Transcript Bla die bla - Forum Alcohol en Drugs

ALCOHOL USE DISORDERS
IN PERSONS WITH
ANXIETY AND/OR DEPRESSIVE DISORDERS
Lynn Boschloo, MSc 1,2 *, Nicole Vogelzangs, MSc 1,2, Johannes H. Smit,
PhD 1,2, Wim van den Brink, MD, PhD 3, Dick J Veltman, MD, PhD 1,3,
Aartjan TF Beekman, MD, PhD 1,2, Brenda WJH Penninx, PhD 1,2,4,5
1
Department of Psychiatry, 2 EMGO Institute for Health and Care Research, VU University Medical Center,
Amsterdam, The Netherlands, 3 AMC Academic Psychiatric Center, AIAR, Amsterdam, The Netherlands,
4 Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands 5 Department of
Psychiatry, Leiden University Medical Center, Leiden, The Netherlands, * Corresponding author: [email protected]
funded through the mental health program of the Netherlands Organization for
Health Research (ZonMW) and matching funds from participating institutes.
H
BACKGROUND
Persons with anxiety or depressive disorders have
an increased risk of comorbid alcohol use
disorders, but only few studies distinguish
between alcohol abuse and alcohol dependence.
Knowledge on risk indicators is limited and
inconsistent, with only very few studies
distinguishing between primary and secondary
alcohol use disorders.
RESEARCH QUESTIONS
1)
What is the comorbidity of alcohol use
disorders with anxiety and/or depressive
disorders?
2)
What are risk indicators of comorbid alcohol
use disorders among anxious and/or depressed
persons?
3)
What is the temporal sequencing of
disorders? Specific risk indicators?
NESDA DESIGN AND SAMPLE
Design:
 Naturalistic cohort study
 Assessments at baseline and after 1, 2, 4, 6, 8
years
Baseline sample:
 2,981 persons:♀1979,♂1002, 18-65 years
 Recruited in community, primary care and
mental health care organizations
CIDI-BASED PSYCHOPATHOLOGY

Anxiety disorder:
Generalized anxiety disorder, social phobia,
panic disorder, agoraphobia

Depressive disorder:
Major depressive disorder, dysthymia

Alcohol use disorder:
Alcohol abuse, alcohol dependence
BASELINE SAMPLE

652 healthy controls

356 lifetime anxiety disorder only

557 lifetime depressive disorder only

1416 both lifetime anxiety and depression
ALCOHOL ABUSE
Prevalence (%)
25
Overall p=.43
20
15
12,7
12,9
12,7
No
dep/anx
(n=652)
Anx only
(n=356)
Dep only
(n=557)
10,8
10
5
0
Both
anx/dep
(n=1416)
ALCOHOL DEPENDENCE
Prevalence (%)
25
Overall p<.001
20,3
20
16,5
15
10
5
12,4
5,5
0
No
dep/anx
(n=652)
Anx only
(n=356)
Dep only
(n=557)
Both
anx/dep
(n=1416)
TEMPORAL SEQUENCING AD
100%
Sec AD
(n=314)
80%
Concurrent
(n=39)
60%
Prim AD
(n=63)
40%
Overall p<.001
20%
0%
Dep only
(n=89)
Anx only
(n=42)
Both
dep/anx
(n=285)
EXAMINED RISK INDICATORS
Socio-demographic: gender, age, education.
Vulnerability: family history (anxiety/depression
and alc dep), personality, childhood
trauma/life-events, other social factors.
Addiction-related: smoking, illicit drug use,
benzodiazepine use.
Anxiety/depression-related: early (<25 years)
onset, duration, severity
RISK INDICATORS AD
Socio-demographic
OR
95% CI
p
Male gender
2.19
1.72-2.79
<.001
Vulnerability
OR
95% CI
p
FH anx/dep
1.66
1.17-2.37
.005
FH alc dep
1.68
1.31-2.15
<.001
Pers: Openness
1.16
1.03-1.30
.01
Pers: Conscientiousness 0.86
0.76-0.98
.02
Soc: No partner
1.37
1.08-1.73
.01
Soc: Childh trauma
1.06
1.01-1.12
.02
RISK INDICATORS AD
Addiction
OR
95% CI
p
Smoking: Former
3.13
2.10-4.66
<.001
Smoking: Current
4.97
3.41-7.24
<.001
Drug use
1.43
1.00-2.04
.05
Clinical
OR
95% CI
p
Early onset
1.32
1.02-1.70
.03
PRIMARY VS SECONDARY AD
Primary alcohol dependence:


Male gender
Extraversion
Secondary alcohol dependence:


Neuroticism
Loneliness
DISCUSSION
Alcohol dependence, and NOT alcohol abuse, is
associated with anxiety/depression.
Alcohol dependence is common in persons with
anxiety/depression; in persons with anxiety and
depression even 1 in 5.
Alcohol dependence tends to follow anxiety
and/or depressive disorders.
DISCUSSION
Addiction-related characteristics and vulnerability
are the most important risk indicators of alcohol
dependence, with considerable variation
depending on temporal sequencing.
Screening instrument for alcohol dependence.
Cross-sectional data
Causality
Longitudinal data
(NESDA)
THANK YOU FOR YOUR ATTENTION!
Netherlands Study of Depression and Anxiety
www.nesda.nl
funded through the mental health program of the Netherlands
Organization for Health Research (ZonMW)
and matching funds from participating institutes