Latent class profile of psychiatric symptoms and treatment utilization in a sample of patients with co-occurring disorders

Abstract

Objective: To identify symptom-based subgroups within a sample of patients with co-occurring disorders (CODs) and to analyze intersubgroup differences in mental health services utilization. Methods: Two hundred and fifteen patients with COD from an addiction clinic completed the Symptom Checklist 90-Revised. Subgroups were determined using latent class profile analysis. Services utilization data were collected from electronic records during a 3-year span. Results:The five-class model obtained the best fit (Bayesian information criteria [BIC] = 3,546.95; adjusted BIC = 3,363.14; bootstrapped likelihood ratio test p o 0.0001). Differences between classes were quantitative, and groups were labeled according to severity: mild (26%), mild-moderate (28.8%), moderate (18.6%), moderate-severe (17.2%), and severe (9.3%). A significant time by class interaction was obtained (chi-square [w Conclusion:The classes with more symptom severity (moderate-severe and severe) displayed lower utilization of services across time when compared to participants belonging to less severe groups. However, as pairwise differences in treatment utilization between classes were not significant between every subgroup, future studies should determine whether subgroup membership predicts other treatment outcomes.

Patterns and temporal change of psychopathological symptoms among inpatients with alcohol use disorder undergoing a twelve-step based treatment

“…In line with some of the previous findings, quantitative differences were observed between the subgroups ( Urbanoski et al, 2015 , Villalobos-Gallegos et al, 2017 ). Namely, classes were separated by symptom profiles with intensifying severity at both measurement points.…”

“…which might have influenced characteristics of the latent classes. This data pattern also corresponds with the concept of hierarchical structure of psychopathology: a higher order dimension of internalizing psychopathology might explain the interrelations of psychopathological symptoms within each class and represent a severity-based risk for experienced psychopathological difficulties ( Kotov et al, 2017 , Villalobos-Gallegos et al, 2017 ).…”

“…These methods allow to obtain better understanding on the heterogeneity within AUD by distinguishing subgroups of individuals where members within each identified class show similar profiles and combinations of psychopathological comorbidity. Among individuals with AUD either from treatment seeking or general population samples, previous studies have identified three to five distinct subgroups based on indicator variables assessing co-occurring psychopathological symptom levels or disorder presence ( Glass et al, 2014 , Müller et al, 2019 , Urbanoski et al, 2015 , Villalobos-Gallegos et al, 2017 , Wallen et al, 2019 ). These studies have been conflicting in terms of the observed differences between the identified latent classes: quantitative (e.g., parallel and severity-based psychopathological symptom profiles; Villalobos-Gallegos et al, 2017 ) and qualitative differences have been suggested between the psychopathology-based subgroups (e.g., classes with mainly externalizing and internalizing comorbidity; Glass et al, 2014 ).…”

“…However, to the best of the authors’ knowledge, no previous study has examined treatment-seeking individuals with AUD profile characteristics as well as temporal change patterns of comorbid psychopathology-based latent classes during an AUD-related treatment participation. Classification participants based on psychopathological symptom severity and change profiles can help (i) to identify subgroups of AUD to whom a given treatment form can be considered as more effective, (ii) to design more individually-customized interventions and (iii) to specify in a more in-depth way how comorbid psychopathological symptoms alter treatment outcomes ( Lanza and Rhoades, 2013 , Urbanoski et al, 2015 , Villalobos-Gallegos et al, 2017 ).…”

“…The aim of the present study was to examine patterns of severity and changes of psychopathological symptoms among subgroups of AUD inpatients attending a twelve-step based treatment program. It was hypothesized that the psychopathological-based latent classes of AUD can be discriminated in terms of symptom severity and temporal change patterns ( Jung and Wickrama, 2008 , Villalobos-Gallegos et al, 2017 ). However, it is important to note, that theoretical and practical conclusions, such as structure of psychopathology in the AUD population or assessment of specific treatment effects, can only cautiously be drawn from the present study due to its methodological limitations (e.g., lack of randomized controlled trial, follow-up data collection, examination of treatment moderators and mediators, potential self-selection bias of the participants, and inclusion of relevant confounding variables).…”