Epidemiology of Comorbid Psychiatric and Addictive Disorders Kathleen Ries Merikangas, Ph.D. Senior Investigator APA, May 4, 2004

Kevin P. Conway, Ph.D. Deputy Branch Chief Epidemiology Research Branch

Goals 1.Identify key patterns emerging from epidemiologic data on drug/mental disorder comorbidity 2.Briefly discuss implications of a heterogeneous phenotype for classification, treatment, and genetics research

Goal 1 Key patterns from epidemiologic data  Comorbidity is the rule rather than the exception  Cross-cultural findings show that the magnitude of comorbidity is more similar than are the differences in baseline prevalence  Risk for drug dependence > drug abuse  Risk varies by mental disorder (Anxiety < Mood < ASPD)  Risk varies by gender (female > male)  Risk varies somewhat by specific drug disorder and number of drug disorders

Lifetime Prevalence and Odds Ratios of Mental Disorders by Substance Use Disorder: ECA Alcohol Drug Comorbid Disorder %O.R.%O.R. Any mental Schizophrenia Affective Anxiety Antisocial (Regier et al., JAMA 264: , 1990)

Goal 1 Key patterns from epidemiologic data  Comorbidity is the rule rather than the exception  Cross-cultural findings show that the magnitude of comorbidity is more similar than are the differences in baseline prevalence  Risk for drug dependence > drug abuse  Risk varies by mental disorder (Anxiety < Mood < ASPD)  Risk varies by gender (female > male)  Risk varies somewhat by specific drug disorder and number of drug disorders

Lifetime Prevalence of Drug Dependence and Mood Disorder International Consortium on Psychiatric Epidemiology (Merikangas et al., Addictive Behaviors, 1998)

Lifetime Comorbidity of Drug Dependence and Mood Disorder International Consortium on Psychiatric Epidemiology (Merikangas et al., Addictive Behaviors, 1998)

Population Attributable Risk of Drug Dependence due to Prior Mental Disorders: International Consortium on Psychiatric Epidemiology Kessler et al., Psychiatria Fennica, 32 (suppl 2): 62-79, 2001

Lifetime Prevalence of Mood Disorder among Puerto Rican Probands with Drug Dependence: Preliminary Results from a Migrant Family Study (Conway, Swendsen, Canino, & Merikangas, in preparation) %

Goal 1 Key patterns from epidemiologic data  Comorbidity is the rule rather than the exception  Cross-cultural findings show that the magnitude of comorbidity is more similar than are the differences in baseline prevalence  Risk for drug dependence > drug abuse  Risk varies by mental disorder (Anxiety < Mood < ASPD)  Risk varies by gender (female > male)  Risk varies somewhat by specific drug disorder and number of drug disorders

Lifetime Comorbidity by Drug Abuse and Dependence: ECA O.R.AbuseDependence Any Anxiety Phobia Panic OCD Any Mood Bipolar MDD Dysthymia Antisocial (Regier et al., JAMA 264: , 1990.)

(median odds ratio across sites) UseAbuseDependence Anxiety Mood Lifetime Anxiety and Mood Comorbidity by Drug Use, Abuse, and Dependence: International Consortium on Psychiatric Epidemiology

Goal 1 Key patterns from epidemiologic data  Comorbidity is the rule rather than the exception  Cross-cultural findings show that the magnitude of comorbidity is more similar than are the differences in baseline prevalence  Risk for drug dependence > drug abuse  Risk varies by mental disorder (Anxiety < Mood < ASPD)  Risk varies by gender (female > male)  Risk varies somewhat by specific drug disorder and number of drug disorders

Lifetime Comorbidity by Specific Drug Use Disorder: NESARC AnxietyMoodASPD O.R.MFMFMF Any Drug Marijuana Cocaine Amphetamine Hallucinogen Opioid Sedative Tranquilizer (Conway, Compton, & Grant, in preparation)

Lifetime Mood and/or Anxiety Comorbidity by Multiple Drug Use Disorders: NESARC (Conway, Compton, & Grant, in preparation)

Goal 2 1.Identify key patterns emerging from epidemiologic data on drug/mental disorder comorbidity 2.Briefly discuss implications of a heterogeneous phenotype for classification, treatment, and genetics research

The Phenotype “Probably the single most important aspect of studies of complex diseases is the phenotype, which may well be multidimensional.” P. Michael Conneally, 2002 ASHG Presidential Address

Pathways to Substance Disorders through Psychopathology: Yale Family Study (Relative Risk) AgeAge ADHDADHD ConductConduct ConductConduct BipolarBipolar AnxietyAnxietyDepressionDepression PhobiaPhobia

Relative Risk of Daily Smoking by Preexisting Psychiatric Disorders (NCS) Any ActivePast MDD Dysthymia Agoraphobia GAD1.92.1ne Simple Phobia Social Phobia Panic Disorder PTSD (Breslau, Novak, & Kessler, Biol Psychiatry 2004)

Drug abuse = 0 Drug abuse = 1 Risk Conventional Definition: Dichotomous Disorder

Antisocial/Substance Biological Diathesis Langbehn et al., DAD, 69: , 2003 Age of Onset of Drug Problems