1. 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

2. 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

3. 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

4. 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

5. 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

6. NESDA NEtherlands Study of Depression and Anxiety Naturalistic cohort study n=2,981: ♀ 1,979, ♂ 1,002, 18-65 years 19% the community; 54% primary care; 27% outpatient mental health care organizations Introduction Methods Results Conclusion

7. 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=2,676 89.8%

8. 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

9. 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

10. 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

11. 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

12. OVERALL FIRST-INCIDENCE RATES Introduction Methods Results Conclusion First-incidencen% Alcohol abuse392.0% Alcohol dependence673.0%

13. 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

14. FIRST-INCIDENCE OF ALCOHOL ABUSE Introduction Methods Results Conclusion

15. 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

16. FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion

17. 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

18. FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion

19. 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

20. FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion

21. 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

22. OTHER RISK FACTORS Introduction Methods Results Conclusion First-incidence of alcohol dependence PredictorHR95% CIp Number of dep/anx disorders1.431.25-1.64<0.001 Male gender2.171.35-3.510.001 Childhood trauma1.141.03-1.260.01 Recent life-events1.301.08-1.560.006 Neuroticism1.771.37-2.29<0.001 Agreeableness0.620.49-0.79<0.001 Conscientiousness0.650.51-0.82<0.001 Subthreshold alcohol problems1.201.16-1.24<0.001 Current smoking2.731.45-5.140.002

23. INDEPENDENT RISK FACTORS Introduction Methods Results Conclusion First-incidence of alcohol dependence PredictorHR95% CIp Number of dep/anx disorders1.281.07-1.530.007 Subthreshold alcohol problems1.191.14-1.23<0.001 Recent life-events1.200.99-1.440.06

24. 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

25. CONCLUSIONS Independent risk factors:  Number of depressive/anxiety disorders  Subthreshold alcohol problems  Recent negative life events? Introduction Methods Results Conclusion

26. Netherlands Study of Depression and Anxiety www.nesda.nl 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