A variety of treatment options for people with alcohol use disorder (AUD) exist. Surveys estimate that 1 in 10 people with AUD utilise treatment, but real-world treatment pathways remain covert. This data-linkage study seeks to characterise treatment utilisation patterns to identify gaps in treatment access and delivery in Germany.

Linking individual-level data from three sources (statutory health insurance, pension funds, outpatient addiction care services) identified seven alcohol-related treatment types delivered in outpatient (brief psychiatric consultation; formal psychotherapy; pharmacotherapy; low-threshold counselling), inpatient (standard, somatic inpatient treatment; intensive inpatient treatment with somatic and psychosocial care), or either of the two settings (long-term rehabilitation treatment) during 2016–2021. For patients with a new AUD diagnosis (ICD-10: F10.1–9), treatment utilisation over 24 months was recorded and patterns were identified using latent class analyses.

Of n = 9,491 patients with a new AUD diagnosis, 30% utilised at least one alcohol-related treatment type. Treatment utilisation was associated with younger age, female sex, unemployment, German nationality, and lower physical comorbidity. Among treatment entrants, nearly half received only brief psychiatric consultation. A similar share of patients utilised standard or intensive inpatient treatment; the latter occasionally followed by rehabilitation treatment. Formal psychotherapy, low-threshold counselling, and pharmacotherapy were rarely utilised and were mostly used in conjunction with other treatments.

The real-world utilisation of alcohol-related treatments contrasts with existing guidelines, as most patients with diagnosed AUD do not receive adequate care. Structural and social barriers should be minimised to ensure healthcare provision for those affected.

Treatment-resistant depression (TRD) affects 10–30% of patients with major depressive disorder, leading to increased comorbidities, higher mortality, and significant economic and social burdens. This study aimed to compare the efficacy and safety of bupropion and aripiprazole as augmentation therapies for TRD.

This population-based, retrospective cohort study included adults aged ≥18 years with a diagnosis of depressive disorder who met the criteria for TRD. Data were collected from a nationwide claims database in South Korea. Patients prescribed bupropion were matched 1:1 with those prescribed aripiprazole. Subgroup analyses were performed according to age. An as-treated analysis was performed as the primary analysis, and an intention-to-treat analysis was performed to identify different risk windows. The primary outcome was depression-related hospitalization, and the secondary outcomes were first-time diagnoses of movement disorder and seizure.

A total of 5,619 patients (bupropion: n = 1,568; aripiprazole: n = 4,051) were included in this study. Bupropion was associated with lower risks of hospitalization (hazard ratio [HR]: 0.51; 95% confidence interval [CI] 0.29–0.86) and movement disorders (HR: 0.56; 95% CI 0.36–0.85) than aripiprazole. No significant difference in seizure risk (HR: 0.65; 95% CI 0.30–1.31) was observed between the two treatments. The subgroup analysis of participants aged ≥60 years revealed no significant differences in the three outcomes between the two medications.

Bupropion augmentation is associated with a significantly lower risk of depression-related re-hospitalization and movement disorders in patients with TRD. Therefore, bupropion augmentation can be a comprehensive treatment strategy for TRD.

Many psychiatric and somatic comorbidities increase the risk of suicidal behavior, but the effect of co-existing comorbidities is sparsely elucidated. We described co-existence of psychiatric and somatic comorbidities and the influence of the combined comorbidity burden on the risk of suicidal behavior.

We defined two case populations above 10 years in the Danish health registries: those who 1) died by suicide (2010–2020) and 2) had an incident suicide attempt (2010–2021). Co-existing somatic and psychiatric comorbidities and relative odds of suicidal behavior at increasing comorbidity burden were assessed.

Among 5.9 million Danish citizens (2021), 6,257 individuals died by suicide whereas 30,570 had an incident suicide attempt. More than half had ≥2 co-existing psychiatric and/or somatic comorbidities. Of those who died by suicide, 18% had co-existing mood disorders and stress disorders, while 5% had both mood disorders and cancer. An 88-fold increase of odds for attempting suicide and a 35-fold increase of odds for suicide were observed among those with the highest combined burden of somatic and psychiatric comorbidities relative to those without. The presence of somatic comorbidities seemed to protect against suicide in older individuals.

Psychiatric and somatic comorbidities commonly co-exist in individuals with suicidal behavior. Higher combined burden of psychiatric and somatic comorbidities increased the odds of suicidal behavior, though the presence of somatic diseases had a potential protective effect on the risk of suicide in older individuals. This warrants collaboration and enhanced awareness of suicidal behavior risks across somatic and psychiatric departments.