H Lynn Boschloo VU Medical Center, Amsterdam, The Netherlands Netherlands Study of Depression and Anxiety Depressive and anxiety disorders predicting first-incidence of alcohol use disorders
PREVIOUS CROSS-SECTIONAL STUDIES Alcohol use disorders are highly prevalent in depressed and/or anxious persons. [e.g., De Graaf et al., 2003; Hasin et al.,2007; Boschloo et al., 2011] Depressive and/or anxiety disorders often precede alcohol dependence. [e.g., Merikangas et al. 1998; Boschloo et al. 2011] Introduction Methods Results Conclusion
PREVIOUS PROSPECTIVE STUDIES Do depressive and/or anxiety disorders predict first-incidence of alcohol use disorders? - Positive [Marquenie et al., 2007] - Negative [Crum and Pratt, 2001; Zimmerman et al., 2003] - Mixed [Kushner et al., 1999; Merikangas et al., 2008; Buckner and Turner 2009] Introduction Methods Results Conclusion
EXPLANATIONS FOR CONFLICTING RESULTS Small samples Heterogeneity of depressive/anxiety disorders - Status: Remitted versus current disorders - Type: Specific disorders - Severity: Number of disorders Introduction Methods Results Conclusion
RESEARCH QUESTIONS 1. Do depressive and/or anxiety disorders predict first-incidence of alcohol abuse? alcohol dependence? 2. Is this association conditional on the: status of disorder? type of disorder? severity? 3. What are other risk factors? Introduction Methods Results Conclusion
NESDA NEtherlands Study of Depression and Anxiety Naturalistic cohort study n=2,981: ♀ 1,979, ♂ 1,002, years 19% the community; 54% primary care; 27% outpatient mental health care organizations Introduction Methods Results Conclusion
DESIGN Introduction Methods Results Conclusion 2 year4 yearbaseline Interview N=2,981N=2,402 [Penninx et al., 2008; Lamers et al., 2011] Response rate: 80.6% Interview N=2,596 Response rate: 87.1% Current analyses: N=2, %
OUTCOME First-incidence of DSM-IV alcohol abuse (CIDI) - Exclusion: Baseline alcohol use disorder (n=714) - Exclusion: Alcohol dependence during FU (n=52) First-incidence of DSM-IV alcohol dependence (CIDI) - Exclusion: Baseline alcohol dependence (n=405) Introduction Methods Results Conclusion
PREDICTOR CIDI-based DSM-IV diagnosis of: Depressive disorder: - Major depressive disorder - Dysthymia Anxiety disorder: - Generalized anxiety disorder - Social phobia - Panic disorder - Agoraphobia Introduction Methods Results Conclusion
PREDICTOR Status of disorder: - Remitted disorder - Current disorder (<6 months) Type of disorder: - Specific depressive and anxiety disorders Severity: - Number of disorders Introduction Methods Results Conclusion
OTHER POTENTIAL RISK FACTORS Sociodemographics Vulnerability - Family history - Childhood trauma - Recent life events - Personality Addiction-related factors - Subthreshold alcohol problems - Illicit drug use - Smoking status Introduction Methods Results Conclusion
OVERALL FIRST-INCIDENCE RATES Introduction Methods Results Conclusion First-incidencen% Alcohol abuse392.0% Alcohol dependence673.0%
RESEARCH QUESTIONS 1. Do depressive and/or anxiety disorders predict first-incidence of alcohol abuse? alcohol dependence? 2. Is this association conditional on the: status of disorder? type of disorder? severity? 3. What are other risk factors? Introduction Methods Results Conclusion
FIRST-INCIDENCE OF ALCOHOL ABUSE Introduction Methods Results Conclusion
RESEARCH QUESTIONS 1. Do depressive and/or anxiety disorders predict first-incidence of alcohol abuse? alcohol dependence? 2. Is this association conditional on the: status of disorder? type of disorder? severity? 3. What are other risk factors? Introduction Methods Results Conclusion
FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion
RESEARCH QUESTIONS 1. Do depressive and/or anxiety disorders predict first-incidence of alcohol abuse? alcohol dependence? 2. Is this association conditional on the: status of disorder? type of disorder? severity? 3. What are other risk factors? Introduction Methods Results Conclusion
FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion
RESEARCH QUESTIONS 1. Do depressive and/or anxiety disorders predict first-incidence of alcohol abuse? alcohol dependence? 2. Is this association conditional on the: status of disorder? type of disorder? severity? 3. What are other risk factors? Introduction Methods Results Conclusion
FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion
RESEARCH QUESTIONS 1. Do depressive and/or anxiety disorders predict first-incidence of alcohol abuse? alcohol dependence? 2. Is this association conditional on the: status of disorder? type of disorder? severity? 3. What are other risk factors? Introduction Methods Results Conclusion
OTHER RISK FACTORS Introduction Methods Results Conclusion First-incidence of alcohol dependence PredictorHR95% CIp Number of dep/anx disorders <0.001 Male gender Childhood trauma Recent life-events Neuroticism <0.001 Agreeableness <0.001 Conscientiousness <0.001 Subthreshold alcohol problems <0.001 Current smoking
INDEPENDENT RISK FACTORS Introduction Methods Results Conclusion First-incidence of alcohol dependence PredictorHR95% CIp Number of dep/anx disorders Subthreshold alcohol problems <0.001 Recent life-events
CONCLUSIONS Depressive/anxiety disorders predicted first-incidence of alcohol dependence, but not alcohol abuse. Conditional on status of disorder Current disorder: Yes Remitted disorder: No Not conditional on type of disorder Conditional on severity Introduction Methods Results Conclusion
CONCLUSIONS Independent risk factors: Number of depressive/anxiety disorders Subthreshold alcohol problems Recent negative life events? Introduction Methods Results Conclusion
Netherlands Study of Depression and Anxiety funded through the mental health program of the Netherlands Organization for Health Research (ZonMW) and matching funds from participating institutes THANK YOU! Lynn Boschloo, MSc Nicole Vogelzangs, PhD Johannes H. Smit, PhD Wim van den Brink, MD, PhD Dick J Veltman, MD, PhD Aartjan TF Beekman, MD, PhD Brenda WJH Penninx, PhD