h lynn boschloo vu medical center, amsterdam, the netherlands netherlands study of depression and...
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H
Lynn BoschlooVU Medical Center, Amsterdam,
The Netherlands
Netherlands Study of Depression and Anxiety
Depressive and anxiety disorders
predicting
first-incidence of alcohol use disorders
PREVIOUS CROSS-SECTIONAL STUDIES
Alcohol use disorders are highly prevalent in depressed and/or anxious persons.
[e.g., De Graaf et al., 2003; Hasin et al.,2007; Boschloo et al., 2011]
Depressive and/or anxiety disorders often precede alcohol dependence.
[e.g., Merikangas et al. 1998; Boschloo et al. 2011]
Introduction Methods Results Conclusion
PREVIOUS PROSPECTIVE STUDIESDo depressive and/or anxiety disorders predict
first-incidence of alcohol use disorders?- Positive [Marquenie et al., 2007]
- Negative [Crum and Pratt, 2001; Zimmerman et al., 2003]
- Mixed [Kushner et al., 1999; Merikangas et al., 2008; Buckner and Turner 2009]
Introduction Methods Results Conclusion
EXPLANATIONS FOR CONFLICTING RESULTSSmall samples
Heterogeneity of depressive/anxiety disorders- Status: Remitted versus current disorders- Type: Specific disorders- Severity: Number of disorders
Introduction Methods Results Conclusion
RESEARCH QUESTIONS1. Do depressive and/or anxiety disorders predict first-
incidence of alcohol abuse? alcohol dependence?
2. Is this association conditional on the: status of disorder? type of disorder? severity?
3. What are other risk factors?
Introduction Methods Results Conclusion
NESDANEtherlands Study of Depression and Anxiety Naturalistic cohort studyn=2,981: 1,979♀ , 1,002♂ , 18-65 years19% the community; 54% primary care; 27%
outpatient mental health care organizations
Introduction Methods Results Conclusion
DESIGN
Introduction Methods Results Conclusion
2 year 4 yearbaseline
Interview Interview
N=2,981 N=2,402
[Penninx et al., 2008; Lamers et al., 2011]
Response rate:80.6%
Interview
N=2,596
Response rate:87.1%
Current analyses:N=2,676
89.8%
OUTCOMEFirst-incidence of DSM-IV alcohol abuse (CIDI)
- Exclusion: Baseline alcohol use disorder (n=714)- Exclusion: Alcohol dependence during FU (n=52)
First-incidence of DSM-IV alcohol dependence (CIDI)- Exclusion: Baseline alcohol dependence (n=405)
Introduction Methods Results Conclusion
PREDICTORCIDI-based DSM-IV diagnosis of:
Depressive disorder:- Major depressive disorder- Dysthymia
Anxiety disorder:- Generalized anxiety disorder- Social phobia- Panic disorder- Agoraphobia
Introduction Methods Results Conclusion
PREDICTORStatus of disorder:
- Remitted disorder- Current disorder (<6 months)
Type of disorder:- Specific depressive and anxiety disorders
Severity:- Number of disorders
Introduction Methods Results Conclusion
OTHER POTENTIAL RISK FACTORSSociodemographicsVulnerability
- Family history- Childhood trauma- Recent life events- Personality
Addiction-related factors- Subthreshold alcohol problems- Illicit drug use- Smoking status
Introduction Methods Results Conclusion
OVERALL FIRST-INCIDENCE RATES
Introduction Methods Results Conclusion
First-incidence n %
Alcohol abuse 39 2.0%
Alcohol dependence 67 3.0%
RESEARCH QUESTIONS1. Do depressive and/or anxiety disorders predict first-
incidence of alcohol abuse? alcohol dependence?
2. Is this association conditional on the: status of disorder? type of disorder? severity?
3. What are other risk factors?
Introduction Methods Results Conclusion
FIRST-INCIDENCE OF ALCOHOL ABUSE
Introduction Methods Results Conclusion
RESEARCH QUESTIONS1. Do depressive and/or anxiety disorders predict first-
incidence of alcohol abuse? alcohol dependence?
2. Is this association conditional on the: status of disorder? type of disorder? severity?
3. What are other risk factors?
Introduction Methods Results Conclusion
FIRST-INCIDENCE OF ALCOHOL DEPENDENCE
Introduction Methods Results Conclusion
RESEARCH QUESTIONS1. Do depressive and/or anxiety disorders predict first-
incidence of alcohol abuse? alcohol dependence?
2. Is this association conditional on the: status of disorder? type of disorder? severity?
3. What are other risk factors?
Introduction Methods Results Conclusion
FIRST-INCIDENCE OF ALCOHOL DEPENDENCE
Introduction Methods Results Conclusion
RESEARCH QUESTIONS1. Do depressive and/or anxiety disorders predict first-
incidence of alcohol abuse? alcohol dependence?
2. Is this association conditional on the: status of disorder? type of disorder? severity?
3. What are other risk factors?
Introduction Methods Results Conclusion
FIRST-INCIDENCE OF ALCOHOL DEPENDENCE
Introduction Methods Results Conclusion
RESEARCH QUESTIONS1. Do depressive and/or anxiety disorders predict first-
incidence of alcohol abuse? alcohol dependence?
2. Is this association conditional on the: status of disorder? type of disorder? severity?
3. What are other risk factors?
Introduction Methods Results Conclusion
OTHER RISK FACTORS
Introduction Methods Results Conclusion
First-incidence of alcohol dependence
Predictor HR 95% CI p
Number of dep/anx disorders 1.43 1.25-1.64 <0.001
Male gender 2.17 1.35-3.51 0.001
Childhood trauma 1.14 1.03-1.26 0.01
Recent life-events 1.30 1.08-1.56 0.006
Neuroticism 1.77 1.37-2.29 <0.001
Agreeableness 0.62 0.49-0.79 <0.001
Conscientiousness 0.65 0.51-0.82 <0.001
Subthreshold alcohol problems 1.20 1.16-1.24 <0.001
Current smoking 2.73 1.45-5.14 0.002
INDEPENDENT RISK FACTORS
Introduction Methods Results Conclusion
First-incidence of alcohol dependence
Predictor HR 95% CI p
Number of dep/anx disorders 1.28 1.07-1.53 0.007
Subthreshold alcohol problems 1.19 1.14-1.23 <0.001
Recent life-events 1.20 0.99-1.44 0.06
CONCLUSIONSDepressive/anxiety disorders predicted first-incidence of
alcohol dependence, but not alcohol abuse.
Conditional on status of disorder Current disorder: Yes Remitted disorder: No
Not conditional on type of disorder
Conditional on severity
Introduction Methods Results Conclusion
CONCLUSIONSIndependent risk factors:
Number of depressive/anxiety disorders
Subthreshold alcohol problems
Recent negative life events?
Introduction Methods Results Conclusion
Netherlands Study of Depression and Anxietywww.nesda.nl
funded through the mental health program of the Netherlands Organization for Health Research (ZonMW) and matching funds
from participating institutes
THANK YOU!
Lynn Boschloo, MScNicole Vogelzangs, PhDJohannes H. Smit, PhD
Wim van den Brink, MD, PhDDick J Veltman, MD, PhD
Aartjan TF Beekman, MD, PhDBrenda WJH Penninx, PhD