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Holzer KJ, Vaughn MG, Loux TM, Mancini MA, Fearn NE, Wallace CL. Prevalence and correlates of antisocial personality disorder in older adults. Aging Ment Health 2022; 26:169-178. [PMID: 33107330 DOI: 10.1080/13607863.2020.1839867] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES There is a paucity of research on antisocial personality disorder (ASPD) in the geriatric population and the majority of knowledge on the disorder is drawn from young adult samples. Researchers posit that the prevalence of ASPD as well as other personality disorders (PDs) is underestimated among older adults. Using a nationally representative sample, the present study examines the prevalence and correlates of ASPD in adults ages 50 and older. METHODS We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions Waves I and III. Multivariate logistic regression analyses were employed to investigate associations between ASPD and sociodemographic characteristics. A series of logistic regression analyses were also conducted to study associations between ASPD and medical conditions (liver and cardiovascular disease, arthritis, and stomach ulcer), major psychiatric disorders (lifetime major depressive disorder, mania, and generalized anxiety disorder), and substance use disorders (lifetime alcohol, marijuana, cocaine, heroin, and nicotine use disorders). RESULTS Findings indicated that the prevalence of ASPD increases through early adulthood, with a peak at 3.91% in younger adults and decline to 0.78% in adults ages ≥65. Older adults with ASPD are more likely to be diagnosed with a substance use disorder, major depression, mania, and generalized anxiety disorder as well as each medical condition. CONCLUSION Older adults with ASPD experience increased rates of medical and psychiatric comorbidities. These conditions exacerbate the existing challenges associated with diagnosing and treating this population and may have serious consequences for the patient, their caregivers and society.
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Affiliation(s)
- Katherine J Holzer
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.,School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.,Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Travis M Loux
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Michael A Mancini
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Noelle E Fearn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Cara L Wallace
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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2
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Shmulewitz D, Aharonovich E, Witkiewitz K, Anton RF, Kranzler HR, Scodes J, Mann KF, Wall MM, Hasin D. The World Health Organization Risk Drinking Levels Measure of Alcohol Consumption: Prevalence and Health Correlates in Nationally Representative Surveys of U.S. Adults, 2001-2002 and 2012-2013. Am J Psychiatry 2021; 178:548-559. [PMID: 33472388 PMCID: PMC8222066 DOI: 10.1176/appi.ajp.2020.20050610] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Little is known about change over time in the prevalence of World Health Organization (WHO) risk drinking levels (very high, high, moderate, low) and their association with health conditions, overall and by gender. The authors used two sets of nationally representative U.S. survey data to determine whether changes over time varied by gender and to examine whether health conditions related to alcohol were associated with WHO risk drinking level within each survey, and whether these associations differed by gender. METHODS Data on current drinkers from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N=26,655) and the 2012-2013 NESARC-III (N=25,659) were analyzed using logistic regression. Prevalence differences between surveys were estimated for each drinking level overall and by gender. Within each survey, prevalence differences by WHO risk drinking level were estimated for alcohol use disorder (AUD), drug use disorders, functional impairment, liver disease, and depressive and anxiety disorders. RESULTS In the 2012-2013 survey, the prevalences of moderate, high, and very high risk drinking were 5.9%, 3.2%, and 3.5%, respectively, representing significant increases from the prevalences in the 2001-2002 survey, which were 1.0%, 0.6%, and 0.9%, respectively. The increase for very high risk drinking among men (0.5%) was smaller than the increase among women (1.4%). Within both surveys, compared with low risk, health conditions were significantly associated with very high risk (range of prevalence differences, 2.2%-57.8%), high risk (2.6%-41.3%), and moderate risk (0.6%-29.8%) drinking. Associations were similar by gender, except that there were stronger effects for AUD in men and for functional impairment and depressive and anxiety disorders in women. CONCLUSIONS The increase in potentially problematic drinking levels among U.S. adults emphasizes the need for better prevention and treatment strategies. The study results support the validity of the WHO risk drinking levels, which show clinical utility as nonabstinent drinking reduction treatment goals. Such goals could engage more people in treatment, improving public health by decreasing personal and societal consequences of risk drinking.
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Affiliation(s)
- Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | | | - Karl F Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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- Department of Psychiatry, Columbia University Irving Medical Center, New York (Shmulewitz, Aharonovich, Wall, Hasin); New York State Psychiatric Institute, New York (Shmulewitz, Aharonovich, Scodes, Wall, Hasin); Department of Psychology, University of New Mexico, Albuquerque (Witkiewitz); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (Anton); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Kranzler); Crescenz Veterans Affairs Medical Center, Philadelphia (Kranzler); Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (Mann); Department of Biostatistics (Wall) and Department of Epidemiology (Hasin), Mailman School of Public Health, Columbia University, New York
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3
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Geoffroy PA, Oquendo MA, Courtet P, Blanco C, Olfson M, Peyre H, Lejoyeux M, Limosin F, Hoertel N. Sleep complaints are associated with increased suicide risk independently of psychiatric disorders: results from a national 3-year prospective study. Mol Psychiatry 2021; 26:2126-2136. [PMID: 32355334 DOI: 10.1038/s41380-020-0735-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 12/21/2022]
Abstract
Prior research suggests that sleep disturbances are associated with increased risk of suicide. However, sleep disturbances are associated with a wide range of psychiatric disorders, and it is unknown whether this association is independent of psychopathology. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of three sleep complaints (i.e., trouble falling asleep, early morning awakening, and hypersomnia) on the 3-year occurrence of attempting suicide. Because psychiatric disorders increase the risk of suicide attempt almost exclusively through a general psychopathology factor representing their shared effect, covariates included that factor, prior history of suicide attempt, and a wide range of sociodemographic and clinical characteristics. The 3-year prevalence rate of suicide attempt was 0.6% (n = 241). Compared with participants who did not attempt suicide between the two waves, those who did reported significantly more frequently having trouble falling asleep (44.6% vs. 16.6%), early morning awakening (38.9% vs. 12.7%), and hypersomnia (35.0% vs. 10.7%). Following adjustments, effects of sleep complaints on this risk were significant and exerted almost exclusively through a general sleep complaints factor representing the shared effect across all sleep complaints. There were no residual associations of any individual sleep complaint with attempting suicide above that association. Sleep complaints are associated with an increased risk of attempting suicide independently of psychopathology, and should be included in suicide risk assessments as these symptoms may provide targets for reducing the risks of suicidal behaviors.
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Affiliation(s)
- Pierre A Geoffroy
- Paris Diderot University-Paris VII, 5 Rue Thomas Mann, 75013, Paris, France. .,Université de Paris, NeuroDiderot, Inserm, F-75019, Paris, France. .,University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
| | - Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philippe Courtet
- INSERM, U1061, Neuropsychiatry, University Montpellier, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France.,Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Michel Lejoyeux
- Paris Diderot University-Paris VII, 5 Rue Thomas Mann, 75013, Paris, France.,University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Frédéric Limosin
- Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France.,Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, Paris, France.,Faculté de médecine Paris Descartes, Université de Paris, Paris, France.,Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nicolas Hoertel
- Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France.,Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, Paris, France.,Faculté de médecine Paris Descartes, Université de Paris, Paris, France.,Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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4
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Holzer KJ, Vaughn MG, Fearn NE, Loux TM, Mancini MA. Age bias in the criteria for antisocial personality disorder. J Psychiatr Res 2021; 137:444-451. [PMID: 33780758 DOI: 10.1016/j.jpsychires.2021.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
The prevalence of antisocial personality disorder (ASPD) decreases with age. As such, research regarding ASPD typically focuses on children and younger adults. The apparent age-specific prevalence of ASPD may be due, in part, to diagnostic criteria informed by research excluding older adults. The present study sought to better understand the manifestation of ASPD in older adults and investigate potential age bias in the diagnostic criteria. Item response theory methods were used to the diagnostic criteria for ASPD with data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III. The measurement of three ASPD criteria showed uniform differential item functioning (DIF), suggesting that older adults were less likely to endorse the item than younger adults despite having the same level of underlying personality disorder. The items with DIF are related to the following criteria for ASPD: Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest (3 items with DIF); irritability and aggressiveness, as indicated by repeated physical fights or assaults (1 item with DIF); and consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations (1 item with DIF). Results of the present study can be used to inform the development of criteria that better capture the age-specific experience of this disorder. Improved criteria will result in increased diagnostic accuracy, systematic estimation of the prevalence, improved assessments, and more effective treatment options for this complex population.
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Affiliation(s)
- Katherine J Holzer
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, 63110, United States; School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States.
| | - Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States; Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Noelle E Fearn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States
| | - Travis M Loux
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63104, United States
| | - Michael A Mancini
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States
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García de la Garza Á, Blanco C, Olfson M, Wall MM. Identification of Suicide Attempt Risk Factors in a National US Survey Using Machine Learning. JAMA Psychiatry 2021; 78:398-406. [PMID: 33404590 PMCID: PMC7788508 DOI: 10.1001/jamapsychiatry.2020.4165] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Because more than one-third of people making nonfatal suicide attempts do not receive mental health treatment, it is essential to extend suicide attempt risk factors beyond high-risk clinical populations to the general adult population. OBJECTIVE To identify future suicide attempt risk factors in the general population using a data-driven machine learning approach including more than 2500 questions from a large, nationally representative survey of US adults. DESIGN, SETTING, AND PARTICIPANTS Data came from wave 1 (2001 to 2002) and wave 2 (2004 to 2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). NESARC is a face-to-face longitudinal survey conducted with a national representative sample of noninstitutionalized civilian population 18 years and older in the US. The cumulative response rate across both waves was 70.2% resulting in 34 653 wave 2 interviews. A balanced random forest was trained using cross-validation to develop a suicide attempt risk model. Out-of-fold model prediction was used to assess model performance, including the area under the receiver operator curve, sensitivity, and specificity. Survey design and nonresponse weights allowed estimates to be representative of the US civilian population based on the 2000 census. Analyses were performed between May 15, 2019, and June 10, 2020. MAIN OUTCOMES AND MEASURES Attempted suicide in the 3 years between wave 1 and wave 2 interviews. RESULTS Of 34 653 participants, 20 089 were female (weighted proportion, 52.1%). The weighted mean (SD) age was 45.1 (17.3) years at wave 1 and 48.2 (17.3) years at wave 2. Attempted suicide during the 3 years between wave 1 and wave 2 interviews was self-reported by 222 of 34 653 participants (0.6%). Using survey questions measured at wave 1, the suicide attempt risk model yielded a cross-validated area under the receiver operator characteristic curve of 0.857 with a sensitivity of 85.3% (95% CI, 79.8-89.7) and a specificity of 73.3% (95% CI, 72.8-73.8) at an optimized threshold. The model identified 1.8% of the US population to be at a 10% or greater risk of suicide attempt. The most important risk factors were 3 questions about previous suicidal ideation or behavior; 3 items from the 12-Item Short Form Health Survey, namely feeling downhearted, doing activities less carefully, or accomplishing less because of emotional problems; younger age; lower educational achievement; and recent financial crisis. CONCLUSIONS AND RELEVANCE In this study, after searching through more than 2500 survey questions, several well-known risk factors of suicide attempt were confirmed, such as previous suicidal behaviors and ideation, and new risks were identified, including functional impairment resulting from mental disorders and socioeconomic disadvantage. These results may help guide future clinical assessment and the development of new suicide risk scales.
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Affiliation(s)
| | - Carlos Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Melanie M. Wall
- Department of Biostatistics, Columbia University, New York, New York,Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York
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6
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Psychiatric disorders and risk for multiple adverse outcomes: a national prospective study. Mol Psychiatry 2021; 26:907-916. [PMID: 31350462 PMCID: PMC6982560 DOI: 10.1038/s41380-019-0459-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/05/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
Abstract
Most psychiatric disorders, when examined individually, are associated with a broad range of adverse outcomes. However, psychiatric disorders often co-occur and their co-occurrence is well explained by a limited number of transdiagnostic factors. Yet it remains unclear whether the risk of these adverse outcomes is due to specific psychiatric disorders, specific dimensions of psychopathology (i.e., internalizing and externalizing dimensions), a general psychopathology factor, or a combination of these explanations. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of common Axis I and Axis II disorders on the risk of ten adverse outcomes (unemployment; financial crisis; low income; poorer general health; worse mental and physical health; legal problems; divorce; problems with a neighbor, friend, or relative; and violence) in the general adult population. Effects of psychiatric disorders were exerted mostly through a general psychopathology factor representing the shared effect across all disorders, independent of sociodemographic characteristics and the presence of the adverse outcomes at baseline. Violence and legal problems were further associated with the externalizing factor, but there were no independent associations of the internalizing factor or any individual psychiatric disorders with any of the adverse outcomes. Our findings reveal that associations between psychiatric disorders and adverse outcomes occur through broad psychological dimensions. Understanding the biological and psychological mechanisms underlying these dimensions should yield key intervention targets to decrease the individual suffering and societal burden associated with common psychiatric disorders.
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7
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Scheer V, Blanco C, Olfson M, Lemogne C, Airagnes G, Peyre H, Limosin F, Hoertel N. A comprehensive model of predictors of suicide attempt in individuals with panic disorder: Results from a national 3-year prospective study. Gen Hosp Psychiatry 2020; 67:127-135. [PMID: 33129137 DOI: 10.1016/j.genhosppsych.2020.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE People with panic disorder are at increased risk of suicide. Multiple factors influence their risk suggesting a need to combine them into an integrative model to develop more effective suicide prevention strategies for this population. In this report, we sought to build a comprehensive model of the 3-year risk of suicide attempt in individuals with panic disorder using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; wave 1, 2001-2002; wave 2, 2004-2005). METHOD We used structural equation modeling to simultaneously examine effects of six broad groups of clinical factors previously identified as potential predictors of suicide attempt in adults with panic disorder: 1) severity of panic disorder, 2) severity of comorbidity, 3) prior history of suicide attempt, 4) family history of psychiatric disorders, 5) sociodemographic characteristics and 6) treatment-seeking behavior. RESULTS The 3-year prevalence rate of suicide attempt was 4.6%. A general psychopathology factor, lower physical health-related quality of life, prior suicide attempt and a greater number of stressful life events at baseline significantly and independently predicted suicide attempt between the two waves (p < .05). R-square of the models ranged from 0.47 to 0.50. CONCLUSION This model may help inform future research and identify high-risk individuals among adults with panic disorder.
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Affiliation(s)
- Valentin Scheer
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France.
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032, USA
| | - Cédric Lemogne
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Guillaume Airagnes
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; UMS 011, Population-based Epidemiological Cohorts, Inserm, Villejuif, France
| | - Hugo Peyre
- Robert Debré Hospital, Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Frédéric Limosin
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nicolas Hoertel
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Associations Between Marijuana Use and Involuntary Job Loss in the United States: Representative Longitudinal and Cross-Sectional Samples. J Occup Environ Med 2020; 61:21-28. [PMID: 30256305 DOI: 10.1097/jom.0000000000001463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate whether marijuana use is associated with involuntary job loss. METHODS Multivariable survey logistic analysis of longitudinal (2001 to 2002/2003 to 2004) and cross-sectional data (2012 to 2013) from National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS Marijuana use increased for all user groups with most workers who use marijuana using marijuana monthly (2.7% in 2001 to 2002 and 10.8% in 2012 to 2013). Past year marijuana users in 2001 to 2002 had higher odds of involuntary job loss in 2003 to 2004 (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.13 to 1.41). Daily marijuana use is associated with higher odds of job loss in adjusted analyses using longitudinal (OR 2.18; 95%CI 1.71 to 2.77) and cross-sectional data (OR 1.40; 95%CI 1.06 to 1.86). Income significantly modifies these effects. CONCLUSIONS Findings indicate that job loss may be an overlooked social cost of marijuana use for US workers. Future studies using an occupational health perspective are needed.
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9
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Sex differences on the relation between major depressive disorder and labor market outcomes: A national prospective study. J Psychiatr Res 2020; 124:144-150. [PMID: 32155478 DOI: 10.1016/j.jpsychires.2020.02.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/02/2020] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
To ascertain the direction of causality and differences by sex between major depressive disorder (MDD) and labor market outcomes in the US population, we used structural equation models separately for males and females to assess prospectively the interdependency of depression and labor market outcomes at Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Diagnosis of MDD used DSM-IV criteria. We found that MDD at Wave 1 predicted being out of the labor force for males at Wave 2 (p = 0.006) and being in the labor force at Wave 1 was associated with lower probability of MDD at Wave 2 (p = 0.049). Among males in the labor force, MDD at Wave 1 was negatively associated with employment at Wave 2 (p = 0.047), and employment at Wave 1 was negatively associated with MDD at Wave 2 (p < 0.001). For women, there was no association between MDD and labor force participation. However, among women in the labor force, MDD at Wave 1 was negatively associated with employment at Wave 2 (p = 0.013) and being employed at Wave 1 was negatively associated with MDD at Wave 2 (p < 0.0001). These results indicate that MDD and negative labor market outcomes are associated with one another at both time points, but the effects differ by sex. To reduce the economic and social burden of MDD, these differences should be considered in clinical practice, vocational rehabilitation, and in the design of social policies.
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10
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Testing a somatization hypothesis to explain the Black-White depression paradox. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1255-1263. [PMID: 30982118 DOI: 10.1007/s00127-019-01707-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Epidemiologic studies document a lower prevalence of major depression in Blacks than Whites in the United States. This is paradoxical from the perspective of social stress theory. A long-standing claim in the (clinical) literature is that Blacks express depression more somatically than Whites. If true, the diagnostic algorithm may undercount depression in Blacks, since the screening symptoms privilege the psychological rather than somatic dimensions of depression. We test hypotheses that (1) Blacks express depression more somatically than Whites which (2) reduces their likelihood of endorsing screening symptoms, thereby undercounting Blacks' depression and explaining the Black-White depression paradox. METHODS We use cross-sectional data collected in 1991-92 from the National Longitudinal Alcohol Epidemiologic Survey (n = 42,862) among Blacks and Whites endorsing at least one past-12-month depression symptom. We compare groups on depression somatization and test whether greater somatization in Blacks leads to lower endorsement of psychological screening symptoms, and therefore under-diagnosis. RESULTS Blacks have higher mean depression somatization scores than Whites (0.28, SE 0.04 vs. 0.15, SE 0.02), t(122) = - 2.15, p = 0.03. This difference is small and driven by Blacks' higher endorsement of 1 somatic symptom (weight/appetite change) and Whites' greater propensity to endorse psychological symptoms. However, Blacks have the same odds as Whites of endorsing screening symptoms, before and after adjusting for somatization. CONCLUSIONS We find minimal evidence that Blacks express depression more somatically than Whites. Furthermore, this small difference does not appear to inhibit endorsement of diagnostic depression screening symptoms among Blacks, and therefore does not resolve the Black-White depression paradox.
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11
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Holzer KJ, Huang J. Physical health-related quality of life among older adults with personality disorders. Aging Ment Health 2019; 23:1031-1040. [PMID: 29749747 DOI: 10.1080/13607863.2018.1468412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objectives: Personality Disorders (PDs) are associated with a multitude of negative consequences. The negative PD effects on health can be even more burdensome for older adults given the physical and social functioning changes that occur with age; however, the majority of research examining the influence of PDs focuses on younger adults. The present study seeks to investigate the relationship between PDs and physical health-related quality of life (PHRQoL) in adults over the age of 50. Methods: Data for 16,884 adults ages 50 and older from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were analyzed. Multiple linear regression models were analyzed to investigate the relationships of seven PDs and participants' PHRQoL. Results: All PDs except histrionic and avoidant PD had statistically significant negative associations with PHRQoL scores, indicating that respondents diagnosed with PDs were expected to have lower PHRQoL than those without PDs, after controlling for sociodemographic characteristics. When psychosocial covariates were added to the model, only dependent, obsessive-compulsive and paranoid PDs were significantly related to PHRQoL score. Conclusions: For adults ages 50 and older, a diagnosis of PD was weakly associated with lower PHRQoL scores for three PDs, however this is unlikely to be a causal association. The strength of the relationship between PDs and PHRQoL varies by type of PD. Given the higher rates of functional and social changes that occur with age, future research should focus on potential causes of worse physical health among older adults with PDs.
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Affiliation(s)
- Katherine J Holzer
- a School of Social Work, College for Public Health and Social Justice , Saint Louis University , St. Louis , MO , United States
| | - Jin Huang
- a School of Social Work, College for Public Health and Social Justice , Saint Louis University , St. Louis , MO , United States
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Franco S, Olfson M, Wall MM, Wang S, Hoertel N, Blanco C. Shared and specific associations of substance use disorders on adverse outcomes: A national prospective study. Drug Alcohol Depend 2019; 201:212-219. [PMID: 31252355 DOI: 10.1016/j.drugalcdep.2019.03.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Substance use disorders (SUD) frequently co-occur and are associated with numerous adverse outcomes and lower quality of life. The goal of this study was to examine whether the associations of SUD with adverse outcomes occur through a shared liability or are disorder-specific even after taking into account their frequent co-occurrence. BASIC PROCEDURES Data were drawn from the National Epidemiological Survey on Alcohol and Related Conditions. The association between nine SUDs assessed at Wave 1 (2001-2002) and a broad range of outcomes (divorce/separation, violence, unemployment, financial crisis, legal problems, problems with a neighbor, friend, or relative, and quality of life) at Wave 2 (2005-2005) were estimated separately and simultaneously using a latent variable model to account for their co-occurrence and identify potential disorder-specific effects. MAIN FINDINGS SUD at Wave 1 were associated with increased prevalence of all adverse outcomes at Wave 2 (p < .05). With the exception of nicotine dependence and tranquilizer use disorder, we found no specific associations of any SUD with any adverse outcome. Rather, associations occurred primarily through the latent variable representing the shared effects of the different SUDs. CONCLUSIONS AND RELEVANCE Our findings underscore the importance of adopting dimensional approaches to model the co-occurrence of SUD. Because SUD increases the risk of adverse outcomes mainly through a general predisposition representing mechanisms shared across SUD rather than through drug-specific mechanisms, this dimension should be considered as a therapeutic target to substantially advance prevention of adverse outcomes caused by SUD.
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Affiliation(s)
- Silvia Franco
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY, 10032, USA; Icahn School of Medicine at Mount Sinai St Luke's-West Hospital, Psychiatry Program, USA.
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY, 10032, USA
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY, 10032, USA
| | - Shuai Wang
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY, 10032, USA
| | - Nicolas Hoertel
- Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; AP-HP, Corentin Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
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13
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Knox J, Wall M, Witkiewitz K, Kranzler HR, Falk DE, Litten R, Mann K, O’Malley SS, Scodes J, Anton R, Hasin DS. Reduction in non-abstinent World Health Organization (WHO) drinking risk levels and drug use disorders: 3-year follow-up results in the US general population. Drug Alcohol Depend 2019; 201:16-22. [PMID: 31174140 PMCID: PMC6662197 DOI: 10.1016/j.drugalcdep.2019.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND To provide information on the clinical relevance of a reduction in the World Health Organization (WHO) drinking risk categories, we examined their relationship to an important indicator of how individuals feel and function: drug use disorders (DUDs), i.e., those involving substances other than alcohol. METHOD Current drinkers in a U.S. national survey (n = 22,005) were interviewed in 2001-02 and re-interviewed 3 years later. WHO drinking risk levels and DSM-IV-defined DUD were assessed at both waves. The relationship of changes in WHO drinking risk levels to the presence of DUD were examined using adjusted odds ratios (aOR). RESULTS At Wave 1, 2.5% of respondents were WHO very-high-risk drinkers, and 2.5%, 4.8%, and 90.2% were high-risk, moderate-risk, and low-risk drinkers, respectively. Among Wave 1 very-high-risk drinkers, significantly lower odds of DUD at Wave 2 were predicted by reductions in WHO risk levels of one, two or three levels (aOR = 0.15, 0.01, 0.24, respectively; all p-values <.0001). Among participants who initially were drinking at lower risk levels, reductions in drinking or abstinence were generally associated with significantly lower odds of DUD, although the results were less consistent. CONCLUSIONS Among very-high-risk drinkers, reduction in the WHO drinking risk categories were associated with lower risk of a DUD. These results add to findings indicating that reductions in WHO drinking risk levels are a meaningful indicator of how individuals feel and function and could therefore serve as informative outcomes in alcohol clinical trials. WHO risk levels can also guide treatment goals and clinical recommendations on drinking reduction.
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Affiliation(s)
- Justin Knox
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Melanie Wall
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA,Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Daniel E. Falk
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Deborah S. Hasin
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
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Hasin DS, Shmulewitz D, Sarvet AL. Time trends in US cannabis use and cannabis use disorders overall and by sociodemographic subgroups: a narrative review and new findings. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:623-643. [PMID: 30870044 PMCID: PMC6745010 DOI: 10.1080/00952990.2019.1569668] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022]
Abstract
Background: Due to significant comorbidity and impairment associated with cannabis use and cannabis use disorder, understanding time trends in cannabis use and cannabis use disorder is an important public health priority.Objectives: To identify trends in cannabis use and cannabis use disorder overall, and by sociodemographic subgroup.Methods: Narrative review of published findings on trends in cannabis use and cannabis use disorders in data from repeated cross-sectional US general population surveys. In addition, in National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2002-2002) and NESARC-III (2012-2013) data, logistic regression was used to examine whether trends differed between subgroups of adults.Results: The review showed that in adults, cannabis use increased over the past decade overall and within sociodemographic subgroups (gender, age, race/ethnicity, income, education, marital status, urbanicity, region, pregnancy status, disability status), with greater increases in men and disabled adults. Most sources also indicated significant increases in cannabis use disorders. New analysis showed significantly greater increases in adult cannabis use and cannabis use disorder in men (p ≤ .0001); young adults (p < .05); Blacks (vs. Whites, p < .01); low income groups (p < .001); never-married p ≤ .0001), and urban residents (p < .05). In adolescents, cannabis use generally decreased, although recent increases were observed in older and non-White adolescents.Conclusion: Cannabis use and cannabis use disorder are increasing in adults, with specific sociodemographic groups at higher risk, and may be increasing in some adolescent subgroups. Studies should determine mechanisms for differential trends to provide information to policymakers and enable informed decisions on cannabis legalization and service planning.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, Columbia University, New York, NY, USA
- Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Medical Center, Columbia University, New York, NY, USA
- Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Aaron L Sarvet
- Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, T. H. Chan Harvard School of Public Health, Harvard University, Boston, MA, USA
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15
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Blanco C, Flórez-Salamanca L, Secades-Villa R, Wang S, Hasin DS. Predictors of initiation of nicotine, alcohol, cannabis, and cocaine use: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Am J Addict 2018; 27:477-484. [PMID: 30088294 DOI: 10.1111/ajad.12764] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/04/2018] [Accepted: 07/08/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There may be substantial overlap in the risk factors for substance use and substance use disorders (SUD). Identifying risk factors for substance use initiation is essential for understanding the etiology and natural history of SUD and to develop empirically-based preventive interventions to reduce initiation. METHODS Analyses were done on Wave 1 participants of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n = 43,093). Estimates of the cumulative probability of substance use initiation were obtained separately for nicotine, alcohol, cannabis, and cocaine. Survival analyses with time-varying covariates were implemented to identify risk factors for substance initiation. RESULTS The lifetime cumulative probabilities of substance initiation were 45.5% for nicotine, 82% for alcohol, 19.6% for cannabis, and 6.4% for cocaine. Among respondents with lifetime nicotine use, 50% had used it by age 15.3, whereas for alcohol, cannabis, and cocaine the respective ages were 17.8, 16.6, and 19.8. Previous use of another substance, being male, having a cluster B personality disorder, family history of SUD, and being separated, divorced, or widowed increased the risk of use of all the substances assessed, whereas social anxiety disorder and some personality disorders were associated with specific substances. DISCUSSION AND CONCLUSIONS Although the age of substance use initiation varies by substance, in more than 50% of cases initiation of use occurs in the first two decades of life. Although most risk factors for substance use initiation are common across substances, some are substance-specific. SCIENTIFIC SIGNIFICANCE This information may help in the development of empirically-based preventive interventions. (Am J Addict 2018;27:477-484).
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Affiliation(s)
- Carlos Blanco
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, New York.,Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Ludwing Flórez-Salamanca
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, New York
| | - Roberto Secades-Villa
- Grupo de Investigacion en conductas adictivas, Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Shuai Wang
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, New York
| | - Deborah S Hasin
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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16
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Algur Y, Elliott JC, Aharonovich E, Hasin DS. A Cross-Sectional Study of Depressive Symptoms and Risky Alcohol Use Behaviors Among HIV Primary Care Patients in New York City. AIDS Behav 2018; 22:1423-1429. [PMID: 29214410 DOI: 10.1007/s10461-017-1986-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
An association between problem drinking and depression among HIV-infected individuals has been previously demonstrated; however, which specific risky drinking behaviors are associated with higher levels of depression has not yet been investigated. Using an adult sample of HIV-infected primary care patients (78% male, 94% Black or Hispanic), we investigated whether depressive symptoms are associated with various risky drinking behaviors. Participants were administered the Beck Depression Inventory-II to assess depressive symptoms, and the Alcohol Use Disorders and Associated Disabilities Interview Schedule-IV to evaluate alcohol involvement. Participants with depressive symptoms (26%) were at higher risk for alcohol dependence [adjusted odds ratio (AOR) 3.8; 95% CI 2.0-7.2], regular binge drinking (AOR 2.0; 95% CI 1.1-3.8), and regular daytime drinking (AOR 2.1; 95% CI 1.2-3.8), in comparison with their non-depressed counterparts. Because both depression and unhealthy drinking negatively affect medication adherence and clinical outcomes, a better understanding of the association between depression and certain risky drinking behaviors among HIV-infected individuals is vital to improving their care and prognoses.
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Affiliation(s)
- Yasemin Algur
- New York State Psychiatric Institute, 1051 Riverside Drive #123, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jennifer C Elliott
- New York State Psychiatric Institute, 1051 Riverside Drive #123, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Efrat Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Drive #123, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive #123, New York, NY, 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
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17
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Hoertel N, Faiz H, Airagnes G, Blanco C, Pascal De Raykeer R, Franco S, Ducoutumany G, Lemogne C, Limosin F. A comprehensive model of predictors of suicide attempt in heavy drinkers: Results from a national 3-year longitudinal study. Drug Alcohol Depend 2018; 186:44-52. [PMID: 29547760 DOI: 10.1016/j.drugalcdep.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/04/2017] [Accepted: 01/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Heavy drinkers are at high risk for suicide attempt and suicide. Multiple factors, when examined in isolation, have been implicated in the risk of suicide attempt in this population. In this report, we present a comprehensive model of the 3-year risk of suicide attempt in heavy drinkers using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; wave 1, 2001-2002; wave 2, 2004-2005). METHODS We used structural equation modeling to simultaneously examine effects of four broad groups of clinical factors previously identified as potential predictors of attempted suicides: 1) alcohol use disorder severity, 2) severity of comorbidity, 3) sociodemographic characteristics and 4) help-seeking for alcohol problems. Heavy drinking was defined as drinking 5 or more drinks in a day more than once a week in the month prior to Wave 1. RESULTS About 1.5% of the 1573 heavy drinker participants (i.e., 5.1% of the NESARC sample) attempted suicide during the 3-year follow-up period. After adjusting for all other factors, several factors independently predicted attempted suicides: the alcohol use disorder liability factor measured by DSM-IV-TR criteria for alcohol abuse and dependence and two dimensions of psychopathology, the general psychopathology factor accounting for the shared effects of all comorbid psychiatric disorders and the externalizing dimension accounting for the shared effects of comorbid substance use disorders. No other factor predicted this risk in addition. CONCLUSION This model may help identify individuals with heavy drinking at high risk of suicide and develop more effective suicide prevention strategies.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.
| | - Hadi Faiz
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France
| | - Guillaume Airagnes
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; Inserm, UMS 011, Population-based Epidemiological Cohorts, Villejuif, France; Inserm UMR 1168, VIMA, Villejuif, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France
| | - Silvia Franco
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Géraldine Ducoutumany
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
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18
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Boyd C, West B, McCabe S. Does misuse lead to a disorder? The misuse of prescription tranquilizer and sedative medications and subsequent substance use disorders in a U.S. longitudinal sample. Addict Behav 2018; 79:17-23. [PMID: 29241081 DOI: 10.1016/j.addbeh.2017.11.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/18/2017] [Accepted: 11/27/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We used two waves of National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data and examined whether the misuse of prescription tranquilizers or sedatives at Wave 1 was associated with either continued misuse, tranquilizer/sedative use disorder, or other substance use disorder (SUD) at Wave 2. METHODS Prospective data were analyzed from structured diagnostic interviews using the Alcohol Use disorders and Associated Disabilities Interview Schedule: DSM-IV Version (AUDADIS-DSM-IV). A nationally representative sample of 34,653 of U.S. adults, 18years or older at Wave 1 (2001-2002), were re-interviewed at Wave 2 (2004-2005). After applying the survey weights, the sample represented a population that was 52% female, 71% White, 12% Hispanic, 11% African American, 4% Asian and 2% Native American or other. RESULTS An estimated 79% of adults who engaged in tranquilizer or sedative misuse at Wave 1 had stopped using these drugs at Wave 2. Only a small percentage (4.3%) of misusers at Wave 1 had a tranquilizer or sedative use disorder at Wave 2. However, 45% (45.0%) of misusers at Wave 1 had at least one other SUD at Wave 2. Among those in remission from a sedative or tranquilizer use disorder at Wave 1, 4.8% had a tranquilizer or sedative use disorder while 34.7% had at least one other SUD at Wave 2. CONCLUSIONS Most adults who engaged in the misuse of prescription tranquilizers or sedatives ceased using within 3years; however, their prior misuse was associated with higher prevalence of having a SUD three years later.
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Geoffroy PA, Hoertel N, Etain B, Bellivier F, Delorme R, Limosin F, Peyre H. Insomnia and hypersomnia in major depressive episode: Prevalence, sociodemographic characteristics and psychiatric comorbidity in a population-based study. J Affect Disord 2018; 226:132-141. [PMID: 28972930 DOI: 10.1016/j.jad.2017.09.032] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/15/2017] [Accepted: 09/23/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine (i) the frequency of different sleep complaints (early wake-up, trouble falling asleep, hypersomnia) and their co-occurrence and (ii) the sociodemographic characteristics and psychiatric comorbidity associated with each type of sleep profiles. METHODS Data were drawn from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of the US adult population (wave 1, 2001-2002; wave 2, 2004-2005). The primary analyses were limited to 3573 participants who had a DSM-IV-TR diagnosis of major depressive episode (MDE) between the two waves. We used a multiple regression model to estimate the strength of independent associations between self-reported sleep complaints, sociodemographic characteristics and lifetime psychiatric comorbidity. RESULTS Most of participants with MDE (92%) reported significant sleep complaints, from whom 85.2% had insomnia and 47.5% hypersomnia symptoms. The prevalence rates were for insomnia "only" of 48.5%, hypersomnia "only" of 13.7%, and their co-occurrence of 30.2%. We found that several sociodemographic characteristics (gender, age, education, individual and familial income, marital status) and psychiatric disorders (bipolar disorders, post-traumatic disorders and panic disorder) were significantly and independently associated with different sleep profiles. The co-occurrence of insomnia (especially early wake-up) and hypersomnia presented with a two-/three- fold increase risk of bipolar disorders. LIMITATIONS Definitions of sleep complaints were qualitative and subjective. CONCLUSION Sleep complaints are prevalent and heterogeneous in expression during MDE. Sleep disturbance profiles are associated with specific patterns of comorbidity. Our findings highlight the importance of continued research on sleep complaints during MDE while taking into account psychiatric comorbidity.
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Affiliation(s)
- Pierre A Geoffroy
- Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France; Fondation FondaMental, Créteil 94000, France.
| | - Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Bruno Etain
- Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France; Fondation FondaMental, Créteil 94000, France
| | - Frank Bellivier
- Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France; Fondation FondaMental, Créteil 94000, France
| | - Richard Delorme
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
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Olfson M, Wall MM, Liu SM, Blanco C. Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States. Am J Psychiatry 2018; 175:47-53. [PMID: 28946762 PMCID: PMC5756122 DOI: 10.1176/appi.ajp.2017.17040413] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The authors sought to determine whether cannabis use is associated with a change in the risk of incident nonmedical prescription opioid use and opioid use disorder at 3-year follow-up. METHOD The authors used logistic regression models to assess prospective associations between cannabis use at wave 1 (2001-2002) and nonmedical prescription opioid use and prescription opioid use disorder at wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Corresponding analyses were performed among adults with moderate or more severe pain and with nonmedical opioid use at wave 1. Cannabis and prescription opioid use were measured with a structured interview (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version). Other covariates included age, sex, race/ethnicity, anxiety or mood disorders, family history of drug, alcohol, and behavioral problems, and, in opioid use disorder analyses, nonmedical opioid use. RESULTS In logistic regression models, cannabis use at wave 1 was associated with increased incident nonmedical prescription opioid use (odds ratio=5.78, 95% CI=4.23-7.90) and opioid use disorder (odds ratio=7.76, 95% CI=4.95-12.16) at wave 2. These associations remained significant after adjustment for background characteristics (nonmedical opioid use: adjusted odds ratio=2.62, 95% CI=1.86-3.69; opioid use disorder: adjusted odds ratio=2.18, 95% CI=1.14-4.14). Among adults with pain at wave 1, cannabis use was also associated with increased incident nonmedical opioid use (adjusted odds ratio=2.99, 95% CI=1.63-5.47) at wave 2; it was also associated with increased incident prescription opioid use disorder, although the association fell short of significance (adjusted odds ratio=2.14, 95% CI=0.95-4.83). Among adults with nonmedical opioid use at wave 1, cannabis use was also associated with an increase in nonmedical opioid use (adjusted odds ratio=3.13, 95% CI=1.19-8.23). CONCLUSIONS Cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032
| | - Melanie M. Wall
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032
| | - Shang-Min Liu
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD 20892
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Hoertel N, Blanco C, Oquendo MA, Wall MM, Olfson M, Falissard B, Franco S, Peyre H, Lemogne C, Limosin F. A comprehensive model of predictors of persistence and recurrence in adults with major depression: Results from a national 3-year prospective study. J Psychiatr Res 2017; 95:19-27. [PMID: 28759845 PMCID: PMC5653405 DOI: 10.1016/j.jpsychires.2017.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
Identifying predictors of persistence and recurrence of depression in individuals with a major depressive episode (MDE) poses a critical challenge for clinicians and researchers. We develop using a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34,653), a comprehensive model of the 3-year risk of persistence and recurrence in individuals with MDE at baseline. We used structural equation modeling to examine simultaneously the effects of four broad groups of clinical factors on the risk of MDE persistence and recurrence: 1) severity of depressive illness, 2) severity of mental and physical comorbidity, 3) sociodemographic characteristics and 4) treatment-seeking behavior. Approximately 16% and 21% of the 2587 participants with an MDE at baseline had a persistent MDE and a new MDE during the 3-year follow-up period, respectively. Most independent predictors were common for both persistence and recurrence and included markers for the severity of the depressive illness at baseline (as measured by higher levels on the general depressive symptom dimension, lower mental component summary scores, prior suicide attempts, younger age at onset of depression and greater number of MDEs), the severity of comorbidities (as measured by higher levels on dimensions of psychopathology and lower physical component summary scores) and a failure to seek treatment for MDE at baseline. This population-based model highlights strategies that may improve the course of MDE, including the need to develop interventions that target multiple psychiatric disorders and promotion of treatment seeking to increase access to timely mental health care.
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Affiliation(s)
- Nicolas Hoertel
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France.
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Bruno Falissard
- Centre de Recherche en Epidemiologie et Santé des Populations (CESP), Paris-Saclay University, Paris-Sud University, UVSQ, INSERM, APHP, Paris, France
| | - Silvia Franco
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris (APHP), Robert-Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
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Mental disorder comorbidity and treatment utilization. Compr Psychiatry 2017; 79:89-97. [PMID: 28215792 PMCID: PMC5550376 DOI: 10.1016/j.comppsych.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/31/2017] [Accepted: 02/04/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Effective interventions have been developed for myriad common psychological and substance use disorders, though they remain highly underutilized. Previous research has shown that the likelihood of treatment utilization varies across disorder diagnosis. However, studies that focus on individual disorders have resulted in a large, piecemeal literature that neglects the high rates of multivariate comorbidity. The current study investigated the association between treatment utilization and transdiagnostic comorbidity factors. METHODS In a nationally representative sample of the United States adult population (N=34,653), we applied the internalizing-externalizing latent comorbidity model to examine its association with lifetime utilization of various treatments for mood, anxiety, and substance use disorders. RESULTS Both internalizing and externalizing transdiagnostic factors were positively associated with all forms of treatment utilization. Stronger within-domain domain (e.g., internalizing's association with mood or anxiety treatment) than between-domain (e.g., internalizing's association with substance use disorder treatment) associations were found. Significant antagonistic internalizing-by-externalizing interactions were also observed. CONCLUSIONS These results underscore the importance of applying a nuanced approach to modeling comorbidity when predicting treatment utilization. Clinical implications are discussed.
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Olfson M, Blanco C, Wall M, Liu SM, Saha TD, Pickering RP, Grant BF. National Trends in Suicide Attempts Among Adults in the United States. JAMA Psychiatry 2017; 74:1095-1103. [PMID: 28903161 PMCID: PMC5710225 DOI: 10.1001/jamapsychiatry.2017.2582] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/04/2017] [Indexed: 11/14/2022]
Abstract
Importance A recent increase in suicide in the United States has raised public and clinical interest in determining whether a coincident national increase in suicide attempts has occurred and in characterizing trends in suicide attempts among sociodemographic and clinical groups. Objective To describe trends in recent suicide attempts in the United States. Design, Setting, and Participants Data came from the 2004-2005 wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012-2013 NESARC-III. These nationally representative surveys asked identical questions to 69 341 adults, 21 years and older, concerning the occurrence and timing of suicide attempts. Risk differences adjusted for age, sex, and race/ethnicity (ARDs) assessed trends from the 2004-2005 to 2012-2013 surveys in suicide attempts across sociodemographic and psychiatric disorder strata. Additive interactions tests compared the magnitude of trends in prevalence of suicide attempts across levels of sociodemographic and psychiatric disorder groups. The analyses were performed from February 8, 2017, through May 31, 2017. Main Outcomes and Measures Self-reported attempted suicide in the 3 years before the interview. Results With use of data from the 69 341 participants (42.8% men and 57.2% women; mean [SD] age, 48.1 [17.2] years), the weighted percentage of US adults making a recent suicide attempt increased from 0.62% in 2004-2005 (221 of 34 629) to 0.79% in 2012-2013 (305 of 34 712; ARD, 0.17%; 95% CI, 0.01%-0.33%; P = .04). In both surveys, most adults with recent suicide attempts were female (2004-2005, 60.17%; 2012-2013, 60.94%) and younger than 50 years (2004-2005, 84.75%; 2012-2013, 80.38%). The ARD for suicide attempts was significantly larger among adults aged 21 to 34 years (0.48%; 95% CI, 0.09% to 0.87%) than among adults 65 years and older (0.06%; 95% CI, -0.02% to 0.14%; interaction P = .04). The ARD for suicide attempts was also significantly larger among adults with no more than a high school education (0.49%; 95% CI, 0.18% to 0.80%) than among college graduates (0.03%; 95% CI, -0.17% to 0.23%; interaction P = .003); the ARD was also significantly larger among adults with antisocial personality disorder (2.16% [95% CI, 0.61% to 3.71%] vs 0.07% [95% CI, -0.09% to 0.23%]; interaction P = .01), a history of violent behavior (1.04% [95% CI, 0.35% to 1.73%] vs 0.00% [95% CI, -0.12% to 0.12%]; interaction P = .003), or a history of anxiety (1.43% [95% CI, 0.47% to 2.39%] vs 0.18% [95% CI, 0.04% to 0.32%]; interaction P = .01) or depressive (0.99% [95% CI, -0.09% to 2.07%] vs -0.08% [95% CI, -0.20% to 0.04%]; interaction P = .05) disorders than among adults without these conditions. Conclusions and Relevance A recent overall increase in suicide attempts among adults in the United States has disproportionately affected younger adults with less formal education and those with antisocial personality disorder, anxiety disorders, depressive disorders, and a history of violence.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Shang-Min Liu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Tulshi D. Saha
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Roger P. Pickering
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Bridget F. Grant
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Blanco C, Wall MM, Wang S, Olfson M. Examining heterotypic continuity of psychopathology: a prospective national study. Psychol Med 2017; 47:2097-2106. [PMID: 28399956 DOI: 10.1017/s003329171700054x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Individuals with one psychiatric disorder are at increased risk for incidence and recurrence of other disorders. We characterize whether the magnitude of such heterotypic continuity varies based on whether the first disorder remits or persists over time. METHOD Cohorts were selected from participants in the National Epidemiologic Survey on Alcohol and Related Conditions wave 1 (2001-2002) and wave 2 (2004-2005) surveys with ⩾1 mood, anxiety, or substance use disorder at wave 1. Among respondents remitting (n = 6719) or not remitting (n = 3435) from ⩾1 of disorder at wave 2, the analyses compared the odds of developing new disorders. RESULTS As compared with adults whose disorders persisted from wave 1 to wave 2, those with ⩾1 remission had lower odds of incidence or recurrence of another disorder. Remission from alcohol dependence [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3-0.5] and drug dependence (OR 0.4, 95% CI 0.3-0.6) were associated with the lowest odds of incidence of another disorder. Social anxiety disorder was associated with the lowest adjusted odds of recurrence (adjusted OR = 0.2, 95% CI 0.1-0.6). Remission of disorders within one class (mood, anxiety, substance use) was consistently associated with lower odds of incidence or recurrence of disorders from the same class than with developing disorders from the other classes. CONCLUSIONS Remission from common psychiatric disorders tends to decrease the risk for incidence or recurrence of disorders and this effect is stronger within than across disorder classes. These results do not support the concept of heterotypic continuity as a substitution of one disorder for another.
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Affiliation(s)
- C Blanco
- Division of Epidemiology,Services and Prevention Research,National Institute on Drug Abuse (NIDA),Bethesda,MD,USA
| | - M M Wall
- Department of Psychiatry,Columbia University/New York State Psychiatric Institute,1051 Riverside Drive,New York,NY 10032,USA
| | - S Wang
- Department of Psychiatry,Columbia University/New York State Psychiatric Institute,1051 Riverside Drive,New York,NY 10032,USA
| | - M Olfson
- Department of Psychiatry,Columbia University/New York State Psychiatric Institute,1051 Riverside Drive,New York,NY 10032,USA
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Grant BF, Chou SP, Saha TD, Pickering RP, Kerridge BT, Ruan WJ, Huang B, Jung J, Zhang H, Fan A, Hasin DS. Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry 2017; 74:911-923. [PMID: 28793133 PMCID: PMC5710229 DOI: 10.1001/jamapsychiatry.2017.2161] [Citation(s) in RCA: 882] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information. OBJECTIVE To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-month DSM-IV AUD, 12-month DSM-IV AUD among 12-month alcohol users, and 12-month DSM-IV AUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013. DESIGN, SETTING, AND PARTICIPANTS The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016. MAIN OUTCOMES AND MEASURES Twelve-month alcohol use, high-risk drinking, and DSM-IV AUD. RESULTS The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV AUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), and DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, and DSM-IV AUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%). CONCLUSIONS AND RELEVANCE Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.
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Affiliation(s)
- Bridget F. Grant
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - S. Patricia Chou
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Tulshi D. Saha
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Roger P. Pickering
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | | | - W. June Ruan
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Boji Huang
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Jeesun Jung
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Haitao Zhang
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Amy Fan
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Deborah S. Hasin
- New York State Psychiatric Institute, New York,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
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Cardiovascular disease and psychiatric disorders among Latinos in the United States. Soc Psychiatry Psychiatr Epidemiol 2017; 52:837-846. [PMID: 28062923 DOI: 10.1007/s00127-016-1325-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 12/15/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Cardiovascular disease (CVD) is the leading cause of death among Latinos and disproportionately impacts people with psychiatric disorders. The aim of this study was to examine the relationships between CVD and psychiatric disorders among different Latino subgroups using a nationally representative sample. METHODS Latinos participants (N = 6359) were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. A structured diagnostic interview was used to determine psychiatric diagnoses for any past-year mood, anxiety, and substance use disorders. A self-reported measure of physician-confirmed CVD was used. The relationships between CVD and psychiatric disorders among Latino subgroups were examined with logistic regression models adjusting for sociodemographics, CVD-risk factors, and acculturation. RESULTS CVD were highest among Puerto Ricans (12%) and Cubans (11%), followed by Other Latinos (7%) and Mexicans (5%). The relationship between psychiatric disorders and CVD differed by Latino subgroups. Significantly increased odds of CVD were found among Mexicans with any past-year mood and anxiety disorders, Puerto Ricans with any past-year psychiatric disorders, Cubans with any past-year mood and substance abuse disorders, and Other Latinos with any past-year mood, anxiety, and lifetime schizophrenia/psychotic disorders. CONCLUSIONS The associations between CVD and psychiatric disorders are not uniform among Latinos. Efforts to address the need for health and mental health services must carefully consider this heterogeneity.
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Hasin DS, Sarvet AL, Cerdá M, Keyes KM, Stohl M, Galea S, Wall MM. US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws: 1991-1992 to 2012-2013. JAMA Psychiatry 2017; 74:579-588. [PMID: 28445557 PMCID: PMC5539836 DOI: 10.1001/jamapsychiatry.2017.0724] [Citation(s) in RCA: 266] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/01/2017] [Indexed: 12/24/2022]
Abstract
Importance Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time. Objective To present national data on state MML and degree of change in the prevalence of cannabis use and disorders. Design, Participants, and Setting Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC ("earlier period"). Late-MML states passed MML between NESARC and NESARC-III ("later period"). Main Outcomes and Measures Past-year illicit cannabis use and DSM-IV cannabis use disorder. Results Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4-percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7-percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04). Conclusions and Relevance Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Aaron L Sarvet
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento
| | - Katherine M Keyes
- Department of Psychiatry, Columbia University Medical Center, New York, New York3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Malka Stohl
- New York State Psychiatric Institute, New York
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York6Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
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Martins SS, Sarvet A, Santaella-Tenorio J, Saha T, Grant BF, Hasin DS. Changes in US Lifetime Heroin Use and Heroin Use Disorder: Prevalence From the 2001-2002 to 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry 2017; 74:445-455. [PMID: 28355458 PMCID: PMC5470460 DOI: 10.1001/jamapsychiatry.2017.0113] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/11/2017] [Indexed: 12/22/2022]
Abstract
Importance Heroin use is an urgent concern in the United States. Little is know about the course of heroin use, heroin use disorder, and associated factors. Objective To examine changes in the lifetime prevalence, patterns, and associated demographics of heroin use and use disorder from 2001-2002 to 2012-2013 in 2 nationally representative samples of the US adult general population. Design, Setting, and Participants This survey study included data from 43 093 respondents of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and 36 309 respondents of the 2012-2013 NESARC-III. Data were analyzed from February 2 to September 15, 2016. Main Outcomes and Measures Lifetime heroin use and DSM-IV heroin use disorder. Results Among the 79 402 respondents (43.3% men; 56.7% women; mean [SD] age, 46.1 [17.9] years), prevalence of heroin use and heroin use disorder significantly increased from 2001-2002 to 2012-2013 (use: 0.33% [SE, 0.03%] vs 1.6% [SE, 0.08%]; disorder: 0.21% [SE, 0.03%] vs 0.69% [SE, 0.06%]; P < .001). The increase in the prevalence of heroin use was significantly pronounced among white (0.34% [SE, 0.04%] in 2001-2002 vs 1.90% [SE, 0.12%] in 2012-2013) compared with nonwhite (0.32% [SE, 0.05%] in 2001-2002 vs 1.05% [SE, 0.10%] in 2012-2013; P < .001) individuals. The increase in the prevalence of heroin use disorder was more pronounced among white individuals (0.19% [SE, 0.03%] in 2001-2002 vs 0.82% [SE, 0.08%] in 2012-2013; P < .001) and those aged 18 to 29 (0.21% [SE, 0.06%] in 2001-2002 vs 1.0% [0.17%] in 2012-2013; P = .01) and 30 to 44 (0.20% [SE, 0.04%] in 2001-2002 vs 0.77% [0.10%] in 2012-2013; P = .03) years than among nonwhite individuals (0.25% [SE, 0.04%] in 2001-2002 vs 0.43% [0.07%] in 2012-2013) and older adults (0.22% [SE, 0.04%] in 2001-2002 vs 0.51% [SE, 0.07%] in 2012-2013). Among users, significant differences were found across time in the proportion of respondents meeting DSM-IV heroin use disorder criteria (63.35% [SE, 4.79%] in 2001-2001 vs 42.69% [SE, 2.87%] in 2012-2013; P < .001). DSM-IV heroin abuse was significantly more prevalent among users in 2001-2002 (37.02% [SE, 4.67%]) than in 2012-2013 (19.19% [SE, 2.34%]; P = .001). DSM-IV heroin dependence among users was similar in 2001-2002 (28.22% [SE, 3.95%]) and in 2012-2013 (25.02% [SE, 2.20%]; P = .48). The proportion of those reporting initiation of nonmedical use of prescription opioids before initiating heroin use increased across time among white individuals (35.83% [SE, 6.03%] in 2001-2002 to 52.83% [SE, 2.88%] in 2012-2013; P = .01). Conclusions and Relevance The prevalence of heroin use and heroin use disorder increased significantly, with greater increases among white individuals. The nonmedical use of prescription opioids preceding heroin use increased among white individuals, supporting a link between the prescription opioid epidemic and heroin use in this population. Findings highlight the need for educational campaigns regarding harms related to heroin use and the need to expand access to treatment in populations at increased risk for heroin use and heroin use disorder.
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Affiliation(s)
- Silvia S. Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Aaron Sarvet
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Julian Santaella-Tenorio
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Tulshi Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
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Thompson RG, Alonzo D, Hu MC, Hasin DS. Substance Use Disorders and Poverty as Prospective Predictors of Adult First-Time Suicide Ideation or Attempt in the United States. Community Ment Health J 2017; 53:324-333. [PMID: 27423659 PMCID: PMC5239762 DOI: 10.1007/s10597-016-0045-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
This study examined whether substance use disorders (SUD) and poverty predicted first-time suicide ideation or attempt in United States national data. Respondents without prior histories of suicide ideation or attempt at Wave 1 of the NESARC (N = 31,568) were analyzed to determine the main and interactive effects of SUD and poverty on first-time suicide ideation or attempt by Wave 2, 3 years later. Adjusted for controls, poverty (AOR = 1.35, CI = 1.05-1.73) and drug use disorders (AOR = 2.10, CI = 1.07-4.14) independently increased risk for first-time suicide ideation or attempt at Wave 2. SUD and poverty did not interact to differentially increase risk for first-time suicide ideation or attempt, prior to or after adjustment for controls. This study reinforces the importance of SUD and poverty in the risk for first-time suicide ideation or attempt. Public health efforts should target messages to drug users and the impoverished that highlight their increased risk for first-time suicide.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA.
| | - Dana Alonzo
- Graduate School of Social Service, Fordham University, West Harrison, NY, 10604, USA
| | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
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Martínez-Ortega JM, Franco S, Rodríguez-Fernández JM, Gutiérrez-Rojas L, Wang S, Gurpegui M. Temporal sequencing of nicotine dependence and major depressive disorder: A U.S. national study. Psychiatry Res 2017; 250:264-269. [PMID: 28183022 DOI: 10.1016/j.psychres.2017.01.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/21/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
Major Depressive Disorder (MDD) and Nicotine dependence (ND) often co-occur. However, little attention has been given to the temporal order between the two disorders. We compared the sociodemographic and clinical characteristics of individuals whose onset of ND preceded (ND-prior) or followed the onset of MDD (MDD-prior). Binary logistic regression models were computed to compare ND-prior (n=546) and MDD-prior (n=801) individuals from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n=43,093). We found that MDD-prior were more likely to have a history of suicide attempts and a family history of both depression and antisocial behavior, to have had psychiatric hospitalization, and to have an earlier age of onset of the first depressive episode; but a later age of onset for both daily smoking and ND. On average, MDD-prior individuals showed a significantly longer transition time from daily smoking to ND (15.6±0.6 vs. 6.9±0.4 years, P<0.001). In contrast, ND-prior subjects had a significantly greater proportion of withdrawal symptoms, and of lifetime alcohol use or alcohol use disorder. We conclude that the phenomenology and course of ND and MDD vary significantly, depending on which disorder had earlier onset.
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Affiliation(s)
- José M Martínez-Ortega
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA; Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; Psychiatry Service, San Cecilio University Hospital, Granada, Spain.
| | - Silvia Franco
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA; Psychiatry Service, San Cecilio University Hospital, Granada, Spain
| | - Jorge M Rodríguez-Fernández
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA; Psychiatry Service, San Cecilio University Hospital, Granada, Spain
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; Psychiatry Service, San Cecilio University Hospital, Granada, Spain
| | - Shuai Wang
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA; Psychiatry Service, San Cecilio University Hospital, Granada, Spain
| | - Manuel Gurpegui
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA; Psychiatry Service, San Cecilio University Hospital, Granada, Spain
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Thompson RG, Eaton NR, Hu MC, Hasin DS. Borderline personality disorder and regularly drinking alcohol before sex. Drug Alcohol Rev 2017; 36:540-545. [PMID: 28321919 DOI: 10.1111/dar.12476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Drinking alcohol before sex increases the likelihood of engaging in unprotected intercourse, having multiple sexual partners and becoming infected with sexually transmitted infections. Borderline personality disorder (BPD), a complex psychiatric disorder characterised by pervasive instability in emotional regulation, self-image, interpersonal relationships and impulse control, is associated with substance use disorders and sexual risk behaviours. However, no study has examined the relationship between BPD and drinking alcohol before sex in the USA. This study examined the association between BPD and regularly drinking before sex in a nationally representative adult sample. DESIGN AND METHODS Participants were 17 491 sexually active drinkers from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models estimated effects of BPD diagnosis, specific borderline diagnostic criteria and BPD criterion count on the likelihood of regularly (mostly or always) drinking alcohol before sex, adjusted for controls. RESULTS Borderline personality disorder diagnosis doubled the odds of regularly drinking before sex [adjusted odds ratio (AOR) = 2.26; confidence interval (CI) = 1.63, 3.14]. Of nine diagnostic criteria, impulsivity in areas that are self-damaging remained a significant predictor of regularly drinking before sex (AOR = 1.82; CI = 1.42, 2.35). The odds of regularly drinking before sex increased by 20% for each endorsed criterion (AOR = 1.20; CI = 1.14, 1.27) DISCUSSION AND CONCLUSIONS: This is the first study to examine the relationship between BPD and regularly drinking alcohol before sex in the USA. Substance misuse treatment should assess regularly drinking before sex, particularly among patients with BPD, and BPD treatment should assess risk at the intersection of impulsivity, sexual behaviour and substance use. [Thompson Jr RG, Eaton NR, Hu M-C, Hasin DS Borderline personality disorder and regularly drinking alcohol before sex Drug Alcohol Rev 2017;36:540-545].
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | | | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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Blanco C, Campbell AN, Wall MM, Olfson M, Wang S, Nunes EV. Toward National Estimates of Effectiveness of Treatment for Substance Use. J Clin Psychiatry 2017; 78:e64-e70. [PMID: 28129499 PMCID: PMC5490656 DOI: 10.4088/jcp.15m10333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/09/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate how results would have varied if a substance abuse clinical trial had been conducted with nationally representative adults with substance use and with representative adults receiving substance use treatment. METHODS Results were analyzed from a multisite clinical trial comparing the effectiveness of the Therapeutic Education System to treatment as usual for outpatient addiction treatment (n = 507). Patients were recruited between June 2010 and August 2011. Abstinence was the primary outcome. The general population sample and general population-treated samples were derived from Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093). Propensity scores provided a standardized measure of the difference between clinical trial participants and the 2 NESARC samples. The clinical trial was reanalyzed by reweighting the sample with propensity scores derived from the 2 samples to obtain generalizable estimates of treatment effects. RESULTS Before the clinical trial sample was reweighted, the odds ratio (OR) of response to Therapeutic Education System versus treatment as usual in the trial was 1.62 (95% CI, 1.12-2.35). After the sample was reweighted to be representative of the 2 NESARC groups, ORs were 1.33 (95% CI, 0.34-5.26) for the representative sample with any substance use and 1.64 (95% CI, 0.82-3.27) for the representative treated sample. CONCLUSIONS Applying propensity score weighting to clinical trial results provides a method for estimating the population generalizability of clinical trial findings that relies on effect moderators observed in the study sample and population. Broader confidence intervals in the reweighted samples do not necessarily indicate lack of efficacy of the Therapeutic Education System but rather greater uncertainty concerning effectiveness in general population samples.
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Affiliation(s)
| | - Aimee N. Campbell
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY
| | - Melanie M. Wall
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, 1051 Riverside Dr, Unit 24, New York, NY 10032. .,Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, New York, USA
| | - Shuai Wang
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY
| | - Edward V. Nunes
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY
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Abstract
BACKGROUND Religiosity is a protective factor against many health problems, including alcohol use disorders (AUD). Studies suggest that religiosity has greater buffering effects on mental health problems among US Blacks and Hispanics than Whites. However, whether race/ethnic differences exist in the associations of religiosity, alcohol consumption and AUD is unclear. METHOD Using 2004-2005 NESARC data (analytic n = 21 965), we examined the relationship of public religiosity (i.e. frequency of service attendance, religious social group size), and intrinsic religiosity (i.e. importance of religious/spiritual beliefs) to frequency of alcohol use and DSM-IV AUD in non-Hispanic (NH) Blacks, Hispanics and NH Whites, and whether associations differed by self-identified race/ethnicity. RESULTS Only public religiosity was related to AUD. Frequency of religious service attendance was inversely associated with AUD (NH Whites β: -0.103, p 0.05) or Hispanics (β: -0.002, p > 0.05). CONCLUSIONS US adults reporting greater public religiosity were at lower risk for AUD. Public religiosity may be particularly important among NH Blacks, while intrinsic religiosity may be particularly important among NH Whites, and among Hispanics who frequently attend religious services. Findings may be explained by variation in drinking-related norms observed among these groups generally, and in the context of specific religious institutions.
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Affiliation(s)
- J L Meyers
- Department of Psychiatry and Behavioral Sciences,State University of New York,Downstate Medical Center,Brooklyn,NY,USA
| | - Q Brown
- Department of Epidemiology,Mailman School of Public Health,Columbia University,New York,NY,USA
| | - B F Grant
- Laboratory of Epidemiology and Biometry,National Institute on Alcohol Abuse and Alcoholism,Bethesda,MD,USA
| | - D Hasin
- Department of Epidemiology,Mailman School of Public Health,Columbia University,New York,NY,USA
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Peyre H, Hoertel N, Rivollier F, Landman B, McMahon K, Chevance A, Lemogne C, Delorme R, Blanco C, Limosin F. Latent class analysis of the feared situations of social anxiety disorder: A population-based study. Depress Anxiety 2016; 33:1178-1187. [PMID: 27575056 DOI: 10.1002/da.22547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/19/2016] [Accepted: 07/27/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Little is known about differences in mental health comorbidity and quality of life in individuals with social anxiety disorder (SAD) according to the number and the types of feared situations. METHODS Using a US nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions, we performed latent class analysis to compare the prevalence rates of mental disorders and quality of life measures across classes defined by the number and the types of feared social situations among individuals with SAD. RESULTS Among the 2,448 participants with a lifetime diagnosis of SAD, we identified three classes of individuals who feared most social situations but differed in the number of feared social situations (generalized severe [N = 378], generalized moderate [N = 1,049] and generalized low [N = 443]) and a class of subjects who feared only performance situations [N = 578]. The magnitude of associations between each class and a wide range of mental disorders and quality of life measures were consistent with a continuum model, supporting that the deleterious effects of SAD on mental health may increase with the number of social situations feared. However, we found that individuals with the "performance only" specifier may constitute an exception to this model because these participants had significantly better mental health than other participants with SAD. CONCLUSIONS Our findings give additional support to the recent changes made in the DSM-5, including the introduction of the "performance only" specifier and the removal of the "generalized" specifier to promote the dimensional approach of the number of social fears.
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Affiliation(s)
- Hugo Peyre
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris, France.,Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Nicolas Hoertel
- Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, AP-HP, Corentin Celton Hospital, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France
| | - Fabrice Rivollier
- INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Sainte-Anne Hospital, Service Hospitalo-Universitaire, Paris Descartes University, Paris, France
| | - Benjamin Landman
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris, France
| | - Kibby McMahon
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | - Astrid Chevance
- Department of Psychiatry, AP-HP, Corentin Celton Hospital, Issy-les-Moulineaux, France
| | - Cédric Lemogne
- Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, AP-HP, Corentin Celton Hospital, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France
| | - Richard Delorme
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Frédéric Limosin
- Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, AP-HP, Corentin Celton Hospital, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France
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Elliott JC, Stohl M, Aharonovich E, O'Leary A, Hasin DS. Reasons for drinking as predictors of alcohol involvement one year later among HIV-infected individuals with and without hepatitis C. Ann Med 2016; 48:634-640. [PMID: 27460482 PMCID: PMC5201313 DOI: 10.1080/07853890.2016.1206668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Heavy drinking can be harmful for individuals with HIV, particularly those coinfected with hepatitis C virus (HCV). HIV patients' reasons for drinking predict short-term alcohol involvement, but whether they predict longer-term involvement is unknown. Also, it remains unknown whether these motives are differentially predictive for HIV monoinfected and HIV/HCV coinfected patients. METHOD HIV-infected heavy drinkers (n = 254) participated in a randomized trial of brief alcohol interventions, 236 (92.9%) of whom reported on baseline motives and alcohol involvement 12 months later (77.1% male, 94.9% minority, 30.6% with HCV). RESULTS Greater endorsement of baseline drinking to cope with negative affect predicted greater alcohol dependence symptoms at 12 months (incident rate ratio [IRR] = 1.80, p < 0.05), while greater endorsement of baseline drinking due to social pressure predicted fewer drinks consumed at 12 months (IRR = 0.67, p < 0.05). Coping and social reasons were both predictive for HIV monoinfected patients, whereas only coping reasons were predictive for HIV/HCV coinfected patients. DISCUSSION Drinking for coping and social reasons predict alcohol involvement 12 months later; however, social reasons may only be important for HIV monoinfected patients. Understanding patient reasons for drinking may help predict patient risk up to a year later. KEY MESSAGES Among HIV patients, drinking motives predict alcohol involvement 12 months later. For HIV monoinfected patients, drinking to cope and drinking for social reasons predict 12-month alcohol involvement. For HIV/Hepatitis C coinfected patients, coping (but not social) motives predict 12-month alcohol involvement.
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Affiliation(s)
- Jennifer C Elliott
- a Department of Psychiatry , Columbia University Medical Center , New York , USA.,b New York State Psychiatric Institute , New York , USA
| | - Malka Stohl
- b New York State Psychiatric Institute , New York , USA
| | - Efrat Aharonovich
- a Department of Psychiatry , Columbia University Medical Center , New York , USA.,b New York State Psychiatric Institute , New York , USA
| | - Ann O'Leary
- c Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Deborah S Hasin
- a Department of Psychiatry , Columbia University Medical Center , New York , USA.,b New York State Psychiatric Institute , New York , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , USA
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Differences in symptom expression between unipolar and bipolar spectrum depression: Results from a nationally representative sample using item response theory (IRT). J Affect Disord 2016; 204:24-31. [PMID: 27318596 PMCID: PMC6447294 DOI: 10.1016/j.jad.2016.06.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND The inclusion of subsyndromal forms of bipolarity in the fifth edition of the DSM has major implications for the way in which we approach the diagnosis of individuals with depressive symptoms. The aim of the present study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression severity, there are differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) between subjects with and without a lifetime history of manic symptoms. METHODS We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS The items sadness, appetite disturbance and psychomotor symptoms were better indicators of depression severity in participants without a lifetime history of manic symptoms, in a clinically meaningful way. DSM-IV symptoms of MDE were substantially less informative in participants with a lifetime history of manic symptoms than in those without such history. LIMITATIONS Clinical information on DSM-IV depressive and manic symptoms was based on retrospective self-report CONCLUSIONS The clinical presentation of depressive symptoms may substantially differ in individuals with and without a lifetime history of manic symptoms. These findings alert to the possibility of atypical symptomatic presentations among individuals with co-occurring symptoms or disorders and highlight the importance of continued research into specific pathophysiology differentiating unipolar and bipolar depression.
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Elliott JC, Delker E, Wall MM, Feng T, Aharonovich E, Tracy M, Galea S, Ahern J, Sarvet AL, Hasin DS. Neighborhood-Level Drinking Norms and Alcohol Intervention Outcomes in HIV Patients Who Are Heavy Drinkers. Alcohol Clin Exp Res 2016; 40:2240-2246. [PMID: 27543208 DOI: 10.1111/acer.13198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/27/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Heavy alcohol consumption can be harmful, particularly for individuals with HIV. There is substantial variability in response to interventions that aim to reduce drinking. Neighborhood drinking norms may explain some of this variability among HIV-infected patients. Therefore, we investigated whether neighborhood-level drinking norms modified response to alcohol intervention among HIV-infected heavy drinkers. METHODS Heavily-drinking HIV comprehensive care patients (n = 230) completed 1 of 3 brief alcohol interventions (an educational intervention, a motivational interviewing [MI] intervention, or an MI intervention with a technological enhancement called HealthCall). Drinking was reported at baseline and end of treatment (60 days). Neighborhood-level drinking norms were obtained from a separate general population study. RESULTS Patients' reductions in drinks per drinking day in response to MI (as compared with the educational control) were more pronounced in neighborhoods with more permissive drinking norms. In contrast, patients' reductions in drinks per drinking day in response to MI plus HealthCall did not significantly vary between neighborhoods with different drinking norms. Norms did not evidence significant interactions with intervention condition for 3 other exploratory drinking outcomes (drinking frequency, binge frequency, and maximum quantity). CONCLUSIONS Neighborhood-level drinking norms help explain differential response to an alcohol MI intervention among HIV-infected patients. This study suggests the utility of considering neighborhood context as an effect modifier of alcohol interventions.
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Affiliation(s)
- Jennifer C Elliott
- New York State Psychiatric Institute , New York City, New York.,Department of Psychiatry , Columbia University Medical Center, New York City, New York
| | - Erin Delker
- New York State Psychiatric Institute , New York City, New York.,San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Epidemiology) , San Diego, California
| | - Melanie M Wall
- New York State Psychiatric Institute , New York City, New York.,Department of Psychiatry , Columbia University Medical Center, New York City, New York.,Department of Biostatistics , Mailman School of Public Health, Columbia University, New York City, New York
| | - Tianshu Feng
- New York State Psychiatric Institute , New York City, New York
| | - Efrat Aharonovich
- New York State Psychiatric Institute , New York City, New York.,Department of Psychiatry , Columbia University Medical Center, New York City, New York
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics , School of Public Health, University at Albany, State University of New York, Rensselaer, New York
| | - Sandro Galea
- School of Public Health , Boston University, Boston, Massachusetts
| | - Jennifer Ahern
- Division of Epidemiology , School of Public Health, University of California, Berkeley, California
| | - Aaron L Sarvet
- New York State Psychiatric Institute , New York City, New York
| | - Deborah S Hasin
- New York State Psychiatric Institute , New York City, New York. , .,Department of Psychiatry , Columbia University Medical Center, New York City, New York. , .,Department of Epidemiology , Mailman School of Public Health, Columbia University, New York City, New York. ,
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Thompson RG, Alonzo D, Hu MC, Hasin DS. The influences of parental divorce and maternal-versus-paternal alcohol abuse on offspring lifetime suicide attempt. Drug Alcohol Rev 2016; 36:408-414. [DOI: 10.1111/dar.12441] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/15/2016] [Accepted: 05/07/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ronald G. Thompson
- Department of Psychiatry, College of Physicians and Surgeons; Columbia University; New York USA
| | - Dana Alonzo
- Graduate School of Social Service; Fordham University; West Harrison USA
| | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons; Columbia University; New York USA
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and Surgeons; Columbia University; New York USA
- Department of Epidemiology, Mailman School of Public Health; Columbia University; New York USA
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Brave Heart MYH, Lewis-Fernández R, Beals J, Hasin DS, Sugaya L, Wang S, Grant BF, Blanco C. Psychiatric disorders and mental health treatment in American Indians and Alaska Natives: results of the National Epidemiologic Survey on Alcohol and Related Conditions. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1033-46. [PMID: 27138948 PMCID: PMC4947559 DOI: 10.1007/s00127-016-1225-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/16/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE To examine the prevalence of common psychiatric disorders and associated treatment-seeking, stratified by gender, among American Indians/Alaska Natives and non-Hispanic whites in the United States. Lifetime and 12-month rates are estimated, both unadjusted and adjusted for sociodemographic correlates. METHOD Analyses were conducted with the American Indians/Alaska Native (n = 701) and Non-Hispanic white (n = 24,507) samples in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions [(NESARC) n = 43,093]. RESULTS Overall, 70 % of the American Indian/Alaska Native men and 63 % of the women met criteria for at least one Diagnostic and Statistical Manual-IV lifetime disorder, compared to 62 and 53 % of Non-Hispanic white men and women, respectively. Adjusting for sociodemographic correlates attenuated the differences found. Nearly half of American Indians/Alaska Natives had a psychiatric disorder in the previous year; again, sociodemographic adjustments explained some of the differences found. Overall, the comparisons to non-Hispanic whites showed differences were more common among American Indian/Alaska Native women than men. Among those with a disorder, American Indian/Alaska Native women had greater odds of treatment-seeking for 12-month anxiety disorders. CONCLUSION As the first study to provide national estimates, by gender, of the prevalence and treatment of a broad range of psychiatric disorders among American Indians/Alaska Natives, a pattern of higher prevalence of psychiatric disorder was found relative to Non-Hispanic whites. Such differences were more common among women than men. Prevalence may be overestimated due to cultural limitations in measurement. Unmeasured risk factors, some specific to American Indians/Alaska Natives, may also partially explain these results.
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Affiliation(s)
- Maria Yellow Horse Brave Heart
- Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, University of New Mexico, MSC09 5030, 1 UNM, Albuquerque, NM, USA.
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA.
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Janette Beals
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Luisa Sugaya
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
- School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Shuai Wang
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
| | - Bridget F Grant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Carlos Blanco
- New York State Psychiatric Institute, New York, NY, 87131-0001, USA
- National Institute on Drug Abuse, Bethesda, MD, USA
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Fernández RL, Morcillo C, Wang S, Duarte CS, Aggarwal NK, Sánchez-Lacay JA, Blanco C. Acculturation dimensions and 12-month mood and anxiety disorders across US Latino subgroups in the National Epidemiologic Survey of Alcohol and Related Conditions. Psychol Med 2016; 46:1987-2001. [PMID: 27087570 PMCID: PMC4942840 DOI: 10.1017/s0033291716000763] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individual-level measures of acculturation (e.g. age of immigration) have a complex relationship with psychiatric disorders. Fine-grained analyses that tap various acculturation dimensions and population subgroups are needed to generate hypotheses regarding the mechanisms of action for the association between acculturation and mental health. METHOD Study participants were US Latinos (N = 6359) from Wave 2 of the 2004-2005 National Epidemiologic Survey of Alcohol and Related Conditions (N = 34 653). We used linear χ2 tests and logistic regression models to analyze the association between five acculturation dimensions and presence of 12-month DSM-IV mood/anxiety disorders across Latino subgroups (Mexican, Puerto Rican, Cuban, 'Other Latinos'). RESULTS Acculturation dimensions associated linearly with past-year presence of mood/anxiety disorders among Mexicans were: (1) younger age of immigration (linear χ2 1 = 11.04, p < 0.001), (2) longer time in the United States (linear χ2 1 = 10.52, p < 0.01), (3) greater English-language orientation (linear χ2 1 = 14.57, p < 0.001), (4) lower Latino composition of social network (linear χ2 1 = 15.03, p < 0.001), and (5) lower Latino ethnic identification (linear χ2 1 = 7.29, p < 0.01). However, the associations were less consistent among Cubans and Other Latinos, and no associations with acculturation were found among Puerto Ricans. CONCLUSIONS The relationship between different acculturation dimensions and 12-month mood/anxiety disorder varies across ethnic subgroups characterized by cultural and historical differences. The association between acculturation measures and disorder may depend on the extent to which they index protective or pathogenic adaptation pathways (e.g. loss of family support) across population subgroups preceding and/or following immigration. Future research should incorporate direct measures of maladaptive pathways and their relationship to various acculturation dimensions.
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Affiliation(s)
- R. Lewis Fernández
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - C. Morcillo
- Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough Foundation Trust, Cambridge, UK
| | - S. Wang
- New York State Psychiatric Institute, New York, NY, USA
| | - C. S. Duarte
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - N. K. Aggarwal
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - J. A. Sánchez-Lacay
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - C. Blanco
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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Boness CL, Lane SP, Sher KJ. Assessment of Withdrawal and Hangover is Confounded in the Alcohol Use Disorder and Associated Disabilities Interview Schedule: Withdrawal Prevalence is Likely Inflated. Alcohol Clin Exp Res 2016; 40:1691-9. [PMID: 27339661 DOI: 10.1111/acer.13121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV) and AUDADIS-5 are diagnostic interviews used in major epidemiological and other studies of alcohol use disorder (AUD). Much of what we know regarding the prevalence of AUD in the United States is based upon this interview. However, past research and meta-analytic evidence suggest that differential operationalization of the AUD criteria across instruments can lead to differential endorsement of symptoms and resulting AUD diagnosis rates. In particular, studies employing the AUDADIS are observed to have markedly higher endorsement rates of withdrawal than other large epidemiological studies. One explanation for this is that when assessing withdrawal, the AUDADIS combines effects from the morning after drinking with those from the days following, thereby conflating hangover and withdrawal. METHODS This study addresses whether this operationalization confounds rates of endorsement when compared to simpler, less ambiguous hangover or withdrawal stems. To this aim, 497 college student drinkers were randomized into 1 of 3 stem conditions: (i) hangover (n = 164), (ii) withdrawal (n = 167), or (iii) combined AUDADIS-IV (n = 166). RESULTS Across conditions, participants were more likely to report the occurrence of each withdrawal symptom in the combined stem condition than in the explicit withdrawal stem condition, but not in the explicit hangover stem condition. Within the combined stem condition, probed symptoms were more likely to be reported as a result of a hangover. CONCLUSIONS The AUDADIS potentially results in false positives for withdrawal, arguably a pathognomonic symptom of alcoholism and, in turn, likely affects rates of the diagnosis of AUD.
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Affiliation(s)
- Cassandra L Boness
- Department of Psychological Science, University of Missouri, Columbia, Missouri
| | - Sean P Lane
- Department of Psychological Science, University of Missouri, Columbia, Missouri
| | - Kenneth J Sher
- Department of Psychological Science, University of Missouri, Columbia, Missouri
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Carpenter RW, Wood PK, Trull TJ. Comorbidity of Borderline Personality Disorder and Lifetime Substance Use Disorders in a Nationally Representative Sample. J Pers Disord 2016; 30:336-50. [PMID: 25893556 DOI: 10.1521/pedi_2015_29_197] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Borderline personality disorder (BPD) is comorbid with substance use disorders (SUDs). However, most epidemiological work on BPD and SUDs has collapsed nonalcohol substances into a drug use disorder indicator, potentially obscuring patterns of association between BPD and individal SUDs. Using a nationally representative sample (National Epidemiologic Survey on Alcohol and Related Conditions; N = 34,481), the authors examined the association between lifetime BPD and nine lifetime SUDs. First, the authors examined the bivariate association of BPD and each SUD. BPD was associated with all nine SUDs. Second, they added relevant covariates (demographic variables, additional psychopathology) to each model. Seven SUDs remained significant. Finally, to account for shared variance across SUDs, the authors conducted a multivariate logistic regression with the nine SUDs and covariates as predictors. Alcohol, cocaine, and opiate use disorder were the only significant SUD predictors, indicating a unique association between BPD and these three SUDs. Future research should explore factors involved in the association of BPD with these specific SUDs.
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Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Jung J, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS, Grant BF. Nonmedical Prescription Opioid Use and DSM-5 Nonmedical Prescription Opioid Use Disorder in the United States. J Clin Psychiatry 2016; 77:772-80. [PMID: 27337416 PMCID: PMC5555044 DOI: 10.4088/jcp.15m10386] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/04/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The authors present 12-month and lifetime prevalence, correlates, psychiatric comorbidity, and treatment of nonmedical prescription opioid use (NMPOU) and DSM-5 NMPOU disorder (NMPOUD). METHODS Data were derived from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) (N = 36,309). RESULTS Prevalences of 12-month and lifetime NMPOU were 4.1% and 11.3%, exceeding rates in the 2001-2002 NESARC (1.8%, 4.7%). Twelve-month and lifetime rates of DSM-5 NMPOUD were 0.9% and 2.1%. NESARC-III DSM-IV NMPOUD rates (0.8%, 2.9%) were greater than those observed in the 2001-2002 NESARC (0.4% and 1.4%). Rates of NMPOU were greater among men, but no sex differential was observed for NMPOUD. Prevalences of NMPOU and NMPOUD were generally greater among 18- to 64-year-old individuals, whites, and Native Americans, and individuals with lower socioeconomic status. Associations were observed between 12-month and lifetime NMPOU and NMPOUD and other drug use disorders, posttraumatic stress disorder, and borderline, schizotypal, and antisocial personality disorders; persistent depression and major depressive disorder (for NMPOU); and bipolar I disorder (for NMPOUD). Only 5.5% and 17.7% of individuals with 12-month NMPOU and NMPOUD were ever treated. CONCLUSIONS NMPOU and NMPOUD have considerably increased over the past decade, are associated with a broad array of risk factors and comorbidities, and largely go untreated in the United States. More information on the determinants, characteristics, and outcomes of NMPOU and NMPOUD is needed to support evidence-based interventions and prevention.
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Affiliation(s)
- Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Bradley T. Kerridge
- Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Risë B. Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Roger P. Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Deborah S. Hasin
- Deborah Hasin, Ph.D. Department of Psychiatry, College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, New York, NY 10032
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
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Lane SP, Steinley D, Sher KJ. Meta-analysis of DSM alcohol use disorder criteria severities: structural consistency is only 'skin deep'. Psychol Med 2016; 46:1769-84. [PMID: 27019218 PMCID: PMC4894493 DOI: 10.1017/s0033291716000404] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Item response theory (IRT) analyses of alcohol use disorder (AUD) and other psychological disorders are a predominant method for assessing overall and individual criterion severity for psychiatric diagnosis. However, no investigation has established the consistency of the relative criteria severities across different samples. METHOD PubMed/Medline, PsycINFO, Web of Science and ProQuest databases were queried for entries relating to alcohol use and IRT. Study data were extracted using a standardized data entry sheet. Consistency of reported criteria severities across studies was analysed using generalizability theory to estimate generalized intraclass correlations (ICCs). RESULTS A total of 451 citations were screened and 34 papers (30 unique samples) included in the research synthesis. The AUD criteria set exhibited low consistency in the ordering of criteria using both traditional [ICC = 0.16, 95% confidence interval (CI) 0.06-0.56] and generalized (ICC = 0.18, 95% CI 0.15-0.21) approaches. These results were partially accounted for by previously studied factors such as age and type of sample (e.g. clinical v. community), but the largest source of unreliability was the diagnostic instrument employed. CONCLUSIONS Despite the robust finding of unidimensional structure of AUDs, inconsistency in the relative severities across studies suggests low replicability, challenging the generalizability of findings from any given study. Explicit modeling of well-studied factors like age and sample type is essential and increases the generalizability of findings. Moreover, while the development of structured diagnostic interviews is considered a landmark contribution toward improving psychiatric research, variability across instruments has not been fully appreciated and is substantial.
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Affiliation(s)
- S. P. Lane
- University of Missouri and the Midwest Alcoholism Research Center, Columbia, MO, USA
| | - D. Steinley
- University of Missouri and the Midwest Alcoholism Research Center, Columbia, MO, USA
| | - K. J. Sher
- University of Missouri and the Midwest Alcoholism Research Center, Columbia, MO, USA
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Curran E, Adamson G, Stringer M, Rosato M, Leavey G. Severity of mental illness as a result of multiple childhood adversities: US National Epidemiologic Survey. Soc Psychiatry Psychiatr Epidemiol 2016; 51:647-57. [PMID: 26952327 DOI: 10.1007/s00127-016-1198-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/20/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine patterns of childhood adversity, their long-term consequences and the combined effect of different childhood adversity patterns as predictors of subsequent psychopathology. METHODS Secondary analysis of data from the US National Epidemiologic Survey on alcohol and related conditions. Using latent class analysis to identify childhood adversity profiles; and using multinomial logistic regression to validate and further explore these profiles with a range of associated demographic and household characteristics. Finally, confirmatory factor analysis substantiated initial latent class analysis findings by investigating a range of mental health diagnoses. RESULTS Latent class analysis generated a three-class model of childhood adversity in which 60 % of participants were allocated to a low adversity class; 14 % to a global adversities class (reporting exposures for all the derived latent classes); and 26 % to a domestic emotional and physical abuse class (exposed to a range of childhood adversities). Confirmatory Factor analysis defined an internalising-externalising spectrum to represent lifetime reporting patterns of mental health disorders. Using logistic regression, both adversity groups showed specific gender and race/ethnicity differences, related family discord and increased psychopathology. CONCLUSIONS We identified underlying patterns in the exposure to childhood adversity and associated mental health. These findings are informative in their description of the configuration of adversities, rather than focusing solely on the cumulative aspect of experience. Amelioration of longer-term negative consequences requires early identification of psychopathology risk factors that can inform protective and preventive interventions. This study highlights the utility of screening for childhood adversities when individuals present with symptoms of psychiatric disorders.
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Affiliation(s)
- Emma Curran
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Magee College, Northland Rd, Derry, BT48 7JL, Northern Ireland, UK.
| | - Gary Adamson
- School of Psychology, Ulster University, Magee College, Northland Rd, Derry, BT48 7JL, Northern Ireland, UK
| | - Maurice Stringer
- School of Psychology, Ulster University, Magee College, Northland Rd, Derry, BT48 7JL, Northern Ireland, UK
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Magee College, Northland Rd, Derry, BT48 7JL, Northern Ireland, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Magee College, Northland Rd, Derry, BT48 7JL, Northern Ireland, UK
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Fu Q, Vaughn MG. A Latent Class Analysis of Smokeless Tobacco Use in the United States. J Community Health 2016; 41:850-7. [DOI: 10.1007/s10900-016-0163-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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McCabe PJ, Christopher PP. SYMPTOM AND FUNCTIONAL TRAITS OF BRIEF MAJOR DEPRESSIVE EPISODES AND DISCRIMINATION OF BEREAVEMENT. Depress Anxiety 2016; 33:112-9. [PMID: 26474367 DOI: 10.1002/da.22446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the removal of the bereavement exclusion from DSM-5, clinicians may feel uncertain on how to proceed when caring for a patient who presents with depressive symptoms following the death of someone close. The ability to better distinguish, on a symptom and functional level, between patients who experience depression in the context of bereavement and those with nonbereavement-related depression, could help guide clinical decision making. METHOD Individual and clustered depressive symptom and impairment measures were used for modeling bereavement status within a nationally representative longitudinal cohort. Deviance, linear shrinkage factor, and bias-corrected c-statistic were used for identifying a well-calibrated and discriminating final model. RESULTS Of the 450 (1.2%) respondents with a single brief major depressive episode, 162 (38.4%) reported the episode as bereavement-related. The bereaved were less likely to endorse worthlessness (P < .001), social conflict (P < .001), distress (P < .001), thoughts of suicide (P = .001), wanting to die (P = .01), self-medicating (P = .01), and being withdrawn (P = .04). In a multivariate model, the bereaved were more likely to have thoughts of their own death (P = .003), guilt coupled with weight or appetite loss (P = .013), and were less likely to report social conflict (P < .001), worthlessness coupled with difficulty making decisions (P < .001), thoughts of suicide (P = .006), distress coupled with weight or appetite gain (P = .022), and self-medicating (P = .045). CONCLUSIONS Traits and trait combinations differentiate individuals who experience brief depressive episodes following the death of a loved one from other brief episodes. These differences can help guide clinical care of patients who present with depressive symptoms shortly after a loved one's death.
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Affiliation(s)
| | - Paul P Christopher
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
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Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Jung J, Pickering RP, Ruan WJ, Smith SM, Huang B, Grant BF. Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry 2015; 72:1235-42. [PMID: 26502112 PMCID: PMC5037576 DOI: 10.1001/jamapsychiatry.2015.1858] [Citation(s) in RCA: 705] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century. OBJECTIVE To present nationally representative information on the past-year prevalence rates of marijuana use, marijuana use disorder, and marijuana use disorder among marijuana users in the US adult general population and whether this has changed between 2001-2002 and 2012-2013. DESIGN, SETTING, AND PARTICIPANTS Face-to-face interviews conducted in surveys of 2 nationally representative samples of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions (data collected April 2001-April 2002; N = 43,093) and the National Epidemiologic Survey on Alcohol and Related Conditions-III (data collected April 2012-June 2013; N = 36,309). Data were analyzed March through May 2015. MAIN OUTCOMES AND MEASURES Past-year marijuana use and DSM-IV marijuana use disorder (abuse or dependence). RESULTS The past-year prevalence of marijuana use was 4.1% (SE, 0.15) in 2001-2002 and 9.5% (SE, 0.27) in 2012-2013, a significant increase (P < .05). Significant increases were also found across demographic subgroups (sex, age, race/ethnicity, education, marital status, income, urban/rural, and region). The past-year prevalence of DSM-IV marijuana use disorder was 1.5% (0.08) in 2001-2002 and 2.9% (SE, 0.13) in 2012-2013 (P < .05). With few exceptions, increases in the prevalence of marijuana use disorder between 2001-2002 and 2012-2013 were also statistically significant (P < .05) across demographic subgroups. However, the prevalence of marijuana use disorder among marijuana users decreased significantly from 2001-2002 (35.6%; SE, 1.37) to 2012-2013 (30.6%; SE, 1.04). CONCLUSIONS AND RELEVANCE The prevalence of marijuana use more than doubled between 2001-2002 and 2012-2013, and there was a large increase in marijuana use disorders during that time. While not all marijuana users experience problems, nearly 3 of 10 marijuana users manifested a marijuana use disorder in 2012-2013. Because the risk for marijuana use disorder did not increase among users, the increase in prevalence of marijuana use disorder is owing to an increase in prevalence of users in the US adult population. Given changing laws and attitudes toward marijuana, a balanced presentation of the likelihood of adverse consequences of marijuana use to policy makers, professionals, and the public is needed.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York2Mailman School of Public Health, Columbia University, New York, New York3New York State Psychiatric Institute, New York
| | - Tulshi D Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Bradley T Kerridge
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Risë B Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - S Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Roger P Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - W June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Sharon M Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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Prins SJ, Bates LM, Keyes KM, Muntaner C. Anxious? Depressed? You might be suffering from capitalism: contradictory class locations and the prevalence of depression and anxiety in the USA. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:1352-1372. [PMID: 26385581 PMCID: PMC4609238 DOI: 10.1111/1467-9566.12315] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite a well-established social gradient for many mental disorders, there is evidence that individuals near the middle of the social hierarchy suffer higher rates of depression and anxiety than those at the top or bottom. Although prevailing indicators of socioeconomic status (SES) cannot detect or easily explain such patterns, relational theories of social class, which emphasise political-economic processes and dimensions of power, might. We test whether the relational construct of contradictory class location, which embodies aspects of both ownership and labour, can explain this nonlinear pattern. Data on full-time workers from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 21859) show that occupants of contradictory class locations have higher prevalence and odds of depression and anxiety than occupants of non-contradictory class locations. These findings suggest that the effects of class relations on depression and anxiety extend beyond those of SES, pointing to under-studied mechanisms in social epidemiology, for example, domination and exploitation.
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Affiliation(s)
- Seth J. Prins
- Department of Epidemiology, Columbia University, USA
| | - Lisa M. Bates
- Department of Epidemiology, Columbia University, USA
| | | | - Carles Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, and Department of Psychiatry, Center for Research in Inner City Health, St Michael’s Hospital, Toronto, Canada
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