Does substance use explain social differences in terms of depression? Findings from the Constances cohort

Nicotine dependence and incident psychiatric disorders: prospective evidence from US national study

We examined the prospective associations between nicotine dependence and the likelihood of psychiatric and substance use disorders in the general adult population. Participants came from a nationally representative sample of US adults aged 18 years or older, who were interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, 2001-2002; Wave 2, 2004-2005). The primary analyses were limited to 32,671 respondents (13,751 male (47.9% weighted); mean age of 45 years (SD = 0.18)) who were interviewed in both waves. We used multiple regression and propensity score matching (PSM) to estimate the strength of independent associations between nicotine dependence related to the use of tobacco products at Wave 1 and incident psychiatric disorders at Wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV). All analyses adjusted for multiple potential confounders, including childhood (family history of substance use disorders, parental loss, vulnerable family environment), early-adolescence (self-esteem, social deviance, conduct disorder), late-adolescence (education, personality and psychiatric disorders), adulthood (divorce, stressful life events, social deviance, quality of life, history of alcohol or other substance use disorder), and sociodemographic factors. Multiple regression analysis and PSM converged in indicating that nicotine dependence was associated with significantly increased incidence of any psychiatric disorder (OR = 1.39(95%CI:1.20;1.60)), including substance use disorders (OR = 1.91(95%CI:1.47;2.47)), and anxiety disorders (OR = 1.31(95%CI:1.06;1.62)). Population Attributable Risk Proportions were substantial, ranging from 12.5%(95%CI:8.10;17.0) for any psychiatric disorder to 33.3%(95%CI:18.7;48.0) for any other drug use disorder. Supplementary analyses also indicated significant associations between nicotine dependence and persistence of psychiatric and substance use disorders among patients having a disorder at Wave 1. In the general adult population, nicotine dependence is associated with an increased likelihood for several psychiatric and substance use disorders. Given its high prevalence, these findings have important public health implications.

Does maternal education moderate the relationship between adolescent cannabis use and mental health in early adulthood?

INTRODUCTION

Socioeconomic disadvantage has been associated with cannabis use and poor mental health. It is therefore hypothesised that lower maternal education, a proxy for socioeconomic disadvantage, may increase the risk of cannabis-related mental health and substance use consequences.

METHODS

A total of 5099 participants from the Avon Longitudinal Study of Parents and Children reported cannabis use via questionnaires at 16 or 18. Logistic regression was used to examine the relationship between any and regular (weekly or more) adolescent cannabis use with depression, anxiety, psychotic experiences, and problematic cannabis use at age 24. Maternal education was included as an effect modifier. Missing data were addressed through multiple imputation using chained equations.

RESULTS

In total, 36.5% of participants reported adolescent cannabis use and, of these, 14% reported regular use. Adolescent cannabis use was associated with an increased likelihood of anxiety and problematic cannabis use; however, there was little evidence of moderation by maternal education. Regular cannabis use was associated with an increased likelihood of problematic cannabis use, with little evidence of moderation by maternal education. There was weak evidence that the association between regular cannabis use and depression (interaction p-value = 0.024) and anxiety (interaction p-value = 0.056) was stronger in people with high maternal education.

DISCUSSION AND CONCLUSIONS

Adolescent cannabis use is associated with increased risk of anxiety and cannabis use disorder, but there was insufficient evidence that childhood socioeconomic position (proxied by maternal education) modifies this relationship. Improved public health messages for all adolescents about these risks may be warranted.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Metabolic syndrome and risk of death in older adults with major psychiatric disorders: Results from a 5-year prospective multicenter study

OBJECTIVES

No study has explored the association of individual components of metabolic syndrome with mortality in older patients with psychiatric disorders. In this report, we examined whether metabolic syndrome or any of its components predicted mortality in a cohort of older adults with psychiatric disorders.

METHODS

We used data from a multicenter 5-year prospective cohort, including 634 in- and out-patients with schizophrenia, bipolar or major depressive disorder. Metabolic syndrome was assessed at baseline following NCEP-ATPIII criteria. Cause of death was categorized as cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality (e.g., infections), suicide and accident.

RESULTS

122 participants (44.0%) were diagnosed with metabolic syndrome at baseline. In the full sample, there was no significant association between metabolic syndrome or any of its components with all-cause, CVD and non-CVD mortality. However, for the subpopulation of older adults with major depressive disorder, metabolic syndrome was significantly associated with increased all-cause and disease-related mortality after adjustment for age, sex and smoking status (p = 0.032 and p = 0.036, respectively). There was a significant interaction between metabolic syndrome and psychiatric diagnoses indicating that in participants with major depressive disorder, metabolic syndrome had a significantly greater effect on all-cause mortality (p = 0.025) and on disease-related mortality (p = 0.008) than in participants with either bipolar disorder or schizophrenia.

CONCLUSIONS

Our findings do not support an association between metabolic syndrome and increased mortality in older patients with major psychiatric disorders. Several explanations are discussed, including a survival bias, a lack of sensitivity of the used cut-offs and a ceiling effect of metabolic syndrome on mortality in this very high-risk population. The latter hypothesis could also explain the significant association between metabolic syndrome and mortality in the depressive subgroup, where a ceiling effect is yet to be reached, given the less marked premature mortality in depressive patients compared to those with bipolar disorder or schizophrenia.

Prospective associations between multiple lifestyle behaviors and depressive symptoms

BACKGROUND

Our aim was to analyze the associations between multiple lifestyle behaviors and depressive symptoms.

METHODS

We included 4,725 adults (18-59y), that provided data in routine health evaluations of a hospital in Brazil, followed for a mean period of 3.1 ± 1.6 years. Physical activity, alcohol consumption (measured using Alcohol Use Disorders Identification Test) and tobacco smoking were categorized as: (1) absence of the behavior (inactivity i.e. not complying with 150 min of moderate-to-vigorous PA/week, not smoking, no risky drinking, i.e. AUDIT<5) during baseline and follow-up; (2) Absence during baseline and presence during follow-up; (3) Presence during baseline and absence during follow-up; (4) Presence during both time points. Depressive symptoms were measured with the Beck Inventory was adopted to analyze patterns of depressive symptoms over time (as exposure). C-reactive protein [HS-CRP]) was assessed and its role in the association was tested. Incidence indicators of behaviors and depressive symptoms were created and used as outcomes. We used crude and adjusted Poisson regression analysis.

RESULTS

Fully adjusted models revealed that persistently physical inactive participants (RR:1.71;95%CI:1.33-2.21), those who became physically inactive (1.68;1.19-2.26), with consistently risky drinking (1.62;1.15-2.30), and who became risky drinkers (1.62;1.15-2.30) had higher risk for incidence of elevated depressive symptoms. Vice versa participants with incidence of depressive symptoms over time presented higher risk for physical inactivity (1.44;1.11-1.87) and risky drinking (1.65;1.16-2.34) incidence. HS-CRP did not influence the associations.

LIMITATIONS

Self-reported physical activity, binary tobacco smoking, and non-probabilistic sampling.

CONCLUSIONS

There is a prospective relationship between elevated depressive symptoms and adverse lifestyle behaviors.

Towards quantifying the reciprocal associations between frequency of cannabis use and alcohol consumption: a cross-lagged analysis from the CONSTANCES cohort

OBJECTIVE

Disentangle the temporal relationships between frequency of cannabis use and alcohol consumption.

METHODS

A cross-lagged model providing standardised coefficients (SCs)±their standard errors in 13 255 men and 13 696 women enrolled in 2015 or 2016 in the French population-based 'CONSulTANts des Centres d'Examens de Santé' (CONSTANCES) cohort. Cannabis use was categorised as follows: 'No use during the past 12 months', 'Use during the past 12 months but not in the past month' and 'Use in the past month' for cannabis use at baseline, and No use during the past 12 months, 'Use less than once per month' and 'Use once per month or more' for cannabis use at 1 year of follow-up. Alcohol consumption was measured at baseline and at 1 year of follow-up and three categories were determined: low risk (<28 drinks per week in men; <14 drinks per week in women), moderate risk (≥28 and<42 in men; ≥14 and<28 in women) and high risk (≥42 in men; ≥28 in women). Analyses were adjusted for age, sex, education, income, tobacco consumption, self-rated health status and depressive symptoms.

RESULTS

Both associations from alcohol to cannabis and from cannabis to alcohol were significant (SC=0.02±0.01 with p=0.003 and SC=0.06±0.01 with p<0.001, respectively). However, the SC of the association from cannabis to alcohol was three times higher than the opposite association (p<0.001). After stratification for sex, SCs of the association from cannabis to alcohol were more than two times higher than for the opposite association in men, and more than four times higher in women (both p<0.001).

CONCLUSIONS

The association between frequency of cannabis use and subsequent alcohol consumption was stronger than the opposite association. This finding encourages considering the risk of increased alcohol consumption among cannabis users.