Use of Psychoactive Substances and Health Care in Response to Anxiety and Depressive Disorders

The use of psychoactive substances in response to psychological distress is not well documented in the general population and has never been studied in combination with health care use. This study estimated the frequency of health care and substance use in response to anxiety or depressive disorders and determined factors associated with these behaviors. From a large survey of adults from four French regions, the authors selected those with a 12-month probable anxiety or depressive disorder without a substance use disorder (N=4,071). These disorders were determined with the Composite International Diagnostic Interview Short Form, and participants were asked whether they used substances or health care in response to each disorder. The use of substances in response to anxiety or depressive disorders was 12.9% among men and 5.2% among women. Compared with those who used health care only, those who used substances (with or without health care) were more likely to be men, single, and young. Those who used both substances and health care were also less likely to have a depressive disorder. This study shows that a sizeable portion of the general population uses substances in response to anxiety or depressive disorders. It also shows that these substance users have distinctive sociodemographic characteristics and can thus be targeted by prevention programs. Strategies to reach substance users with depressive or anxiety disorders who do not use health care remain to be elaborated.

Perceived Need for Mental Health Care and Service Use Among Adults in Western Europe: Results of the ESEMeD Project

Employment Among Persons With Past and Current Mood and Anxiety Disorders in the Israel National Health Survey

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Diagnosis and Treatment of Depression and Anxiety in Rural and Nonrural Primary Care: National Survey Results

The purpose of this study was to determine the extent of comorbid substance use disorders in patients referred for treatment of personality disorders. Two hundred inpatients and outpatients were assessed by semistructured interviews for substance use and personality disorders. Univariate odds ratios were calculated for groups of substance use disorders and each DSM-III-R axis II disorder; comorbidity among axis II disorders was controlled in multivariate models predicting current or lifetime substance use disorder groups. The impact of personality disorder on chronicity and overall impairment associated with substance use disorders was evaluated. Close to 60% of subjects with substance use disorders had personality disorders. Borderline personality disorder was significantly associated with current substance use disorders, excluding alcohol and cannabis, and with lifetime alcohol, stimulant, and other substance use disorders, excluding cannabis. Antisocial personality disorder was associated with lifetime substance use disorders other than alcohol, cannabis, and stimulants. These relationships remained significant after controlling for the presence of all other personality disorders. There was no evidence that personality disorders increased the chronicity of substance use disorders, but comorbid personality disorders were associated with greater global impairment. Borderline personality disorder may be associated with a wide variety of substance use disorders, especially among patients seeking treatment for personality problems.

The Critical Relationship Between Anxiety and Depression.

Use of Outpatient Mental Health Services by Depressed and Anxious Children as They Grow Up

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

There is limited empirical evidence on the extent to which perceived public stigma prevents individuals from using mental health services, despite substantial recent policy interest in this issue. This study investigated associations between perceived public stigma and mental health care seeking. This study used cross-sectional survey data from a representative sample of undergraduate and graduate students (N=2,782) at one university. A five-item scale was used to assess perceived public stigma toward mental health service use. Perceived need for help in the past 12 months and current presence of depressive and anxiety disorders were also assessed. Perceived stigma was higher among males, older students, Asian and Pacific Islanders, international students, students with lower socioeconomic status backgrounds, and students with current mental health problems. Perceived stigma was also higher among those without any family members or friends who had used mental health services and among those who believed that therapy or medication is not very helpful. Perceived stigma was negatively associated with the likelihood of perceiving a need for mental health services, but only among younger students. Among those with probable depressive or anxiety disorders, there was no evidence that perceived stigma was associated with service use. These results suggest that, at least in this population, perceived stigma may not be as important a barrier to mental health care as the mental health policy discourse currently assumes.

BackgroundBetter management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively.MethodsIn eight family practices 1046 consulting patients (25–79 yrs) were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV) using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP).ResultsIn the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.1–1.7)). Anxiety disorders had no independent effect.ConclusionHealth care planning should focus on the recognition and treatment of somatoform as well as affective disorders.

The prevalence of mental disorders in 76 first-degree relatives (parents and nontwin siblings) of 33 subjects with anxiety disorder was compared with the prevalence of mental disorders in 45 first-degree relatives of 20 subjects with mood disorder and 13 first-degree relatives of 6 subjects with psychoactive substance use disorder. All subjects were personally interviewed with the Structured Clinical Interview for DSM-III-R Axis I (SCID I). Interrater reliability was high for most diagnoses. Significantly more first-degree relatives of subjects with anxiety disorder had panic disorder and generalized anxiety disorder compared with relatives of probands with mood disorder. Significantly more female than male relatives of anxiety subjects suffered from anxiety disorders; there were no gender differences in the prevalence of anxiety disorders in relatives of mood and psychoactive substance use disorder (PSUD) subjects. The combination of anxiety and mood disorder was overrepresented in first-degree relatives of subjects with the same type of comorbidity. In relatives of subjects with mixed anxiety and psychoactive substance use disorder, but no mood disorder, there was an overrepresentation of PSUD; mainly alcohol abuse or dependence.

Aim: The aim of this study was to determine the prevalence and correlates of anxiety and depression among psychoactive substance users in a rehabilitation centre.
 Place and Duration of Study: The study was carried out in a rehabilitation centre in Lagos state, Nigeria.
 Methodology: All the inhabitants of the centre who agreed to participate in the study were included in the study. However, individuals who had stayed at the centre for less than a week were excluded from the study because the effect of use or withdrawal effects of some of the drugs may mimic depressive or anxiety symptoms. The 9-item Patient Health Questionnaire (PHQ-9) and the Mini International Neuropsychiatric Interview (M.I.N.I) (anxiety modules) were used to asses for depression and anxiety disorder respectively.
 Results: A total of seventy six people participated in this study. Their ages ranged from 17 to 52 years (mean= 25.9 years SD= 8.4). A high number of the subjects were males (72.4%), single (78.7%) and unemployed (64.5%). Almost all the subjects (92.1%) were introduced to the use of psychoactive substances by friends/peers. Only 4 (5.3%) subjects reported injection drug use (IDU). 53.9% of the subjects had an anxiety disorder. While 68.4% had depression. The factors associated with having anxiety disorder were female sex, older age, being divorced/ separated/widowed, unemployment, multiple substance use, long duration of use of alcohol, cocaine and heroin.
 Factors associated with depression included; young age of onset of substance use, female sex, being separated or divorced or widowed, unemployment, long duration/ frequency of use of substances and multiple substance use.
 Conclusion: This study has shown that there is a high rate of anxiety and depression among psychoactive substance users.

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample