DSM-IV Substance Use Research Articles

Alcohol or Drug Self-Help Use Among Adults in the United States: Age, Period, and Cohort Effects Between 2002 and 2018.

The online version contains supplementary material available at 10.1007/s11469-023-01012-2.

Perceived helpfulness of service sectors used for mental and substance use disorders: Findings from the WHO World Mental Health Surveys

BackgroundMental healthcare is delivered across service sectors that differ in level of specialization and intervention modalities typically offered. Little is known about the perceived helpfulness of the combinations of service sectors that patients use.MethodsRespondents 18 + years with 12-month DSM-IV mental or substance use disorders who saw a provider for mental health problems in the year before interview were identified from WHO World Mental Health surveys in 17 countries. Based upon the types of providers seen, patients were grouped into nine mutually exclusive single-sector or multi-sector ‘treatment profiles’. Perceived helpfulness was defined as the patient’s maximum rating of being helped (‘a lot’, ‘some’, ‘a little’ or ‘not at all’) of any type of provider seen in the profile. Logistic regression analysis was used to examine the joint associations of sociodemographics, disorder types, and treatment profiles with being helped ‘a lot’.ResultsAcross all surveys combined, 29.4% (S.E. 0.6) of respondents with a 12-month disorder saw a provider in the past year (N = 3221). Of these patients, 58.2% (S.E. 1.0) reported being helped ‘a lot’. Odds of being helped ‘a lot’ were significantly higher (odds ratios [ORs] = 1.50–1.89) among the 12.9% of patients who used specialized multi-sector profiles involving both psychiatrists and other mental health specialists, compared to other patients, despite their high comorbidities. Lower odds of being helped ‘a lot’ were found among patients who were seen only in the general medical, psychiatrist, or other mental health specialty sectors (ORs = 0.46–0.71). Female gender and older age were associated with increased odds of being helped ‘a lot’. In models stratified by country income group, having 3 or more disorders (high-income countries only) and state-funded health insurance (low/middle-income countries only) were associated with increased odds of being helped ‘a lot’.ConclusionsPatients who received specialized, multi-sector care were more likely than other patients to report being helped ‘a lot’. This result is consistent with previous research suggesting that persistence in help-seeking is associated with receiving helpful treatment. Given the nonrandom sorting of patients by types of providers seen and persistence in help-seeking, we cannot discount that selection bias may play some role in this pattern.

The relationship of frequency of cocaine use to substance and psychiatric disorders in the U.S. general population

BackgroundIn clinical trials of pharmacotherapy for substance use, abstinence is the primary endpoint accepted by regulatory agencies. However, this endpoint could be overly restrictive, impeding efforts to identify effective medications for cocaine use disorder. To examine non-abstinent gradations in cocaine use as potential indicators of improvement, we investigated the relationship of frequency of cocaine use to clinical correlates in national survey data. MethodsLifetime cocaine users (n = 2501) were interviewed in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) in 2001−2002 and re-interviewed in 2004–2005. Adjusted odds ratios (aORs) indicated associations between heaviest frequency of cocaine use and use of other substances, DSM-IV substance use disorders, psychiatric disorders, and change between 2001−2002 and 2004–2005. The reference category for all aORs was non-users. ResultsGreater lifetime cocaine use frequency was associated with lifetime cocaine, alcohol, and cannabis dependence (aOR for a linear trend = 2.80, 1.22, 1.22, respectively) and past-year cocaine, alcohol, and cannabis dependence (aOR = 1.78, 1.13, 1.16, respectively). Greater lifetime cocaine use frequency was associated with past-year depressive, panic, and generalized anxiety disorders (aOR = 1.07, 1.09, 1.12, respectively). Among cocaine users in 2001−2002, compared to the reference group using less than monthly, use ≥1x/week and use 1−3 times a month was associated with cocaine use disorder in 2004–2005 (aOR = 2.13 and aOR = 1.67, respectively). ConclusionGradations in risk for dependence on cocaine, other substances and psychiatric disorders by frequency of cocaine use indicates a promising direction for more sensitive outcome measures of treatment effects on cocaine outcomes than binary indicators (e.g., any use vs. none). Study results add to findings suggesting that non-abstinent measures might be useful indicators of treatment efficacy in clinical trials.

Testing the interrelationship between mental well-being and mental distress in young people

ABSTRACTThe relationship between mental well-being and distress in young people is unclear but important for both theoretical and practical reasons. This study tests these relationships using both dimensional and categorical measures of mental well-being and distress. Two thousand and eighty-two Australians’ (16–25 years) completed an online survey. A subsample (n = 389) completed diagnostic telephone interviews to identify 12-month DSM-IV mood, anxiety and substance use disorders. Five competing models of the relationship between mental well-being and distress were compared. Only the bifactor model fit the data, indicating both mental well-being and distress are important subcomponents of a young person’s overall level of mental health. Over 90% of young people had flourishing or moderate well-being and only 6% were languishing. Those with past year mental disorders were only 15% less likely to be flourishing and 4% more likely to be languishing. These findings highlight the well-being potential of young people living with and without mental disorders.

Race/ethnicity, nativity, and lifetime risk of mental disorders in US adults.

There has been no comprehensive examination of how race/ethnicity and nativity intersect in explaining differences in lifetime prevalence of mental disorders among Asian, Black, Latino, and White adults. This study aims to estimate racial/ethnic differences in lifetime risk of mental disorders and examine how group differences vary by nativity. Survival models were used to estimate racial/ethnic and nativity differences in lifetime risk of DSM-IV anxiety, mood, and substance use disorders in a nationally representative sample of over 20,000 respondents to four US surveys. Asians had the lowest lifetime prevalence of mental disorders (23.5%), followed by Blacks (37.0%), Latinos (38.8%), and Whites (45.6%). Asians and Blacks had lower lifetime risk than Whites for all disorders even after adjusting for nativity; Latinos and Whites had similar risk after adjusting for nativity. Risk of disorder onset was lowest for foreign-born respondents in years before migration. There were significant race/ethnicity and nativity interactions for mood and substance use disorders. Odds of mood disorder onset were higher for Whites with at least one US-born parent. Odds of substance use disorder onset among Asians were higher for US-born respondents; for Latinos, they were higher for those with at least one US-born parent. Parental foreign-born nativity is associated with a low risk of mental disorders, but not uniformly across racial/ethnic groups or disorders. Exposure to the US context may be associated with greater mental disorder risk for Latinos and Whites particularly. Investigations of cultural processes, including among Whites, are needed to understand group differences.

Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences.

This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men.

Ethnic differences in psychosocial factors in methadone maintenance: Hmong versus non-Hmong

ABSTRACTLittle is known about the characteristics of U.S.-based Asian populations undergoing methadone maintenance treatment for opioid use disorders. We evaluated psychosocial factors in 76 Hmong and 130 non-Hmong on methadone maintenance for at least two months in a single urban methadone maintenance clinic. Assessments included the Addiction Severity Index 5th Edition, the Symptom Checklist-90, and the Structured Clinical Interview for DSM-IV Axis I Disorders. The Hmong were older, predominately male, and on lower doses of methadone than the non-Hmong. Hmong had significantly lower ASI composite scores across all dimensions except employment and legal. While the SCL-90 Global Severity Index (GSI) score did not differ between groups, the Hmong had lower scores in the interpersonal sensitivity, depression, anxiety, hostility, and paranoid ideation dimensions. Sixty-seven percent of Hmong and 29% of non-Hmong were without Axis I diagnoses (p < .001). There was no difference between the groups in DSM-IV substance use diagnoses. The extent to which these psychosocial differences impact methadone dose requirements and treatment outcomes in Hmong and non-Hmong remains unknown.

Clinical predictors of conversion to bipolar disorder in a prospective longitudinal familial high-risk sample: focus on depressive features.

Identifying clinical features that predict conversion to bipolar disorder (BD) in those at high familial risk (HR) would assist in identifying a more focused population for early intervention. In total 287 participants aged 12-30 (163 HR with a first-degree relative with BD and 124 controls (CONs)) were followed annually for a median of 5 years. We used the baseline presence of DSM-IV depressive, anxiety, behavioural and substance use disorders, as well as a constellation of specific depressive symptoms (as identified by the Probabilistic Approach to Bipolar Depression) to predict the subsequent development of hypo/manic episodes. At baseline, HR participants were significantly more likely to report ⩾4 Probabilistic features (40.4%) when depressed than CONs (6.7%; p < .05). Nineteen HR subjects later developed either threshold (n = 8; 4.9%) or subthreshold (n = 11; 6.7%) hypo/mania. The presence of ⩾4 Probabilistic features was associated with a seven-fold increase in the risk of 'conversion' to threshold BD (hazard ratio = 6.9, p < .05) above and beyond the fourteen-fold increase in risk related to major depressive episodes (MDEs) per se (hazard ratio = 13.9, p < .05). Individual depressive features predicting conversion were psychomotor retardation and ⩾5 MDEs. Behavioural disorders only predicted conversion to subthreshold BD (hazard ratio = 5.23, p < .01), while anxiety and substance disorders did not predict either threshold or subthreshold hypo/mania. This study suggests that specific depressive characteristics substantially increase the risk of young people at familial risk of BD going on to develop future hypo/manic episodes and may identify a more targeted HR population for the development of early intervention programs.

Gender differences in lifetime psychiatric and substance use disorders among people who use substances in Barcelona, Spain

PurposeThe purpose of this paper is to examine gender differences in lifetime substance use and non-substance use (non-SUD) psychiatric disorders among illicit drug users and determine factors associated with non-SUD psychiatric disorders independently for males and for females.Design/methodology/approachSecondary analysis of five cross-sectional studies conducted in Barcelona, Spain during 2000-2006. Lifetime DSM-IV substance use and non-SUD psychiatric diagnoses were assessed using the Spanish Psychiatric Research Interview for Substance and Mental disorders (PRISM) among 629 people who use substances (68 per cent male) recruited from treatment (n=304) and out of treatment (n=325) settings. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using binary logistic regression.FindingsThe prevalence of any lifetime psychiatric (non-SUD) disorder was 41.8 per cent, with major depression (17 per cent) and antisocial personality disorder (17 per cent) being the most prevalent disorders. After adjusting for age and study, the odds of having any lifetime non-SUD (OR 2.10; 95%CI 1.48, 2.96); any mood disorder (OR 2.13; 95%CI 1.46, 3.11); any anxiety disorder (OR 1.86; 95%CI 1.19; 2.92); any eating disorder (OR 3.09; 95%CI 1.47, 6.47); or borderline personality disorder (OR 2.30; 95%CI 1.36, 3.84) were greater for females than males. Females were less likely than males to meet criteria for antisocial personality disorder (OR 0.59; 95%CI 0.36, 0.96) and attention deficit disorder (OR 0.37; 95%CI 0.17, 0.78).Research limitations/implicationsPsychiatric disorders are common among people who use substances, with gender differences reported for specific disorders. Gender-sensitive integrated treatment approaches are required to prevent and to address comorbidity psychiatric disorders among this population.Originality/valueThis secondary analysis of five cross-sectional studies included a large sample size allowing sufficient power to examine the differences between men and women. An additional strength of the methodology is the use of the gold standard PRISM which was used to assess disorders.

Association of physical injury and mental health: Results from the national comorbidity survey- adolescent supplement

Nonfatal injury is common among adolescents in the U.S., but little is known about the bi-directional associations between injury and mental health. Utilizing a nationally representative sample of U.S. adolescents, we examined 1) associations between lifetime mental health history and subsequent injury; 2) concurrent associations between injury and mental health; and 3) associations between injury and subsequent mental disorders. Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), a national survey of adolescents aged 13 through 17 years (N = 10,123). Twelve-month prevalence of nonfatal injury requiring medical attention was assessed along with lifetime, 12-month, and 30-day prevalence of DSM-IV depressive, anxiety, behavior, substance use, and bipolar disorders. We used Poisson regression to examine associations between 1) lifetime history of mental disorders and 12-month exposure to injury; 2) concurrent associations between 12-month exposure to injury and 12-month prevalence of mental disorders; and 3) 12-month exposure to injury and 30-day prevalence of mental disorders. A total of 11.6% of adolescents experienced an injury requiring medical attention in the year before the survey. Lifetime history of mental disorders was not associated with past-year injury. Behavior and bipolar disorders were concurrently associated with past-year injury. Past-year injury occurrence predicted increased risk for past-month anxiety disorders and decreased risk of past-month depressive disorders. Our findings reveal reciprocal associations between injury and mental disorders and highlight the need for systematic assessment, prevention, and treatment of mental disorders among injured youth.

Item Response Theory Analysis to Assess Dimensionality of Substance Use Disorder Abuse and Dependence Symptoms

Item response theory (IRT) based studies conducted on diverse samples showed a single dominant factor for DSM-III-R and DSM-IV substance use disorder (SUD) abuse and dependence symptoms of alcohol, cannabis, sedative, cocaine, stimulants, and opiates use disorders. IRT provides the opportunity, within a person-centered framework, to accurately gauge each person's severity of disorder that, in turn, informs required intensiveness of treatment. The aim of this study was to determine whether the SUD symptoms indicate a unidimensional trait or instead need to be conceptualized and quantified as a multidimensional scale. The sample was composed of families of adult SUD+ men (n=349), and SUD+ women (n=173), who qualified for DSM-III-R diagnosis of substance use disorder (abuse or dependence) and families of adult men and women who did not qualify for a SUD diagnosis (SUD- men: n=190, SUD- women: n=133). An expanded version of the Structured Clinical Interview for DSM-III-R (SCID) was administered to characterize lifetime and current substance use disorders. Item response theory methodology was used to assess the dimensionality of DSM-III-R SUD abuse and dependence symptoms. A bi-factor model provided the optimal representation of the factor structure of SUD symptoms in males and females. SUD symptoms are scalable as indicators of a single common factor, corresponding to general (non-drug-specific, common) liability to addiction, combined with drug-specific liabilities. IRT methodology used to quantify the continuous general liability to addiction (GLA) latent trait in individuals having SUD symptoms was found effective for accurately measuring SUD severity in men and women. This may be helpful for person-centered medicine approaches to effectively address intensity of treatment.

Psychometric Properties of the Arabic Version of the Drug Use Disorders Identification Test (DUDIT) in Clinical, Prison Inmate, and Student Samples

PurposeThe study aimed to validate the Arabic version of the Drug Use Disorders Identification Test (DUDIT) by (1) assessing its factor structure, (2) determining structural validity, (3) evaluating item-total and inter-item correlation, and (4) assessing its predictive validity.MethodThe study population included 169 prison inmates, 51 patients with clinical diagnosis of substance used disorder, and 53 students (N = 273). All participants completed the self-report version of the Arabic DUDIT. After exploratory factor analysis, internal consistency of the Arabic DUDIT was determined and external validation was performed.ResultsPrincipal factor analysis showed that Arabic DUDIT exhibited only one factor, which explained 66.9% of the variance. Reliability based on Cronbach’s alpha was .95. When compared to the DSM-IV substance use disorder diagnosis in a clinical sample, DUDIT had an area under the curve (AUC) of .98, with a sensitivity of .98 and a specificity of .90.ConclusionThe Arabic version of DUDIT is a valid and reliable tool for screening for drug use in Arabic-speaking countries.

Sensitivity and specificity of the gain short-screener for predicting substance use disorders in a large national sample of emerging adults

Background and objectivesEmerging Adults (ages 18–25) have the highest prevalence of substance use disorders and rarely receive treatment from the specialty care system. Thus, it is important to have screening instruments specifically developed for emerging adults for use in Screening, Brief Intervention and Referral to Treatment (SBIRT) models. Optimal cutoffs for the widely-used GAIN Short-Screener’s (GAIN-SS) Substance Disorder Screener (SDScrY) are not established specifically for emerging adults. Therefore, this study examined the sensitivity and specificity of the SDScrY in predicting emerging adult (ages 18–25) substance use disorders. MethodsWe analyzed data from emerging adults in a large clinical sample (n=9,808) who completed both the five-item SDScrY (α=0.85) and the full criteria set for DSM-IV Substance Use Disorders. We estimated the sensitivity, specificity and area under the curve to determine optimal cutoffs. ResultsAnalyses revealed a high correlation between the SDScrY screener and its longer parent scale (r=0.95, p<0.001). Sensitivity (83%) and specificity (95%) were highest at a cutoff score of two (AUC=94%) on the SDScrY for any past year substance use disorder. Sensitivity (85%) was also high at a cutoff score of two on the SDScrY for any past year alcohol disorder. ConclusionsThe five-item Substance Use Disorder Screener is a sensitive and specific screener for emerging adults, and could be used to identify emerging adults who may benefit from SBIRT interventions.

The longitudinal relationship between flourishing mental health and incident mood, anxiety and substance use disorders

High levels of mental well-being might protect against the onset of mental disorders but longitudinal evidence is scarce. This study examines whether flourishing mental health predicts first-incidence and recurrent mental disorders 3 years later. Data were used from 4482 representative adults participating in the second (2010-12) and third wave (2013-15) of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Mental well-being was assessed with the Mental Health Continuum-Short Form (MHC-SF) at the second wave. The classification criteria of this instrument were used to classify participants as having flourishing mental health: high levels of both hedonic well-being (life-satisfaction, happiness) and eudaimonic well-being (social contribution, purpose in life, personal growth). DSM-IV mood, anxiety and substance use disorders were measured with the Composite International Diagnostic Interview (CIDI) 3.0 at all waves. Odds ratios of (first and recurrent) incident disorders were estimated, using logistic regression analyses adjusting for potential confounders. Flourishing reduced the risk of incident mood disorders by 28% and of anxiety disorders by 53%, but did not significantly predicted substance use disorders. A similar pattern of associations was found for either high hedonic or high eudaimonic well-being. Significant results were found for substance use disorders when life-events and social support were removed as covariates. This study underscores the rationale of promoting mental well-being as a public mental health strategy to prevent mental illness. In wealthy European nations it seems fruitful to measure and pursuit a flourishing life rather than merely high levels of hedonic well-being.

Retrospective age-of-onset and projected lifetime prevalence of psychiatric disorders among U.S. Army National Guard soldiers

BackgroundThe study of military-related mental health has been disproportionately focused on current symptomology rather than potentially more informative life course mental health. Indeed, no study has assessed age-of-onset and projected lifetime prevalence of disorders among reservists. MethodsAge-of-onset and projected lifetime DSM-IV anxiety, mood, and substance use disorders were assessed in 671 Ohio Army National Guard soldiers aged 17–60 years. Between 2008 and 2012, face-to-face clinical assessments and surveys were conducted using the Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale. ResultsLifetime prevalence of psychiatric disorders was 61%. Alcohol abuse/dependence (44%) and major depressive disorder (23%) were the most common disorders. The majority (64%) of participants reported disorders antedating enlistment. Median age-of-onset varied with anxiety disorders – particularly phobias and OCD – having the earliest (median=15 years) and mood disorders the latest median age-of-onset (median=21 years). LimitationsThe study was limited by both the retrospective investigation of age-of-onset and the location of our sample. As our sample may not represent the general military population, our findings need to be confirmed in additional samples. ConclusionsEach psychiatric disorder exhibited a distinct age-of-onset pattern, such that phobias and OCD onset earliest, substance use disorders onset during a short interval from late-adolescence to early-adulthood, and mood disorders onset the latest. Our finding that the majority of participants reported disorders antedating enlistment suggests that an assessment of lifetime psychopathology is essential to understanding the mental health burden of both current and former military personnel.

Developing and Testing Twelve-Step Facilitation for Adolescents with Substance Use Disorder: Manual Development and Preliminary Outcomes.

Adolescent substance use disorder treatment programs are often based on the 12-step philosophy of Alcoholics Anonymous and/or link adolescents to these free resources. Despite this, no studies have developed and rigorously tested a twelve-step facilitation (TSF) intervention for young people, leaving a significant evidence gap. This study describes the first systematic development of an outpatient adolescent TSF treatment. An integrated twelve-step facilitation (iTSF) treatment incorporated TSF, motivational enhancement therapy, and cognitive behavioral therapy elements and was developed in an iterative manner with weekly feedback provided by 36 adolescents (M age 17 years [SD = 1.4]; 52.8% white) with DSM-IV substance use disorder recruited from the community. Assessments were conducted at baseline and at three and six months. Participants completed 6 of 10 sessions on average (8 participants completed all 10). Notable treatment developments were the inclusion of “in-services” led by Marijuana Anonymous members, including parents in a portion of individual sessions to provide a rationale for TSF, and use of a Socratic therapeutic interaction style. Acceptability and feasibility of the treatment were excellent (treatment satisfaction was 4.29 [SD = 0.59] out of 5). In keeping with TSF theory, the intervention substantially increased 12-step participation, and greater participation related to greater abstinence. iTSF is a replicable manualized treatment that can be implemented and tested in outpatient settings. Given the widespread compatibility of iTSF with the current adolescent treatment, if found efficacious, iTSF could be relatively easily adopted, implemented, and sustained and could provide an evidence-based option that could undergird current practice.

Race, Coping Style, and Substance Use Disorder Among Non-Hispanic African American and White Young Adults in South Florida

Background: Despite their higher rates of stress, African American young adults tend toward similar or lower rates of substance misuse than their White counterparts. Arguably, such patterns derive from: (1) racial variations in the availability of coping strategies that mitigate stress; and/or (2) racial differences in the efficacy of available coping styles for reducing substance misuse. Objectives: We assessed whether two coping style types—problem-focused and avoidance-oriented—varied by race (non-Hispanic African American vs. non-Hispanic White) and whether the effects of coping styles on substance misuse were moderated by race. Methods: Using data from a community sample of South Florida young adults, we employed logistic regression analyses to examine racial differences in coping style and to test if race by coping style interactions (race × problem-focused coping and race × avoidance-oriented coping) influenced the odds of qualifying for a DSM-IV substance use disorder, net of lifetime stressful events and sociodemographic controls. Results: We found that African American young adults displayed lower problem-focused coping, and higher avoidance-oriented coping, than did White young adults. Among both African American and White respondents, problem-focused coping was associated with reduced odds of illicit drug use disorder (excluding marijuana), and among Whites, avoidance-oriented coping was associated with increased odds of an aggregate measure of alcohol, marijuana, and other illicit drug use disorders. Among African Americans, however, avoidance-oriented coping was associated with lower odds of marijuana use disorder. Conclusion: Substance misuse policies and practices that consider the sociocultural contexts of stress and coping are recommended.

Bulimic Behaviors and Early Substance Use: Findings from a Cotwin-Control Study.

Bulimic behaviors (i.e., binge eating and compensatory behaviors) and substance use frequently co-occur. However, the etiology underlying this association is poorly understood. This study evaluated the association between bulimic behaviors and early substance use, controlling for genetic and shared environmental factors. Participants were 3,540 young adult women from the Missouri Adolescent Female Twin Study. A telephone adaptation of the Semi-Structured Assessment for the Genetics of Alcoholism interview assessed DSM-IV bulimic behaviors, substance use, and other psychological characteristics. Lifetime bulimic behaviors were examined in twin pairs concordant and discordant for early substance use. Logistic regressions were adjusted for the nonindependence of twin data, zygosity, age, body mass index, early menarche (onset before age 12), and early sex (first consensual sexual intercourse before age 15). In the entire study population, women who reported early use of alcohol or nicotine were more likely to engage in bulimic behaviors after adjusting for covariates. In 53 pairs of monozygotic twins discordant for alcohol experimentation before age 15, the twin who reported early alcohol experimentation had 3.21 (95% confidence interval = 1.54 to 6.67) times higher odds of reporting bulimic behaviors than the cotwin who did not report early alcohol experimentation, even after adjustment for covariates. Findings suggest that early alcohol experimentation may contribute to the development of bulimic behaviors via mechanisms extending beyond shared vulnerability, including individual-specific environmental experiences or causal pathways.

Suicidal ideation and suicide attempts among adults with psychotic experiences: data from the Collaborative Psychiatric Epidemiology Surveys.

Suicide is a leading cause of preventable death, especially among individuals with psychotic disorders, and may also be common among nonclinical populations of adults with subthreshold psychotic experiences. Understanding this association has the potential to critically bolster suicide prevention efforts. To examine the association between 12-month suicidality and 12-month psychotic experiences and to test the hypotheses that psychotic experiences are associated with increased prevalence of suicidal ideation and suicide attempts during the concurrent period and with greater severity of suicidal behavior. Cross-sectional survey data were drawn from a large general population-based sample of households in the United States identified through the Collaborative Psychiatric Epidemiology Surveys (2001-2003). Adult household residents (n = 11,716) were selected using a clustered multistage sampling design with oversampling of racial/ethnic minority groups. Logistic regression models were adjusted for potential demographic confounders and co-occurring DSM-IV mental health conditions. Twelve-month psychotic experiences assessed with the Composite International Diagnostic Interview, version 3.0 psychosis screen. Twelve-month suicidal ideation and suicide attempts. Respondents reporting psychotic experiences were more likely to report concurrent suicidal ideation (odds ratio [OR], 5.24; 95% CI, 2.85-9.62) and suicide attempts (OR, 9.48; 95% CI, 3.98-22.62). Most respondents with psychotic experiences (mean [SE], 65.2% [4.2%]) met criteria for a DSM-IV depressive, anxiety, or substance use disorder. Among respondents with suicidal ideation, those with psychotic experiences were likely to make an attempt during the concurrent 12-month period (OR, 3.49; 95% CI, 1.05-11.58) when adjusting for co-occurring psychiatric disorders. In contrast, depressive (OR, 1.67; 95% CI, 0.62-4.52), anxiety (OR, 1.57; 95% CI, 0.40-6.09), and substance use disorders (OR, 1.64; 95% CI, 0.24-11.17) did not reliably identify those at risk for attempts among respondents with suicidal ideation. The mean (SE) 12-month prevalence of suicide attempts among individuals reporting ideation and psychotic experiences and meeting criteria for any psychiatric disorder was 47.4% (10.9%) compared with 18.9% (4.8%) among those with just ideation and a disorder. Psychotic experiences were especially prevalent among individuals reporting severe attempts and may account for nearly one-third of attempts with intent to die (population attributable risk, 29.01%) in the United States annually. Assessment of psychotic experiences among individuals with suicidal ideation has potential clinical and public health utility in reducing the prevalence of suicide attempts, particularly attempts with intent to die.

A longitudinal examination of anxiety disorders and physical health conditions in a nationally representative sample of U.S. older adults

BackgroundThere has been growing interest in the relation between anxiety disorders and physical conditions in the general adult population. However, little is known about the nature of this association in older adults. Understanding the complex relationship between these disorders can help to inform prevention and treatment strategies unique to this rapidly growing segment of the population. MethodsA total of 10,409 U.S. adults aged 55+ participated in Wave 1 (2001–2002) and Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Lifetime and past-year DSM-IV anxiety, mood, and substance use disorders, and lifetime personality disorders, were assessed in both waves. Participants self-reported on whether they had been diagnosed by a healthcare professional with a broad range of physical health conditions; this study focuses on cardiovascular disease, gastrointestinal disease, and arthritis. Multivariable logistic regressions adjusted for sociodemographics, comorbid mental disorders, and number of physical health conditions assessed: (1) the relation between past-year physical conditions at Wave 1 and incident past-year anxiety disorders at Wave 2 and; (2) the relation between individual lifetime anxiety disorders at Wave 1 and incident physical conditions at Wave 2. A second set of adjusted multinomial logistic regressions examined Wave 1 sociodemographic and physical and mental health risk factors associated with incident physical condition alone, anxiety disorder alone, and comorbid anxiety and physical condition at Wave 2. ResultsPast-year arthritis at Wave 1 was significantly associated with increased odds of incident generalized anxiety disorder at Wave 2. Further, any lifetime anxiety disorder and posttraumatic stress disorder at Wave 1 were significantly associated with increased odds of incident gastrointestinal disease at Wave 2. Differential sociodemographic and physical and mental health predictors were significantly associated with increased odds of incident comorbid anxiety disorder and physical conditions. ConclusionResults of the current study elucidate the longitudinal bidirectional relationships between anxiety disorders and physical health conditions in a large, nationally representative sample of older adults. These results have important implications for identifying at risk older adults, which will not only impact this growing segment of the population directly, but will also potentially lessen burden on the healthcare system as a whole.