A Change in Perspective: From Dual Diagnosis to Multimorbidity

Psychiatr Serv. 2018 Jan 1;69(1):112-116. doi: 10.1176/appi.ps.201700194. Epub 2017 Oct 16.


Objective: There has been increasing interest within psychiatry in the concept of multimorbidity because psychiatric patients typically present with multiple concurrent disorders, these disorders mutually exacerbate one another, and their interaction shapes treatment options. Metrics have not been developed to document multimorbidity in psychiatric clinical practice.

Methods: Four classes of indicators relevant to multimorbidity were defined and evaluated among veterans treated in mental health specialty clinics nationally in the Veterans Health Administration (VHA) in fiscal year 2012.

Results: Of the 843,583 veterans with at least three visits to a specialty mental health clinic, 94.6% had more than one general medical or mental disorder and 77.6% had more than one mental disorder, compared with 30.6% with co-occurring psychiatric and substance use disorders.

Conclusions: Real-world psychiatric care is more accurately approached from the multimorbidity perspective than from the perspective of principal, dual, or comorbid diagnoses.

Keywords: Comorbidity; Dual diagnosis; Medical morbidity and mortality in psychiatric patients; Morbidity; Substance-Related Disorders.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Diagnosis, Dual (Psychiatry)*
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Multimorbidity*
  • Multiple Chronic Conditions / epidemiology*
  • Substance-Related Disorders / epidemiology
  • United States / epidemiology
  • United States Department of Veterans Affairs / statistics & numerical data
  • Veterans / statistics & numerical data*