H

Lynn BoschlooVU 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 STUDIESDo 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 RESULTSSmall samples

Heterogeneity of depressive/anxiety disorders- Status: Remitted versus current disorders- Type: Specific disorders- Severity: Number of disorders

Introduction Methods Results Conclusion

RESEARCH QUESTIONS1. 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

NESDANEtherlands Study of Depression and Anxiety Naturalistic cohort studyn=2,981: 1,979♀ , 1,002♂ , 18-65 years19% the community; 54% primary care; 27%

outpatient mental health care organizations

Introduction Methods Results Conclusion

DESIGN

Introduction Methods Results Conclusion

2 year 4 yearbaseline

Interview Interview

N=2,981 N=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%

OUTCOMEFirst-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

PREDICTORCIDI-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

PREDICTORStatus 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 FACTORSSociodemographicsVulnerability

- 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-incidence n %

Alcohol abuse 39 2.0%

Alcohol dependence 67 3.0%

RESEARCH QUESTIONS1. 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 QUESTIONS1. 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 QUESTIONS1. 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 QUESTIONS1. 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 QUESTIONS1. 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

Predictor HR 95% CI p

Number of dep/anx disorders 1.43 1.25-1.64 <0.001

Male gender 2.17 1.35-3.51 0.001

Childhood trauma 1.14 1.03-1.26 0.01

Recent life-events 1.30 1.08-1.56 0.006

Neuroticism 1.77 1.37-2.29 <0.001

Agreeableness 0.62 0.49-0.79 <0.001

Conscientiousness 0.65 0.51-0.82 <0.001

Subthreshold alcohol problems 1.20 1.16-1.24 <0.001

Current smoking 2.73 1.45-5.14 0.002

INDEPENDENT RISK FACTORS

Introduction Methods Results Conclusion

First-incidence of alcohol dependence

Predictor HR 95% CI p

Number of dep/anx disorders 1.28 1.07-1.53 0.007

Subthreshold alcohol problems 1.19 1.14-1.23 <0.001

Recent life-events 1.20 0.99-1.44 0.06

CONCLUSIONSDepressive/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

CONCLUSIONSIndependent risk factors:

Number of depressive/anxiety disorders

Subthreshold alcohol problems

Recent negative life events?

Introduction Methods Results Conclusion

Netherlands Study of Depression and Anxietywww.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, MScNicole Vogelzangs, PhDJohannes H. Smit, PhD

Wim van den Brink, MD, PhDDick J Veltman, MD, PhD

Aartjan TF Beekman, MD, PhDBrenda WJH Penninx, PhD