A longitudinal study of the order of onset of alcohol dependence and major depression

Real-time impaired control over drinking: The role of contextual influences during naturally occurring drinking episodes

BACKGROUND

Impaired control over drinking is a central feature of Alcohol Use Disorder (AUD), yet little within-person research on impaired control is available. As a result, there is little research regarding the dynamic impact of social drinking context on impaired control. The current study sought to fill these gaps, testing a sequential mediation model wherein social drinking context predicted episode-specific deviations in perceived impaired control, which indirectly predicted daily negative consequences via drinking more than planned. We also modeled if estimated blood alcohol concentration (eBAC) moderated associations between social context and perceived impaired control.

METHODS

Emerging adults (N = 131; 51.8 % female) completed 21 days of ecological momentary assessments, including assessments of past-night drinking and planned drinking on a given day, and event-contingent reports during acute drinking episodes.

RESULTS

At the episode-level, social drinking context predicted higher perceived impaired control than an individual's daily average. At the daily-level, social drinking context predicted higher perceived impaired control, which indirectly predicted more negative consequences than a person's average via drinking more than planned. There was a residual effect of social context on drinking more than planned and negative consequences, and of perceived impaired control on negative consequences above and beyond drinking more than planned. Episode-level relations between social context and perceived impaired control were potentiated at higher vs. lower eBACs than an individual's daily average, but the same pattern was not observed at the daily-level.

CONCLUSIONS

Just-in-time interventions may benefit from increasing perceptions of control over drinking behavior, particularly during social drinking episodes.

Predicting the Risk of Driving Under the Influence of Alcohol Using EEG-Based Machine Learning

Driving under the influence of alcohol (DUIA) is closely associated with alcohol use disorder (AUD). Our previous study on machine learning (ML) algorithms revealed a very high accuracy of decision trees with neuropsychological features in predicting the risk of DUIA despite limited data availability. Thus, this study aimed at comparing six well-known ML algorithms based on electroencephalographic (EEG) signals to differentiate adults with AUD and DUIA (AUD-DD) from those with AUD without DUIA (AUD-NDD) and controls. Fifteen AUD-DD and 10 AUD-NDD participants were recruited from a single tertiary referral center. Fourteen social drinkers without DUIA served as controls. Their EEG signals related to driving conditions were gathered using a VR headset with eight electrodes (F3, F4, Fz, C3, C4, Cz, P3, and P4). Based on the labeled features of EEG asymmetry and theta/beta ratio (TBR), comparisons between different algorithms were conducted. Fz and Cz electrodes exhibited differences in TBR across the three groups (all p < 0.02), while there were no significant differences between AUD-DD individuals and social drinkers. In contrast, asymmetries of between-group differences were not observed (all p > 0.09). K-nearest neighbors (KNN) with TBR showed the highest accuracy (83 %) in distinguishing AUD-DD individuals from controls, while logistic regression (LR), support vector machines (SVM), and naive Bayes (NB) with EEG asymmetric features demonstrated high accuracy in identifying DUIA (all 80 %) in AUD adults. LR, SVM, and NB with asymmetry may be employed in predicting DUIA among AUD adults, while KNN with TBR may be used for identifying DUIA in the general population.

Association of Combined Effect of Metals Exposure and Behavioral Factors on Depressive Symptoms in Women

This study investigates the combined effects of environmental pollutants (lead, cadmium, total mercury) and behavioral factors (alcohol consumption, smoking) on depressive symptoms in women. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 cycle, specifically exposure levels of heavy metals in blood samples, were used in this study. The analysis of these data included the application of descriptive statistics, linear regression, and Bayesian Kernel Machine Regression (BKMR) to explore associations between environmental exposures, behavioral factors, and depression. The PHQ-9, a well-validated tool that assesses nine items for depressive symptoms, was used to evaluate depression severity over the prior two weeks on a 0-3 scale, with total scores ranging from 0 to 27. Exposure levels of heavy metals were measured in blood samples. BKMR was used to estimate the exposure-response relationship, while posterior inclusion probability (PIP) in BKMR was used to quantify the likelihood that a given exposure was included in the model, reflecting its relative importance in explaining the outcome (depression) within the context of other predictors in the mixture. A descriptive analysis showed mean total levels of lead, cadmium, and total mercury at 1.21 µg/dL, 1.47 µg/L, and 0.80 µg/L, respectively, with a mean PHQ-9 score of 5.94, which corresponds to mild depressive symptoms based on the PHQ-9 scoring. Linear regression indicated positive associations between depression and lead as well as cadmium, while total mercury had a negative association. Alcohol and smoking were also positively associated with depression. These findings were not significant, but limitations in linear regression prompted a BKMR analysis. BKMR posterior inclusion probability (PIP) analysis revealed alcohol and cadmium as significant contributors to depressive symptoms, with cadmium (PIP = 0.447) and alcohol (PIP = 0.565) showing notable effects. Univariate and bivariate analyses revealed lead and total mercury's strong relationship with depression, with cadmium showing a complex pattern in the bivariate analysis. A cumulative exposure analysis of all metals and behavioral factors concurrently demonstrated that higher quantile levels of combined exposures were associated with an increased risk of depression. Finally, a single variable-effects analysis in BKMR revealed lead, cadmium, and alcohol had a stronger impact on depression. Overall, the study findings suggest that from exposure to lead, cadmium, mercury, alcohol, and smoking, cadmium and alcohol consumption emerge as key contributors to depressive symptoms. These results highlight the need to address both environmental and lifestyle choices in efforts to mitigate depression.

Alcohol milestones and internalizing, externalizing, and executive function: longitudinal and polygenic score associations

BACKGROUND

Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk.

METHODS

Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11-36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones.

RESULTS

Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20).

CONCLUSIONS

Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.

Adolescent predictors of psychiatric disorders in adulthood: The role of emotional distress and problem drinking in emerging adulthood

The current study evaluated risk factors in adolescence on problem drinking and emotional distress in late adolescence and emerging adulthood, and meeting criteria for diagnosed disorders in adulthood. The study included 501 parents and their adolescent who participated from middle adolescence to adulthood. Risk factors in middle adolescence (age 18) included parent alcohol use, adolescent alcohol use, and parent and adolescent emotional distress. In late adolescence (age 18), binge drinking and emotional distress were assessed, and in emerging adulthood (age 25), alcohol problems and emotional distress were examined. Meeting criteria for substance use, behavioral, affective, or anxiety disorders were examined between the ages of 26 and 31. Results showed parent alcohol use predicted substance use disorder through late adolescent binge drinking and emerging adulthood alcohol problems. Behavioral disorders were indirectly predicted by adolescent and emerging adult emotional distress. Affective disorders were indirectly predicted by parent emotional distress through adolescent emotional distress. Finally, anxiety disorders were predicted by parent alcohol use via adolescent drinking; parent emotional distress via adolescent emotional distress, and through adolescent alcohol use and emotional distress. Results provided support for the intergenerational transmission of problem drinking and emotional distress on meeting criteria for diagnosed psychiatric disorders in adulthood.

Examining the relationship between the oral microbiome, alcohol intake and alcohol-comorbid neuropsychological disorders: protocol for a scoping review

INTRODUCTION

Heavy alcohol use and alcohol use disorder (AUD) continues to rise as a public health problem and increases the risk for disease. Elevated rates of anxiety, depression, sleep disruption and stress are associated with alcohol use. Symptoms may progress to diagnosed neurophysiological conditions and increase risk for relapse if abstinence is attempted. Research on mechanisms connecting the gastrointestinal microbiome to neuropsychological disorders through the gut-brain axis is well-established. Less is known how the oral microbiome and oral microbial-associated biomarkers may signal to the brain. Therefore, a synthesis of research studying relationships between alcohol intake, alcohol-associated neurophysiological symptoms and the oral microbiome is needed to understand the state of the current science. In this paper, we outline our protocol to collect, evaluate and synthesise research focused on associations between alcohol intake and AUD-related neuropsychological disorders with the oral microbiome.

METHODS AND ANALYSIS

The search strategy was developed and will be executed in collaboration with a medical research librarian. Studies will be screened by two independent investigators according to the aim of the scoping review, along with the outlined exclusion and inclusion criteria. After screening, data will be extracted and synthesised from the included papers according to predefined demographic, clinical and microbiome methodology metrics.

ETHICS AND DISSEMINATION

A scoping review of primary sources is needed to synthesise the data on relationships between alcohol use, neuropsychological conditions associated with AUD and the oral microbiome. The proposed scoping review is based on the data from publicly available databases and does not require ethical approval. We expect the results of this synthesis will identify gaps in the growing literature and highlight potential mechanisms linking the oral-brain axis to addiction and other associated neuropsychological conditions. The study findings and results will be disseminated through journals and conferences related to psychology, neuroscience, dentistry and the microbiome.

The potential causal relationship between various lifestyles and depression: a univariable and multivariable Mendelian randomization study

Background

Previous studies have shown that lifestyle was associated with depression. Thus, the aim of this study was to examine the causality between multiple lifestyles and depression by Mendelian randomization (MR) analysis.

Methods

The single-nucleotide polymorphisms (SNPs) of depression, alcoholic drinks per week, sleeplessness or insomnia, body mass index (BMI), mood swings, weekly usage of mobile phone in the last 3 months, beef intake, cooked vegetable intake, and "smoking status: never" were acquired from the Integrative Epidemiology Unit Open genome-wide association study database. Causal effects of eight exposure factors and depression were investigated using MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode, and results were primarily referred to IVW. Subsequently, univariable MR (UVMR) analysis was performed on eight exposure factors and depression, separately. In addition, sensitivity analysis, including heterogeneity test, horizontal pleiotropy, and leave-one-out (LOO) methods, was conducted to evaluate the stability of MR results. Furthermore, multivariable MR (MVMR) analysis was carried out.

Results

UVMR analysis revealed that all eight exposure factors were causally associated with depression; alcoholic drinks per week, sleeplessness or insomnia, BMI, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake were risk factors, and beef intake and "smoking status: never" were protection factors. Heterogeneity tests revealed no heterogeneity for alcoholic drinks per week, sleeplessness or insomnia, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake. Meanwhile, there was no horizontal pleiotropy in UVMR, and LOO analysis verified that univariable analysis results were reliable. Moreover, MVMR analysis indicated that mood swings and weekly usage of mobile phone in the last 3 months were risk factors, and beef intake was a protection factor for depression when multiple factors occurred at the same time.

Conclusion

Alcoholic drinks per week, sleeplessness or insomnia, BMI, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake were risk factors, and beef intake and "smoking status: never" were protection factors. In addition, mood swings, weekly usage of mobile phone in the last 3 months, and beef intake had a direct effect on depression when multiple factors occurred simultaneously.

Extracellular matrix abnormalities in the hippocampus of subjects with substance use disorder

Contextual triggers are significant factors contributing to relapse in substance use disorders (SUD). Emerging evidence points to a critical role of extracellular matrix (ECM) molecules as mediators of reward memories. Chondroitin sulfate proteoglycans (CSPGs) are a subset of ECM molecules that form perineuronal nets (PNN) around inhibitory neurons. PNNs restrict synaptic connections and help maintain synapses. Rodent models suggest that modulation of PNNs may strengthen contextual reward memories in SUD. However, there is currently a lack of information regarding PNNs in the hippocampus of people with SUD as well as how comorbidity with major depressive disorder (MDD) may affect PNNs. We used postmortem hippocampal tissues from cohorts of human and nonhuman primates with or without chronic alcohol use to test the hypothesis that PNNs are increased in subjects with SUD. We used histochemical labeling and quantitative microscopy to examine PNNs, and qRT-PCR to examine gene expression for ECM molecules, synaptic markers and related markers. We identified increased densities of PNNs and CSPG-labeled glial cells in SUD, coinciding with decreased expression of the ECM protease matrix metalloproteinase 9 (Mmp9), and increased expression for the excitatory synaptic marker vesicle associated membrane protein 2 (Vamp2). Similar increases in PNNs were observed in monkeys with chronic alcohol self-administration. Subjects with MDD displayed changes opposite to SUD, and subjects with SUD and comorbid MDD had minimal changes in any of the outcome measures examined. Our findings demonstrate that PNNs are increased in SUD, possibly contributing to stabilizing contextual reward memories as suggested by preclinical studies. Our results also point to a previously unsuspected role for CSPG expression in glial cells in SUD. Evidence for increased hippocampal PNNs in SUD suggests that targeting PNNs to weaken contextual reward memories is a promising therapeutic approach for SUD, however comorbidity with MDD is a significant consideration.

Extracellular Matrix Abnormalities in the Hippocampus of Subjects with Substance Use Disorder

Contextual triggers are significant factors contributing to relapse in substance use disorders (SUD). Emerging evidence points to a critical role of extracellular matrix (ECM) molecules as mediators of reward memories. Chondroitin sulfate proteoglycans (CSPGs) are a subset of ECM molecules that form perineuronal nets (PNN) around inhibitory neurons. PNNs restrict synaptic connections and help maintain synapses. Rodent models suggest that modulation of PNNs may strengthen contextual reward memories in SUD. However, there is currently a lack of information regarding PNNs in the hippocampus of people with SUD as well as how comorbidity with major depressive disorder (MDD) may affect PNNs. We used postmortem hippocampal tissues from cohorts of human and nonhuman primates with or without chronic alcohol use to test the hypothesis that PNNs are increased in subjects with SUD. We used histochemical labeling and quantitative microscopy to examine PNNs, and qRT-PCR to examine gene expression for ECM molecules, synaptic markers and related markers. We identified increased densities of PNNs and CSPG-labeled glial cells in SUD, coinciding with decreased expression of the ECM protease matrix metalloproteinase 9 (Mmp9), and increased expression for the excitatory synaptic marker vesicle associated membrane protein 2 (Vamp2). Similar increases in PNNs were observed in monkeys with chronic alcohol self-administration. Subjects with MDD displayed changes opposite to SUD, and subjects with SUD and comorbid MDD had minimal changes in any of the outcome measures examined. Our findings demonstrate that PNNs are increased in SUD, possibly contributing to stabilizing contextual reward memories as suggested by preclinical studies. Our results also point to a previously unsuspected role for CSPG expression in glial cells in SUD. Evidence for increased hippocampal PNNs in SUD suggests that targeting PNNs to weaken contextual reward memories is a promising therapeutic approach for SUD, however comorbidity with MDD is a significant consideration.

Non-abstinent recovery in alcohol use disorder is associated with greater regional cortical volumes than heavy drinking

BACKGROUND

Harm-reduction (i.e., non-abstinent recovery) approaches to substance use treatment have garnered increasing attention. Reduced levels of alcohol consumption post-treatment have been associated with better psychosocial functioning and physical health, yet less is known regarding differences in brain structures associated with varying levels of alcohol consumption. This study investigated regional cortical volumes after alcohol use disorder (AUD) treatment among individuals who achieved complete abstinence and those who returned to lower and higher levels of consumption.

METHODS

Data were collected from individuals with AUD (n = 68) approximately 8 months after the initiation of treatment. Using risk drinking levels defined by the World Health Organization, participants were classified as abstaining (AB) or relapsing with low (RL) or higher (RH) levels. Data were also obtained from 34 age-matched light/non-drinking controls (LN). All participants completed a 1.5 T magnetic resonance imaging session and volumes for 34 bilateral cortical regions of interest were quantitated with FreeSurfer. Generalized linear models were used to examine group differences in cortical volume. All group findings are significant at an FDR-corrected value of 0.018.

RESULTS

Adjusting for age and intracranial volume, significant group differences were found in 13/34 cortical regions. AB showed greater volumes than RL in 2/13 regions and RH in 6/13 regions. RH demonstrated significantly smaller volumes than LN in 12/13 ROIs, whereas RL differed from LN in 9/13 regions. RH and RL differed in only two cortical regions.

CONCLUSIONS

Individuals who consumed low-risk levels of alcohol post-treatment exhibited regional cortical volumes more similar to abstainers than individuals who returned to higher-risk levels. This suggests that low-risk levels of alcohol consumption are associated with brain integrity that is comparable to that seen with complete abstinence. Given the previously demonstrated improvement in psychosocial and physical health with reduced levels of alcohol consumption post-treatment, harm reduction may be a beneficial and more attainable goal for some individuals with AUD who are seeking treatment.

Deconstructing the heterogeneity of alcohol use disorder: lifetime comorbid non-alcohol substance use disorder as a distinct behavioral phenotype?

BACKGROUND

Alcohol use disorder (AUD) is an etiologically and clinically heterogeneous condition. Accumulating evidence suggests that persons with lifetime histories of comorbid AUD and non-alcohol substance use disorder (DRUG) constitute an important subgroup of AUD. This study evaluated the distinctiveness of the comorbid AUD/DRUG behavioral phenotype in a community sample with respect to risk factors, AUD course features, and outcome variables assessed at age 30. Contrast groups included persons with histories of AUD only, DRUG only, and neither AUD nor DRUG.

METHODS

This research utilized a prospective study design with an age-based cohort (n = 732). Participants completed four comprehensive diagnostic evaluations during the high-risk periods of adolescence, emerging adulthood, and young adulthood.

RESULTS

The comorbid AUD/DRUG group was distinguished from the AUD only group by risk factors, AUD course features, and outcomes. Group differences in outcomes were also explained by overall substance use disorder (SUD) severity. Persons with AUD/DRUG comorbidity were indistinguishable from those with DRUG only histories with respect to risk factors and outcomes but demonstrated greater overall SUD severity. Persons with AUD only were indistinguishable from those with neither AUD nor DRUG histories in risk factor endorsements and were mostly similar in outcomes.

CONCLUSIONS

Findings collectively suggest that young adults with histories of AUD only and those with comorbid AUD/DRUG are drawn from dissimilar populations. Similarities between the AUD only group with those absent AUD or DRUG histories are likely related to the former group's developmentally limited AUD course accompanied by relatively few or short-lived alcohol-related problems.

BDNF rs6265 Met carriers with alcohol use disorder show greater age-related decline of N-acetylaspartate in left dorsolateral prefrontal cortex

BACKGROUND

Brain-derived neurotrophic factor (BDNF) is implicated in neuronal and glial cell growth and differentiation, synaptic plasticity, and apoptotic mechanisms. A single-nucleotide polymorphism of the BDNF rs6265 gene may contribute to the pattern and magnitude of brain metabolite abnormalities apparent in those with an Alcohol Use Disorder (AUD). We predicted that Methionine (Met) carriers would demonstrate lower magnetic resonance spectroscopy (MRS) measures of N-acetylaspartate level (NAA) and greater age-related decline in NAA than Valine (Val) homozygotes.

METHODS

Veterans with AUD (n=95; 46±12 years of age, min = 25, max = 71) were recruited from VA Palo Alto residential treatment centers. Single voxel MRS, at 3 Tesla, was used to obtain NAA, choline (Cho) and creatine (Cr) containing compounds from the left dorsolateral prefrontal cortex (DLPFC). Metabolite spectra were fit with LC Model and NAA and Cho were standardized to total Cr level and NAA was also standardized to Cho.

RESULTS

Val/Met (n=35) showed markedly greater age-related decline in left DLPFC NAA/Cr level than Val/Val (n=60); no differences in mean metabolite levels were observed between Val/Met and Val/Val. Val/Met demonstrated greater frequency of history of MDD and higher frequency of cannabis use disorder over 12 months prior to study.

CONCLUSIONS

The greater age-related decline in left DLPFC NAA/Cr and the higher frequency of MDD history and Cannabis Use disorder in BDNF rs6265 Met carriers with AUD are novel and may have implications for non-invasive brain stimulation targeting the left DLFPC and other psychosocial interventions typically utilized in the treatment of AUD.

Longitudinal associations between alcohol use, smoking, genetic risk scoring and symptoms of depression in the general population: a prospective 6-year cohort study

BACKGROUND

Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms.

METHODS

In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables.

RESULTS

In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms (p < 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use (p = 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms (p = 0.001-0.028). Results of genetic risk score analyses aligned with these findings.

CONCLUSIONS

While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.

Active Cigarette Smoking Is Associated With Increased Age-Related Decline on Measures of Visuospatial Learning and Memory and Executive Function in Alcohol Use Disorder

AIMS

The goal of this study was to determine if active cigarette smoking in Veterans with alcohol use disorder (AUD) was associated with greater age-related neurocognitive decline.

METHODS

Veterans with AUD, in residential treatment (n = 125; 47 ± 14 years of age, min = 24, max = 76, 29 ± 26 days of abstinence), completed measures of executive functions, learning and memory, processing speed and working memory. Actively smoking AUD (AsAUD, n = 47) were active daily cigarette smokers; former smoking AUD (FsAUD, n = 45) were predominately daily smokers prior to study but did not smoke at the time of study; non-smoking AUD (NsAUD, n = 33) never used cigarettes or smoked 'only a few times' during lifetime.

RESULTS

AsAUD demonstrated greater age-related decline on measures of visuospatial learning and memory, and response inhibition/cognitive flexibility, primarily relative to NsAUD; there were no age-related differences between FsAUD and NsAUD on any measure. There were few significant mean differences between groups across the 15 neurocognitive measures. In AsAUD, higher scores on indices of smoking severity were associated with poorer performance on measures of auditory-verbal learning and memory, response inhibition, set-shifting and working memory. In FsAUD, longer smoking cessation duration was related to lower PTSD, anxiety and depressive symptomatology.

CONCLUSIONS

Active smoking was associated with accelerated age-related decline on cognitive functions implicated in response to common evidence-based AUD interventions. Results suggest that smoking history contributes to the considerable heterogeneity observed in neurocognitive function in early AUD recovery, and reinforce the clinical movement to offer smoking cessation resources concurrent with treatment for AUD.

Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya

Background: Female Sex Workers (FSWs) are at high risk of harmful alcohol and other drug use. We use quantitative data to describe the prevalence of alcohol and other drug use and identify associated occupational and socio-economic risk factors, and aim to elucidate patterns of alcohol and drug use through information drawn from qualitative data. Methods: Maisha Fiti was a mixed-method longitudinal study conducted in 2019 among a random sample of FSWs in Nairobi, Kenya. We used baseline date from the behavioural−biological survey, which included the WHO Alcohol, Smoking and Substance Involvement Screening Test that measures harmful alcohol and other drug use in the past three months (moderate/high risk score: >11 for alcohol; >4 for other drugs). In-depth interviews were conducted with 40 randomly selected FSWs. Findings: Of 1003 participants, 29.9% (95%CI 27.0−32.6%) reported harmful (moderate/high risk) alcohol use, 21.5% harmful amphetamine use (95%CI 19.1−24.1%) and 16.9% harmful cannabis use (95%CI 14.7−19.2%). Quantitative analysis found that harmful alcohol, cannabis and amphetamine use were associated with differing risk factors including higher Adverse Childhood Experience (ACE) scores, street homelessness, food insecurity (recent hunger), recent violence from clients, reduced condom use, depression/anxiety and police arrest. Qualitative interviews found that childhood neglect and violence were drivers of entry into sex work and alcohol use, and that alcohol and cannabis helped women cope with sex work. Conclusions: There is a need for individual and structural-level interventions, tailored for FSWs, to address harmful alcohol and other drug use and associated syndemic risks including ACEs, violence and sexual risk behaviours.

Behavior change versus stability during the college-to-work transition: Life course and the "stickiness" of alcohol misuse at career entry

To what extent and under what conditions do college graduates disengage from employment-incompatible behaviors during the college-to-work transition? Drawing from the life course perspective, we proposed a model highlighting considerable stability of employment-incompatible behaviors during initial months of organizational socialization. Our model predicted that maturing out of such behaviors, which is expected by employers and beneficial to career adjustment, would be more likely to occur given a conducive transition context. Using a large dataset tracking graduates from their last semester in college to up to approximately 1.5 years after graduation and with alcohol use as our empirical referent, we demonstrated that a pattern of high-risk drinking behavior may remain even after the transition into full-time employment. We further showed that lower levels of perceived cohort drinking norms and higher levels of mentoring were associated with a higher probability of maturing out, manifesting in a transition from a high-risk drinking profile before graduation to a moderate drinking profile after starting full-time employment. Finally, we found that maturing out was associated with lagged outcomes including lower levels of sleep problems and depression and fewer work days lost to absenteeism, thus underscoring the consequential nature of behavior profile shifts during the college-to-work transition.

Effect of vortioxetine in subjects with major depressive and alcohol use disorders: a 6-month retrospective analysis

BACKGROUND

Major depressive disorder (MDD) and alcohol use disorder (AUD) are highly comorbid, with greater clinical complexity and psychosocial impairment. Several antidepressants have been used in this population, with mixed results. This preliminary study aims to investigate the effects of the multimodal antidepressant vortioxetine in MDD + AUD subjects.

METHODS

We retrospectively evaluated 57 MDD + AUD and 56 MDD outpatients, matched for baseline characteristics. Patients were assessed after 1, 3, and 6 months treatment with vortioxetine (10-20 mg/d, flexibly dosed) in combination with continuous psychosocial support. The primary outcome was improvement in depressive symptoms measured by the Montgomery-Åsberg Depression Rating Scale. We also investigated changes in anxiety, anhedonia, cognition, functioning, quality of life, and clinical global severity using the following instruments: Hamilton Anxiety Rating Scale, Snaith-Hamilton Pleasure Scale, Digit Symbol Substitution Test, Perceived Deficits Questionnaire-Depression, Functioning Assessment Short Test, Quality of Life Index, and Clinical Global Impression-Severity Scale.

RESULTS

Vortioxetine significantly improved mood in MDD + AUD patients (P < .001), with no differences when compared to MDD (P = .36). A substantial rate (45.6%) of comorbid subjects obtained clinical remission at endpoint (P = .36 vs MDD). We additionally observed baseline to endpoint improvements on all secondary outcomes (P < .001), with no significant difference between groups. Overall, vortioxetine was safe and well tolerated.

CONCLUSIONS

Given its effectiveness on mood, cognition, and functioning, its good safety and tolerability profile, and low potential for abuse, vortioxetine could represent a valid pharmacological intervention in MDD + AUD patients as part of an integrated therapeutic-rehabilitation program.

Prevalence and correlates of aggressive behavior in psychiatric inpatient populations

Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.

Prevalence and correlates of common mental health problems and recent suicidal thoughts and behaviours among female sex workers in Nairobi, Kenya

BACKGROUND

Adverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance use are associated with poor mental health outcomes, but few studies have examined these risks among Female Sex Workers (FSWs). We examine the prevalence and correlates of common mental health problems including suicidal thoughts and behaviours among FSWs in Kenya.

METHODS

Maisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline behavioural-biological survey (n = 1003) data were collected June-December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD) and a two-item tool to measure recent suicidal thoughts/behaviours. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Descriptive statistics and multivariable logistic regression were conducted using a hierarchical modelling approach.

RESULTS

Of 1039 eligible FSWs, 1003 FSWs participated in the study (response rate: 96%) with mean age 33.7 years. The prevalence of moderate/severe depression was 23.2%, moderate/severe anxiety 11.0%, PTSD 14.0% and recent suicidal thoughts/behaviours 10.2% (2.6% suicide attempt, 10.0% suicidal thoughts). Depression, anxiety, PTSD and recent suicidal thoughts/behaviours were all independently associated with higher ACE scores, recent hunger (missed a meal in last week due to financial difficulties), recent sexual/physical violence and increased harmful alcohol/substance. PTSD was additionally associated with increased chlamydia prevalence and recent suicidal thoughts/behaviours with low education and low socio-economic status. Mental health problems were less prevalent among women reporting social support.

CONCLUSIONS

The high burden of mental health problems indicates a need for accessible services tailored for FSWs alongside structural interventions addressing poverty, harmful alcohol/substance use and violence. Given the high rates of ACEs, early childhood and family interventions should be considered to prevent poor mental health outcomes.

Alcohol consumption and dependence is linked to the extent that people experience need satisfaction while drinking alcohol in two Aboriginal and Torres Strait Islander communities

BACKGROUND

Unhealthy alcohol use is a key concern for Aboriginal and Torres Strait Islander ('Indigenous Australian') communities. Due to systematic disadvantage and inter-generational trauma, Indigenous Australians may be less likely to have satisfied basic psychological needs (autonomy, competence, and relatedness). When people are need-thwarted, they may engage in compensatory behaviours to feel better in the short-term. We explore the relationship between perceived basic psychological needs satisfaction and alcohol consumption use among Indigenous Australians. Better understanding the functions that alcohol may play for some Indigenous Australian drinkers may aid communities, clinicians, and policy makers in improving programs for reducing drinking-related harms.

METHODS

We performed a cross-sectional survey of Indigenous Australians (aged 16 years or older) living in two South Australian communities. Participants were eligible if they had consumed any alcohol in the past 12 months. Spearman correlations and linear regressions were used to determine if feeling more autonomous, competent, and related to others (need satisfied) while drinking, was linked to alcohol consumption and dependence.

RESULTS

Controlling for participant demographics, reporting feeling need satisfied while drinking was linked to drinking more alcohol per day, reporting more frequent symptoms of alcohol dependence, spending more money on alcohol, and scoring higher on the AUDIT-C.

CONCLUSIONS

Unhealthy drinking may partly stem from attempts to satisfy basic psychological needs. Programs which support Indigenous Australians to meet basic psychological needs could reduce attempts to meet psychological needs through alcohol consumption.

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Pain is the most distressing and disruptive feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) resulting in low quality of life (QOL) and disabilities. There is no single, characteristic pain pattern in patients with RAP and CP. Abdominal imaging features of CP accurately reflect morphologic features but they do not correlate with pain. Pain is the major driver of poor quality of life (QOL) and it is the constant pain, rather than intermittent pain that drives poor QOL. Furthermore, the most severe constant pain experience in CP is also a complex condition. The ability to target the etiopathogenesis of severe pain requires new methods to detect the exact pain mechanisms in an individual at cellular, tissue, system and psychiatric levels. In patients with complex and severe disease, it is likely that multiple overlapping mechanisms are simultaneously driving pain, anxiety and depression. Quantitative sensory testing (QST) shows promise in detecting alterations in central processing of pain signals and to classify patients for mechanistic and therapeutic studies. New genetic research suggests that genetic loci for severe pain in CP overlap with genetic loci for depression and other psychiatric disorders, providing additional insights and therapeutic targets for individual patients with severe CP pain. Well-designed clinical trials that integrate clinical features, QST, genetics and psychological assessments with targeted treatment and assessment of responses are required for a quantum leap forward. A better understanding of the context and mechanisms contributing to severe pain experiences in individual patients is predicted to lead to better therapies and quality of life.

Economic burden of treatment-resistant depression in privately insured US patients with co-occurring anxiety disorder and/or substance use disorder

OBJECTIVE

To assess the burden of treatment-resistant depression (TRD) among privately insured patients with anxiety disorder and/or substance use disorders (SUD).

METHODS

Adults <65 years old were identified in the Optum Health Care Solutions Inc. database (July 2009-March 2017). Among those with major depressive disorder (MDD) and antidepressant use, patients who initiated a third antidepressant (index date) after two regimens at adequate dose and duration were classified in the TRD cohort and patients without evidence of TRD were classified in the non-TRD MDD control cohort. The non-MDD control cohort comprised patients without MDD. In the non-TRD MDD and non-MDD cohorts, the index date was imputed to mimic the distribution of time in the TRD cohort from the first antidepressant to the index date or from the start of eligibility to the index date, respectively. Patients with <6 months of continuous insurance eligibility pre-/post-index, psychosis, schizophrenia, bipolar disorder and related conditions, dementia, and development disorders, and/or no baseline anxiety disorder and/or SUD were excluded. Patients with TRD were matched 1:1 to patients with non-TRD MDD and patients without MDD, based on exact matching factors (i.e. availability of work loss data) and propensity scores computed based on characteristics measured pre-index. Outcomes, including healthcare resource use (HRU) and costs, work productivity loss and related costs measured per patient per year ≤24 months post-index were compared between matched TRD, non-TRD MDD and non-MDD cohorts.

RESULTS

A total of 3166 patients were identified in the TRD cohort and matched to non-TRD MDD and non-MDD cohorts. Among patients with TRD (mean age 39 years, 60.5% female), 87.3% had an anxiety disorder, 24.1% had SUD. The TRD cohort had higher HRU vs non-TRD MDD and non-MDD cohorts: 0.32 vs 0.20 and 0.14 inpatient admissions, 0.91 vs 0.73 and 0.58 emergency department visits, and 23.8 vs 16.8 and 11.6 outpatient visits, respectively (all p < .01). The TRD cohort had higher healthcare costs ($16,674) vs non-TRD MDD ($10,945) and non-MDD ($6493) cohorts (all p < .01). Among patients with work loss data (N = 310/cohort), patients with TRD had more work loss days (54) and higher work loss-related costs ($13,674) vs patients with non-TRD MDD (32 days; $7131) and without MDD (17 days; $4798; all p < .01).

CONCLUSIONS

In patients with an anxiety disorder and/or SUD, TRD was associated with higher HRU, healthcare costs, work loss days and work loss-related costs.

Correlation of Alcohol Use Disorders with Common Mental Disorders and Its Association with Socio-demographic Characteristics Among Community in Ethiopia: A Cross-sectional Study

Background

Alcohol use disorders occurring together with common mental disorders are common and have been recognized worldwide as a crucial public health concern. However, there is a scarcity of data about the correlation of alcohol use disorders with common mental disorders and its association with socio-demographic characteristics among community in Ethiopia, especially in the study area. The aim of the study is to assess the correlation of alcohol use disordesr with common mental disorders and its association with socio-demographic characteristics among adults of selected woredas of the Ilu Aba Bor zone.

Methods

Community-based cross-sectional study was employed on 690 participants selected by using the multistage sampling technique. Data were collected by using the alcohol use disorder identification test (AUDIT) and self-reporting questionnaire (SRQ-20) scale. Data analysis were done using SPSS version 20. Pearson correlation was used to see the relation of two variables. The strength of the association was determined at p-value <0.005.

Results

14.1% of the study sample positive for alcohol use disorders and 27.2% for common mental disorders. There is a significant positive relationship between alcohol use disorders and common mental disorders, r(688)=0.314, p=0.001. From socio-demographic characteristics, multivariable logistic regression analysis revealed marital status being single, orthodox religion followers, and living in urban had a significant association with alcohol use disorders.

Conclusion

In the Ilu Aba Bor zone, 14.1% of participants reported alcohol use disorders, and 27.2% have a common mental disorders. There is a significant positive relationship between alcohol use disorders and common mental disorders. Being single, orthodox religion, and living in urban had a significant association with alcohol use disorders. Detection and treatment of people with alcohol use disorders and common mental disorders in the community have been recommended at the same time through integrated treatment.

Psychiatric Comorbidity in Patients With Chronic Pancreatitis Associates With Pain and Reduced Quality of Life

INTRODUCTION

Abdominal pain, frequent in patients with chronic pancreatitis (CP), has a negative impact on quality of life (QOL). Psychiatric comorbidities including anxiety and depression are associated with pain, but their prevalence and effects on QOL in CP have not been quantified. We studied the prevalence of anxiety and depression in patients with CP and their associated patient and disease characteristics and impact on QOL.

METHODS

This was a cross-sectional, multicenter prospective study. Patients were screened with the Hospital Anxiety and Depression Scale questionnaire. A Hospital Anxiety and Depression Scale score >7 on the respective anxiety or depression subscales indicated the presence of anxiety or depression and was used as a surrogate for the diagnosis of psychiatric comorbidities. Patient demographics, disease characteristics, QOL (EORTC-QLQ-C30), and pain symptoms (Brief Pain Inventory Short Form) were compared between patients with and without psychiatric comorbidities.

RESULTS

One hundred seventy-one patients with CP (mean age 53.8 ± 13.7 years, 60% men) were included. Anxiety and depression were present in 80 (46.8%) and 66 (38.6%) patients, with overlap in 50 (29%). Patients with anxiety or depression reported higher pain prevalence, pain severity, and pain interference scores (all P < 0.001). Psychiatric comorbidities also associated with reduced global health scores and functional subscales (all P < 0.001) and higher symptom burden (P ≤ 0.03). An independent association was noted between global health status and depression (P < 0.001).

DISCUSSION

Psychiatric comorbidities are prevalent in patients with CP and associated with pain and QOL. Where the effect of anxiety on QOL may be mediated via pain, depression is independently related to QOL. These findings warrant consideration in the management of patients with CP.

Interaction of Heavy Drinking Patterns and Depression Severity Predicts Efficacy of Quetiapine Fumarate XR in Lowering Alcohol Intake in Alcohol Use Disorder Patients

Background:

Shared etiological pathways of dopamine and serotonin neurotransmission play a central role in heavy alcohol intake and exacerbation in the symptoms of depression.

We investigated the treatment efficacy of Quetiapine fumarate extended release (XR) in lowering alcohol intake in alcohol use disorder (AUD) patients indicated by the shared alleviation of depression ratings and patterns of heavy drinking.

Methods:

Hundred and eight male and female heavy drinking AUD patients in the age range of 18 to 64 years. participated in a randomized clinical trial (RCT) to receive 12 weeks of quetiapine XR or placebo (N = 115). Participants were sub-grouped by the severity grading of depression using Montgomery-Asberg Depression Rating Scale (MADRS) (clinically relevant ⩾8 [CR], clinically non-relevant ⩽7 [CNR]) at baseline in both the groups. Drinking history and depression ratings were assessed at the patients’ visits.

Results:

Heavy drinking days (HDD) and total drinks (TD) were significantly fewer in CR patients at the treatment end. A true positive response in AUROC analysis supported the lowering of TD in CR patients. The number of drinking days (NDD) and average drinks per drinking day (AvgD) were lower in the CNR patients at treatment-end. Significant associations with increasing effect sizes were observed for all the heavy drinking measures (HDD, TD, NDD, and AvgD) and MADRS scores by the end of the treatment course.

Conclusions:

Baseline elevated depressive symptoms could likely predict the course of heavy alcohol drinking during the treatment, and efficacy outcome of a treatment. AUD patients with baseline clinically significant depression had a progressive lowering in heavy drinking markers significantly corresponding to the lowering of depression symptoms by the end of treatment with Quetiapine fumarate XR.

ClinicalTrials.gov: NCT#0049862 (https://clinicaltrials.gov/ct2/show/NCT00498628?term=litten&draw=2&rank=3)

Longitudinal associations between negative urgency, symptoms of depression, cannabis and alcohol use in veterans

There is a high comorbidity between symptoms of depression and cannabis and alcohol use in civilian and veteran populations. Prospective studies attempting to clarify the directionality of these comorbidities have yielded mixed results. Further, the relations between these constructs and impulsive personality, particularly negative urgency (NU, the tendency to act rashly when experiencing emotional distress) warrants further attention, as NU relates to symptoms of depression and alcohol and cannabis use. Importantly, NU partially accounts for the association between symptoms of depression and cannabis and alcohol problems in cross-sectional studies. This study examined alternative theories of directionality in order to better understand the longitudinal associations between symptoms of depression, NU, and cannabis or alcohol use. Three semiannual waves of data (baseline, 6-month, and 12-month) were collected in parallel assessments from a sample of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (N = 361). Autoregressive cross-lagged panel models were used to test four alternative theory-driven models about the longitudinal associations between the interaction of symptoms of depression and NU and cannabis or alcohol use. Models revealed unique direction of effects specific to each substance, such that the interaction between symptoms of depression and NU at 6 months postbaseline predicted more alcohol use at 12 months postbaseline, whereas more cannabis use at 6 months postbaseline predicted more severe symptoms of depression at 12 months postbaseline. Results suggests alternate directions of effect for cannabis and alcohol use. Future research should examine these patterns over wider assessment periods in order to see more variability and change over time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Harmful drinking is associated with mental health conditions and other risk behaviours in Australian young people

OBJECTIVE

To investigate factors associated with alcohol use in adolescents, with the focus on analysing the comorbidities between single-occasion harmful-drinking episodes with mental health issues and risk behaviours.

METHODS

This study used data from the Young Minds Matter survey, designed to inform on the prevalence of the seven most common mental health disorders of children and adolescents. Logistic regression modelling was used to assess the odds of harmful drinking behaviour in young people aged 13-17 years in Australia.

RESULTS

We found a strong association between single-occasion harmful drinking and mental health issues, which hold after controlling for sociodemographic characteristics. Young people with severe mental health issues within the past year were four times more likely to have been drinking at harmful levels in the past 30 days.

CONCLUSIONS

Alcohol use can have adverse health effects among children and adolescents. Research has found a bidirectional association between alcohol use and mental health conditions where the presence of one issue almost doubles the risk of having the other issue. Implications for public health: The comorbidity between these issues suggests the need for strategies to integrate policies addressing mental health and alcohol use disorders in young people.

Addiction is driven by excessive goal-directed drug choice under negative affect: translational critique of habit and compulsion theory

Drug addiction may be a goal-directed choice driven by excessive drug value in negative affective states, a habit driven by strong stimulus-response associations, or a compulsion driven by insensitivity to costs imposed on drug seeking. Laboratory animal and human evidence for these three theories is evaluated. Excessive goal theory is supported by dependence severity being associated with greater drug choice/economic demand. Drug choice is demonstrably goal-directed (driven by the expected value of the drug) and can be augmented by stress/negative mood induction and withdrawal-effects amplified in those with psychiatric symptoms and drug use coping motives. Furthermore, psychiatric symptoms confer risk of dependence, and coping motives mediate this risk. Habit theory of addiction has weaker support. Habitual behaviour seen in drug-exposed animals often does not occur in complex decision scenarios, or where responding is rewarded, so habit is unlikely to explain most human addictive behaviour where these conditions apply. Furthermore, most human studies have not found greater propensity to habitual behaviour in drug users or as a function of dependence severity, and the minority that have can be explained by task disengagement producing impaired explicit contingency knowledge. Compulsion theory of addiction also has weak support. The persistence of punished drug seeking in animals is better explained by greater drug value (evinced by the association with economic demand) than by insensitivity to costs. Furthermore, human studies have provided weak evidence that propensity to discount cost imposed on drug seeking is associated with dependence severity. These data suggest that human addiction is primarily driven by excessive goal-directed drug choice under negative affect, and less by habit or compulsion. Addiction is pathological because negative states powerfully increase expected drug value acutely outweighing abstinence goals.

Ultra-brief breath counting (mindfulness) training promotes recovery from stress-induced alcohol-seeking in student drinkers

The therapeutic effect of mindfulness interventions on problematic drinking is thought to be driven by increased resilience to the impact of stress on negative mood and alcohol-seeking behaviour, but this claim needs empirical support. To address this hypothesis, the current study tested whether brief training of one component of mindfulness - breath counting - would reduce drinkers' sensitivity to the effect of noise stress on subjective mood and alcohol-seeking behaviour. Baseline alcohol-seeking was measured by choice to view alcohol versus food thumbnail pictures in 192 student drinkers. Participants then received a 6-minute audio file which either trained breath counting or recited a popular science extract, in separate groups. All participants were then stressed by a loud industrial noise and alcohol-seeking was measured again simultaneously to quantify the change from baseline. Subjective mood was measured after all three stages (baseline, post intervention, post stress test). The breath counting group were instructed to deploy this technique during the stress test. Results showed that the breath counting versus control intervention improved subjective mood relative to baseline, attenuated the worsening of subjective mood produced by stress induction, and accelerated recovery from a stress induced increase in alcohol-seeking behaviour. Exploratory moderation analysis showed that this accelerated recovery from stress induced alcohol-seeking by breath counting was weaker in more alcohol dependent participants. Mindfulness therapies may improve problematic drinking by increasing resilience to stress induced negative mood and alcohol-seeking, as observed in this study. The weaker therapeutic effect of breath counting in more dependent drinkers may reveal limitations to this intervention strategy.

Sex differences in incidence and psychiatric comorbidity for alcohol dependence in patients with panic disorder

BACKGROUND

Sex differences in the development of alcohol dependence (AD) among patients with panic disorder (PD) remain unexplored. The study investigated sex as an effect modifier in the incidence of AD among patients with PD.

METHOD

We included 9480 patients with PD from the Taiwan National Health Insurance Research Database. A total of 169 patients (89 men and 80 women) developed incident AD during the follow-up period. Standardized incidence ratios (SIRs) were used to represent the relative risks of incident AD compared with the general population. Based on a nested case-control study design, 10 controls were selected for each case. Medical utilization and psychiatric comorbidity before diagnosing AD were analyzed using conditional logistic regression.

RESULTS

The SIR of incident AD was 3.36 for men and 6.29 for women. Women with PD and incident AD had more visits to the outpatient department than the controls did, whereas men exhibited no significant differences. Women with incident AD were more likely to comorbid with depressive disorder (adjusted risk ratio [aRR] = 2.94), personality disorder (aRR = 5.03), and sleep disorder (aRR = 1.72), whereas men with incident AD were more likely to comorbid with sleep disorder (aRR = 1.85) and other substance use disorders (aRR = 3.08).

CONCLUSION

Patients with PD have an additional risk of developing AD compared with the general population, and that risk is higher in women. Women and men exhibited dissimilar patterns of medical utilization and psychiatric comorbidity before developing AD. Sex differences should be taken into consideration when establishing preventive measures.

Prevalence, Demographic, and Clinical Correlates of Comorbid Depressive Symptoms in Chinese Psychiatric Patients With Alcohol Dependence

BACKGROUND

Depressive symptoms are common among psychiatric patients with alcohol dependence (AD). However, the prevalence and clinical correlates of comorbid depressive symptoms are less well studied in Chinese Han patients.

METHODS

In this hospital-based survey, we recruited 378 psychiatric patients diagnosed with AD according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV). All patients completed the Beck Depression Inventory (BDI) to evaluate depressive symptoms and the Alcohol Use Disorders Identification Test (AUDIT) to assess the severity of drinking.

RESULTS

Compared to patients without depressive symptoms, 48.9% (185/378) of the patients with comorbid depressive symptoms were younger, had a more unstable marital status, had a higher AUDIT total score, and had a higher adverse consequences subscore (all P < 0.05). Further logistic regression analysis showed that unstable marital status (Odds ratios [OR] = 2.20, 95% confidence interval [CI] 1.21-3.99) and AUDIT total score (OR=1.07, 95% CI 1.03-1.11) were significantly associated with depressive symptoms.

CONCLUSIONS

Our findings indicate high comorbidity between AD and depressive symptoms in Chinese psychiatric patients. Moreover, some variables are correlates of comorbid depressive symptoms. Particular attention should be paid to the early detection and intervention for this comorbid condition and its risk factors.

Indirect Associations of Anxiety Sensitivity with Tobacco, Alcohol, and Other Drug Use Problems Through Emotional Disorder Symptoms in Adolescents

Theoretically, anxiety sensitivity-fear of anxiety symptoms-enhances perception of and emotional reactivity to autonomic arousal and mental distress, thereby increasing negative affect and motivation to use substances for negative reinforcement. Because no prior study of adolescents has tested if anxiety sensitivity is indirectly associated with substance use problems through symptoms of emotional disorders (i.e., disorders involving high levels of negative affect), the current cross-sectional study examined this theoretical pathway. Participants included ninth-grade students from 10 different high schools in the Los Angeles metropolitan area (N = 3005; 54.3% female). Self-report measures of anxiety sensitivity, emotional disorder symptoms, tobacco dependence, and alcohol and other drug problems were administered. Controlling for sex, race/ethnicity, parental education, school, and impulsiveness, we tested the associations of anxiety sensitivity with tobacco, alcohol, and other drug use problems as well as the indirect effects of anxiety sensitivity on each domain of substance use problems through emotional disorder symptoms. Anxiety sensitivity was associated with more severe tobacco dependence and greater alcohol problems and other drug problems, and anxiety sensitivity further was indirectly associated with all three domains of substance use problems through emotional disorder symptoms. Current findings suggest that adolescents high in anxiety sensitivity tend to experience emotional disorder symptoms, which may increase risk for substance use problems. Interventions that target anxiety sensitivity and enhance negative-affect coping skills may assist in preventing and reducing adolescent substance use problems.

Stress vulnerability promotes an alcohol-prone phenotype in a preclinical model of sustained depression

Major depression and alcohol‐related disorders frequently co‐occur. Depression severity weighs on the magnitude and persistence of comorbid alcohol use disorder (AUD), with severe implications for disease prognosis. Here, we investigated whether depression vulnerability drives propensity to AUD at the preclinical level. We used the social defeat–induced persistent stress (SDPS) model of chronic depression in combination with operant alcohol self‐administration (SA). Male Wistar rats were subjected to social defeat (five episodes) and prolonged social isolation (~12 weeks) and subsequently classified as SDPS‐prone or SDPS‐resilient based on their affective and cognitive performance. Using an operant alcohol SA paradigm, acquisition, motivation, extinction, and cue‐induced reinstatement of alcohol seeking were examined in the two subpopulations. SDPS‐prone animals showed increased alcohol SA, heightened motivation to acquire alcohol, persistent alcohol seeking despite alcohol unavailability, signs of extinction resistance, and increased cue‐induced relapse; the latter could be blocked by the α₂ adrenoreceptor agonist guanfacine. In SDPS‐resilient rats, prior exposure to social defeat increased alcohol SA without affecting any other measures of alcohol seeking and alcohol taking. Our data revealed that depression proneness confers vulnerability to alcohol, emulating patterns of alcohol dependence seen in human addicts, and that depression resilience to a large extent protects from the development of AUD‐like phenotypes. Furthermore, our data suggest that stress exposure alone, independently of depressive symptoms, alters alcohol intake in the long‐term.

The grey future: Overgenerality of emotional future thinking in alcohol-use disorders

BACKGROUND

While previous research has highlighted the overgenerality of future thinking in alcohol-use disorders (AUD), the emotional characteristics of future thinking were not taken into account. We therefore evaluated the ability to retrieve episodic (i.e., events that happened at a particular place and time and lasted for a day or less) emotional future events in AUD.

METHODS

We invited 36 participants with AUD and 40 control participants to imagine positive, negative and neutral future scenarios and analyzed these scenarios regarding their episodic characteristics (i.e., the ability of participants to imagine future events situated in time and space enriched with phenomenological details).

RESULTS

Analysis demonstrated lower episodic positive, negative and neutral future thinking in participants with AUD than in control participants. Participants with AUD also demonstrated lower episodic positive and negative future thinking compared to episodic neutral future thinking. Interestingly, high depression scores were associated with overgenerality of neutral, positive, and negative future thinking in AUD participants.

CONCLUSIONS

These findings demonstrate overgenerality of both positive and negative future thinking in AUD. This overgenerality may represent an avoidance strategy in which individuals with AUD may try to avoid the hopelessness and/or conflicts that may be activated when constructing future scenarios.

The Minnesota Model: A Clinical Assessment of Its Effectiveness in Treating Anxiety and Depression Compared to Addiction

The current study compared and assessed the effectiveness of the Minnesota model in reducing psychological symptoms of anxiety and depression among two groups: individuals with clinically diagnosed addiction only (n = 29) and individuals with clinically diagnosed anxiety/depression in the absence of addiction (n = 25). Anxiety and depression were measured using the Generalised Anxiety Disorder 7 and the Patient Health Questionnaire 9, respectively. Two one-way analyses of covariance found no significant differences in post-intervention anxiety and depression scores when comparing the addiction group and the anxiety/depression group (F(1, 51) = 0.075, p = 0.786 and F(1, 51) = 0.302, p = 0.585, respectively). Reliable change index calculations also indicated that both the addiction group and the anxiety/depression group exhibited clinically significant reductions in anxiety and depression following treatment. These findings are considered in light of key methodological limitations, and the theoretical and therapeutic implications are discussed.

Depression and alcohol misuse among older adults: exploring mechanisms and policy impacts using agent-based modelling

PURPOSE

To: (1) explore how multi-level factors impact the longitudinal prevalence of depression and alcohol misuse among urban older adults (≥ 65 years), and (2) simulate the impact of alcohol taxation policies and targeted interventions that increase social connectedness among excessive drinkers, socially isolated and depressed older adults; both alone and in combination.

METHODS

An agent-based model was developed to explore the temporal co-evolution of depression and alcohol misuse prevalence among older adults nested in a spatial network. The model was based on Los Angeles and calibrated longitudinally using data from the Multi-Ethnic Study of Atherosclerosis.

RESULTS

Interventions with a social component targeting depressed and socially isolated older adults appeared more effective in curbing depression prevalence than those focused on excessive drinkers. Targeting had similar impacts on alcohol misuse, though the effects were marginal compared to those on depression. Alcohol taxation alone had little impact on either depression or alcohol misuse trajectories.

CONCLUSIONS

Interventions that improve social connectedness may reduce the prevalence of depression among older adults. Targeting considerations could play an important role in determining the success of such efforts.

Substance type moderates the longitudinal association between depression and substance use from pre-treatment through a 1-year follow-up

BACKGROUND

Research examining directionality of the relationship between depressive symptoms and substance use following treatment entry is limited. Furthermore, substances differ in their neurobiological effects on mood. The relationship between depression and substance use following treatment entry may be moderated by dependence on specific substances. The study tested (a) lagged effects between depressive symptoms and substance use frequency following substance use treatment entry through a 1-year post-treatment follow-up and (b) if substance dependence type moderates these effects.

METHODS

Participants (N = 263) entering residential treatment were assessed for DSM-IV substance dependence, depressive symptoms (Beck Depression Inventory), and percentage of substance use days at post-treatment, 1-, 3-, 6- and 12-month follow-up assessments (time t0 to t4). Linear mixed effects models tested lagged effects between depressive symptoms and substance use frequency and the impact of substance type (i.e., dependence on alcohol, cannabis, opioid, cocaine, hallucinogen/PCP) on this relationship.

RESULTS

After controlling for concurrent effects, substance type moderated each longitudinal relationship. Depressive symptoms significantly predicted substance use frequency at the subsequent follow-up assessment, only among individuals with pre-treatment opioid dependence (B = 5.55, SE = 0.89, z = 6.21, p < 0.01). Substance use frequency significantly predicted depressive symptoms at the subsequent follow-up assessment, but not among individuals with cannabis dependence at pre-treatment (B = 1.01, SE = 0.22, t (524) = 4.49, p < 0.01).

CONCLUSIONS

The directionality of depression-substance use comorbidity may differ based on the substance of dependence at pre-treatment. Opioid users may especially benefit from treating both depression and substance use.

Antidepressant activities of escitalopram and blonanserin on prenatal and adolescent combined stress-induced depression model: Possible role of neurotrophic mechanism change in serum and nucleus accumbens

BACKGROUND

There has been number of studies suggesting experiences of adversity in early life interrelated subsequent brain development, however, neurobiological mechanisms confer risk for onset of psychiatric illness remains unclear.

METHODS

In order to elucidate the pathogenic mechanisms underlying early life adversity-induced refractory depression in more detail, we administered corticosterone (CORT) to adolescent rats with or without prenatal ethanol exposure followed by an antidepressant or antipsychotic and examined alterations in depressive and social function behaviors and brain-derived neurotrophic factor (BDNF) levels in serum, the hippocampus, anterior cingulate cortex, and nucleus accumbens.

RESULTS

The combined stress exposure of prenatal ethanol and adolescent CORT prolonged immobility times in the forced swim test (FST), and increased investigation times and numbers in the social interaction test (SIT). A treatment with escitalopram reversed depression-like behavior accompanied by reductions in BDNF levels in serum and the nucleus accumbens, while a treatment with blonanserin ameliorated abnormal social interaction behavior with reductions in serum BDNF levels.

LIMITATIONS

Further studies are needed to clarify the clinical evinces responding to these results, and many questions remain regarding the mechanisms by which refractory depression and antidepressant/antipsychotic treatments cause changes in serum and brain regional BDNF levels.

CONCLUSION

These results strongly implicate changes in BDNF levels in serum and the nucleus accumbens in the pathophysiology and treatment of early life combined stress-induced depression and highlight the therapeutic potential of escitalopram and new generation antipsychotic blonanserin for treatment-resistant refractory depression.

Impaired Specificity of Future Thinking in Alcohol Use Disorders

BACKGROUND

While there has been a body of work that has investigated past thinking in individuals with alcohol use disorders (AUD), little is known about future thinking in these individuals.

METHODS

We invited participants with AUD and control participants to construct past and future events. We have also investigated the relationship between constructing past and future events and depression.

RESULTS

By analyzing the specificity (i.e., the ability in constructing specific events situated in time and space) of these events, results demonstrated lower specificity of past and future thinking in AUD participants compared to control participants. No significant differences were observed between the specificity of past and future thinking in AUD or in control participants. Further, significant negative correlations were observed between depression and past/future thinking in AUD participants but not in controls.

CONCLUSIONS

Difficulties in constructing specific future scenarios, as observed in AUD participants compared with controls, are presumably related to ruminative thinking and emotional avoidance aspects of depression, which should be investigated in future studies. More specifically, individuals with AUD may tend to construct general future scenarios to dwell on negative past events and/or to avoid coping with hopelessness and processing of upsetting or distressful future scenarios.

Lifetime experience of multiple common mental disorders and 19-year mortality: results from a Canadian population-based cohort

AIMS

To examine the impact of multiple psychiatric disorders over the lifetime on risk of mortality in the general population.

METHODS

Data came from a random community-based sample of 1397 adults in Atlantic Canada, recruited in 1992. Major depression, dysthymia, panic disorder, generalised anxiety disorder and alcohol use disorders were assessed using the Diagnostic Interview Schedule (DIS). Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. Cox proportional hazard models with age at study entry as the time scale were used to investigate the relationship between DIS diagnoses and mortality, adjusted for participant education, smoking and obesity at baseline.

RESULTS

Results suggested that mood and anxiety disorders rarely presented in isolation - the majority of participants experienced multiple psychiatric disorders over the lifetime. Elevated risk of death was found among men with both major depression and dysthymia (HR 2.56; 95% CI 1.12-5.89), depression and alcohol use disorders (HR 2.45; 95% CI 1.18-5.10) and among men and women who experienced both panic disorder and alcohol use disorders (HR 3.80; 95% CI 1.19-12.16).

CONCLUSION

The experience of multiple mental disorders over the lifetime is extremely common, and associated with increased risk of mortality, most notably among men. Clinicians should be aware of the importance of considering contemporaneous symptoms of multiple psychiatric conditions.

The Mutual Relationship Between Men's Drinking and Depression: A 4-Year Longitudinal Analysis

Aims

The purpose of the current study was to examine the longitudinal reciprocal relationship between depression and drinking among male adults from the general population.

Methods

This study used a panel dataset from the Korean Welfare Panel (from 2011 to 2014). The subjects were 2511 male adults aged between 20 and 65 years. Based on the Korean Version of the Alcohol Use Disorders Identification Test (AUDIT-K) scores, 2191 subjects were categorized as the control group (AUDIT-K < 12) and 320 subjects were categorized as the problem drinking group (AUDIT-K ≥ 12). An autoregressive cross-lagged modelling analysis was performed to investigate the mutual relationship between problem drinking and depression measured consecutively over time.

Results

The results indicated that alcohol drinking and depression were stable over time. In the control group, there was no significant causal relationship between problem drinking and depression while in the problem drinking group, drinking in the previous year significantly influenced depression in the following second, third and fourth years.

Conclusion

This study compared normal versus problem drinkers and showed a 4-year mutual causal relationship between depression and drinking. No longitudinal interaction between drinking and depression occurred in normal drinkers, while drinking intensified depression over time in problem drinkers.

Short summary

This study found that problem drinking was a risk factor for development of depression. Therefore, more attention should be given to problem alcohol use in the general population and evaluation of past alcohol use history in patients with depressive disorders.

Vital exhaustion and risk of alcohol use disorders: A prospective cohort study

OBJECTIVE

Vital exhaustion is an emotional state characterized by fatigue and depressive symptoms. We examined the prospective association between vital exhaustion and risk of alcohol use disorders (AUD). Furthermore, we investigated whether cohabitation status modifies the effect of this potential association.

METHODS

Vital exhaustion was assessed by a condensed, 17 item, version of the Maastricht Questionnaire as part of the Copenhagen City Heart Study in 1991-93. The study population consisted of 8956 individuals aged 21-93 years, who were followed for a first-time diagnosis of AUD in national registers until 2016. The mean length of follow-up was 16.6 years.

RESULTS

During follow-up, AUD was diagnosed in 146 men and 103 women. For both sexes, the risk of AUD increased dose-dependently with increasing vital exhaustion. Individuals who reported high vital exhaustion had a 2- to 3-fold higher risk of AUD in both men (HR = 2.46, 95% CI: 1.40-4.29) and women (HR = 3.34, 95% CI: 1.62-6.85). A potential modifying effect of cohabitation status on the relation between vital exhaustion and AUD was found for men.

CONCLUSION

The results showed that vital exhaustion is significantly associated with a higher risk of AUD in both men and women and that living with a cohabitee may have a protective effect among men.

Alvanzo AA, Mojtabai R, Pacek LR, Cullen BA, Reboussin BA. Transitions through stages of alcohol involvement: The potential role of mood disorders

INTRODUCTION

Although prior clinical and population-based studies have demonstrated comorbidity between mood and alcohol use disorders (AUD), there is a paucity of research assessing whether mood disorders predict transition across stages of alcohol involvement.

METHOD

Hypothesizing that mood disorders predict transition across sex-specific alcohol involvement stages, we used prospective data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of US adults, which included male (n = 14,564) and female (n = 20,089) participants surveyed in 2001-2 and re-interviewed in 2004-5. Latent class (LCA) and latent transition analyses (LTA) were used to assess patterns of alcohol involvement in the US and the association of lifetime mood disorders at baseline with transition across stages of alcohol involvement during follow-up.

RESULTS

A three-class model of AUD criteria was identified (No problems, Moderate problems and Severe problems) for both sexes. Positive cross-sectional associations between mood disorder and problem classes of alcohol involvement were found among both sexes, as were positive longitudinal associations. Propensity score adjustment mitigated the associations of baseline mood disorder with progressive transition for both sexes. However, among females, baseline mood disorder was consistently associated with reduction in remission from Severe to Moderate alcohol problems (aOR = 0.30, CI = 0.09-0.99, p = .048) over time.

DISCUSSION

Our study provides evidence that mood disorders impact transition through stages of alcohol involvement and are most strongly associated with hindering remission among females. Findings advance our understanding of these comorbid relationships and have clinical implications for ongoing assessment of drinking patterns among individuals with mood disorders.

Anxiety sensitivity components in relation to alcohol and cannabis use, motives, and problems in treatment-seeking cigarette smokers

Anxiety sensitivity (AS)- fear of anxiety symptoms and their potential negative consequences-has been implicated in the development of substance use problems and motivation to use substances for coping with distress, though the AS components (physical, cognitive, and social concerns) have not been studied extensively in relation to alcohol- and cannabis-related variables. In a cross-sectional design, self-report measures of AS and alcohol and cannabis use, motives, and problems were administered to 364 treatment-seeking cigarette smokers with a history of alcohol and cannabis use. In both adjusted and unadjusted analyses, linear regression models indicated that AS cognitive concerns are related to cannabis-use conformity motives, alcohol-use coping motives, and alcohol problems; AS physical and cognitive concerns are related to greater cannabis problems specifically in males; and AS social concerns are associated with greater social, coping, enhancement, and conformity drinking motives. AS cognitive and physical concerns were also related to greater alcohol and cannabis problems, respectively, in subsamples limited to 214 current alcohol users and 170 current cannabis users. Together with prior work, current findings suggest that it may be beneficial to focus more on addressing AS cognitive concerns in individuals with tobacco-alcohol problem comorbidity, whereas it may be beneficial to focus on addressing both AS physical and cognitive concerns in males with tobacco-cannabis problem comorbidity. In addition, cigarette smokers high in AS social concerns may benefit from relaxation training to lessen their social anxiety as well as behavioral activation to enhance their positive affect.

Exploring Demographics and Health as Predictors of Risk-Taking in UK Help-Seeking Veterans

Risk-taking amongst veterans has severe consequences, yet few studies have examined factors that may predict risk-taking in help-seeking veteran populations. This paper presents a cross-sectional study involving a random sample of 667 UK help-seeking veterans, investigating the role of demographics, mental health and physical health presentations on the propensity for risk-taking. Out of 403 (73.4%) veterans, 350 (86.8%) reported risk-taking in the past month. We found that younger age, being in a relationship, probable PTSD, common mental health difficulties and traumatic brain injury were significantly associated with risk-taking. Additionally, a direct association was found between increased risk-taking and PTSD symptom clusters, including higher hyperarousal, elevated negative alterations in mood and cognition. Our findings provide initial evidence for demographic and mental health presentations as predictors of risk-taking in help-seeking veterans. Further research and longitudinal studies are needed to facilitate valid risk assessments, and early intervention for veteran services.

Influence of comorbid alcohol use disorders on the clinical patterns of major depressive disorder: A general population-based study

BACKGROUND

To compare the symptom patterns of major depressive disorder (MDD) among subjects with MDD and 1) no alcohol use disorder (AUD), 2) alcohol abuse and 3) alcohol dependence, respectively.

METHODS

In a general population survey of 38,694 French individuals, MDD and AUDs were assessed using the Mini International Neuropsychiatric Interview 5.0.0 (MINI). A total of 4339 subjects (11.2%) in the sample met the criteria for MDD. Among them, 413 (9.5%) AUD subjects were identified: 138 (3.2%) for alcohol abuse and 275 (6.3%) for alcohol dependence. The associations of each of the ten MDD criteria of the MINI and psychiatric clinical features were compared among the three groups. The relative profiles of 'MDD + AUD' vs. 'MDD alone' were determined using a multivariable stepwise regression model.

RESULTS

With the noAUD group as the reference, sadness (OR = 0.46; 95%CI, 0.29-0.74) and anhedonia (OR = 1.66; 95%CI, 1.06-2.73) were only associated with alcohol abuse. Sleep disorders (OR = 2.07; 95%CI, 1.51-2.88), feelings of guilt (OR = 1.41; 95%CI, 1.05-1.90), diminished concentration/indecisiveness (OR = 1.52; 95%CI, 1.12-2.07) and thoughts of death (OR = 1.95; 95%CI 1.49-2.55) were only associated with alcohol dependence. Weight or appetite variations were both associated with alcohol abuse (OR = 1.7; 95%CI, 1.15-2.53) and dependence (OR = 1.41; 95%CI, 1.06-1.88). Bipolar disorder and PTSD were only associated with alcohol dependence. Psychotic features, previous suicide attempts, and panic disorder were more frequent in the MDD-AUD group.

CONCLUSION

MDD-AUD subjects displayed a more severe profile with specific symptomatology and comorbidity profiles compared to MDD-only subjects.

First and Subsequent Lifetime Alcoholism and Mental Disorders in Suicide Victims With Reference to a Community Sample-the Lundby Study 1947-1997

Background: Suicide victims have been found to frequently suffer from mental disorders, often more than one, and comorbidity has also been found to be a risk factor for suicide. The aim of the present study was to determine the first disorder and possible subsequent disorders in suicide victims during their lifetimes and to compare their development with the development of mental and alcohol use disorders (AUDs) in a community sample. Methods: The Lundby Study is a prospective longitudinal study of mental health in a general population comprising 3,563 subjects, including 68 suicide victims, followed by four field investigations from 1947 to 1997; mortality was monitored up to 2011. Results: AUD was most common as a first diagnosis (26/68, 38.2%) among suicide victims, followed by "depression" (20/68, 29.4%) and "anxiety" (7/68, 10.3%). A predominance of AUD as a first diagnosis was found in the male group, whereas "depression" was the most common first diagnosis in the female group. However, there were very few females with AUD in the Lundby Study. In the whole population, it was more common for someone who started with an AUD to develop a subsequent mental disorder than the other way around. The same was true for AUD in relation to depression. Conclusions: AUD was the most common first mental disorder among male suicide victims and could thus be considered a starting point in the suicidal process. We propose that in addition to detecting and treating depression, it is important to detect and treat AUD vigorously and to be alert for subsequent symptoms of depressive and other mental disorders in suicide prevention efforts.

Principal component analysis of early alcohol, drug and tobacco use with major depressive disorder in US adults

Early alcohol, tobacco and drug use prior to 18 years old are comorbid and correlated. This study included 6239 adults with major depressive disorder (MDD) in the past year and 72,010 controls from the combined data of 2013 and 2014 National Survey on Drug Use and Health (NSDUH). To deal with multicollinearity existing among 17 variables related to early alcohol, tobacco and drug use prior to 18 years old, we used principal component analysis (PCA) to infer PC scores and then use weighted multiple logistic regression analyses to estimate the associations of potential factors and PC scores with MDD. The odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. The overall prevalence of MDD was 6.7%. The first four PCs could explain 57% of the total variance. Weighted multiple logistic regression showed that PC1 (a measure of psychotherapeutic drugs and illicit drugs other than marijuana use), PC2 (a measure of cocaine and hallucinogens), PC3 (a measure of early alcohol, cigarettes, and marijuana use), and PC4 (a measure of cigar, smokeless tobacco use and illicit drugs use) revealed significant associations with MDD (OR = 1.12, 95% CI = 1.08-1.16, OR = 1.08, 95% CI = 1.04-1.12, OR = 1.13, 95% CI = 1.07-1.18, and OR = 1.15, 95% CI = 1.09-1.21, respectively). In conclusion, PCA can be used to reduce the indicators in complex survey data. Early alcohol, tobacco and drug use prior to 18 years old were found to be associated with increased odds of adult MDD.

Multilevel Influences on Depressive Symptoms among Men in Bangladesh

Depression is a worldwide problem, and is especially prevalent in lower-income countries with insufficient resources and widespread poverty, such as Bangladesh. Yet multilevel determinants of depressive symptoms in men have not been studied in this context. We leverage a novel dataset from men in Bangladesh to determine the community- and individual-level influences of masculine dominance strain and financial strain on the frequency of married men's depressive symptoms in Bangladesh. Data were collected between January and June, 2011, as part of the UN Multi-Country Study of Men and Violence, conducted by The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Masculine dominance strain at both levels was related to the frequency of depressive symptoms. Financial strain only at the individual level was related to the frequency of depressive symptoms. We conclude that community-level economic interventions may not directly influence individual-level depression; however, addressing customary conceptions of masculinity at the community and individual level and addressing individual-level financial strain are promising joint strategies to improve married men's mental health in Bangladesh and similar settings.