental health and substance use disorders in youth, as these conditions often occur together and are difficult for clinicians to treat. Best practices remain unclear.What did the researchers do?The researchers conducted a scoping review, systematically searching six electronic health databases for peer-reviewed studies focused on interventions for youth (ages 10-29) dealing with both mental health and substance use disorders. They screened and extracted data independently from eligible studies.What did the researchers find?The review included 30 studies, and 63.3% were randomized controlled trials (RCTs). A majority (56.7%) of the studies included participants with unspecified substance use disorders. The most common specified substance use disorders were alcohol (23.3%), and cannabis (20.0%). Mood disorders were prevalent in 50.0% of the studies, followed by behavioural disorders (30.0%) and unspecified psychiatric issues (16.7%). Non-pharmacological interventions were investigated in 60.0% of the studies, and pharmacological interventions were examined in 40.0%.What do the findings mean?The review found several studies, but they varied significantly in participant population and study design, highlighting a need for more RCTs for youth with concurrent disorders. Additional research will help establish clearer clinical practice guidelines and inform future systematic reviews and meta-analyses.