Epidemiologic Study Of Young Adults Research Articles

A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection

Background: We examine whether traumatic events increase the risk for major depression independent of their effects on posttraumatic stress disorder (PTSD). Methods: Data come from the Epidemiologic Study of Young Adults in southeast Michigan ( N = 1007). Retrospective and prospective data were used to estimate the risk of major depression in persons with PTSD and persons exposed to trauma with no PTSD, compared with persons who did not experience a trauma. National Comorbidity Survey data were used to evaluate the influence of trauma type. Results: In the retrospective lifetime data, hazard ratios were, for first-onset major depression in exposed persons with PTSD, 2.8 and, in exposed persons with no PTSD, 1.3 (not significant), as compared with persons who were not exposed. Corresponding estimates from the prospective data were 11.7 and 1.4 (not significant). The difference in the risk for depression associated with PTSD versus exposure without PTSD is unlikely to be due to differences in trauma type. Conclusions: The findings of a markedly increased risk for major depression in persons with PTSD, but not in exposed persons without PTSD, do not support the hypothesis that PTSD and major depression in trauma victims are influenced by separate vulnerabilities.

Predicting smoking cessation and major depression in nicotine-dependent smokers.

This study examined the relationship of nicotine dependence with smoking cessation and major depression, using the Fagerstrom Test for Nicotine Dependence (FTND) and the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R). In an epidemiologic study of young adults that used the FTND and the National Institute of Mental Health Diagnostic Interview Schedule, 238 daily smokers were assessed with respect to nicotine dependence. Cessation (abstinence for 1 year or more) was assessed 2 years later. FTND-defined nicotine dependence predicted cessation, with non-dependent smokers 4 times more likely to quit. DSM-III-R-defined nicotine dependence also predicted cessation, but much more weakly. Number of cigarettes per day was the best predictor of cessation. FTND-defined dependence was unrelated to major depression, whereas DSM-III-R-defined dependence signaled a 3-fold risk for major depression. The association of DSM-III-R-defined nicotine dependence with major depression might be driven by the behavioral rather than the physiologic symptoms of dependence. The more a measure of dependence is based exclusively on level of daily smoking, the greater is its ability to predict cessation. The number of DSM-III-R behavioral symptoms might be an indicator of severity of dependence or of personality traits, which in turn might be associated with major depression.

219. A second look at comorbidity in victims of trauma: the PTSD—major depression connection

A high rate of comorbid major depression has been reported in persons with Posttraumatic Stress Disorder (PTSD). The reasons for this comorbidity are unclear. Data come from an epidemiologic study of young adults in southeast Michigan (N = 1,007). Lifetime data gathered at baseline were used to estimate hazard ratios of first onset major depression in persons with PTSD and persons exposed to trauma with no PTSD, using Cox proportional hazards models with time-dependent covariates. Prospective data were used to estimate these hazard ratios during a 5-year follow-up interval. Data from the National Comorbidity Survey (NCS) were used to estimate hazard ratios for major depression associated with PTSD and exposure only with no PTSD, stratified by trauma type. In the lifetime data, hazard ratio for first onset major depression in exposed persons with PTSD was 3.8 and in exposed persons with no PTSD, 1.6 (not significant). Corresponding estimates from the prospective data were 12.2 vs 1.6, respectively. Results from the NCS indicate that the difference in the risk for depression associated with PTSD vs exposure only is unlikely to be due to differences in trauma type. The findings of a markedly increased risk for major depression in exposed persons with PTSD, but not in exposed persons who did not develop PTSD, support the hypothesis that PTSD and major depression in trauma victims are influenced by common vulnerabilities, rather than separate and distinct.

40. Smoking and panic disorder: an epidemiologic investigation

Epidemiologic studies have reported a lifetime association between smoking and panic disorder. In this study we examine potential explanations for this association. Analysis was conducted on data from two epidemiologic studies, the Epidemiologic Study of Young Adults in southeast Michigan (N = 1,007) and the National Comorbidity Survey, Tobacco Supplement (public use data) (n = 4,411). Cox proportional hazards models with time-dependent covariates were used to estimate the risk for onset of panic disorder associated with prior daily smoking and vice versa, controlling for history of major depression. The role of lung disease in the smoking—panic association was explored. Parallel analyses of the two epidemiologic data sets revealed that daily smoking signaled an increased risk for first occurrence of panic attack and disorder; the risk was higher in active smokers than in past smokers. These relationships held in both males and females with no evidence of sex interactions. No significant risk was detected for onset of daily smoking in persons with prior panic attack or disorder. Exploratory analyses suggest that lung disease might be one of the mechanisms linking smoking to panic attacks. The evidence that the association between smoking and panic disorder might result primarily from an influence in one direction, i.e., from prior smoking to first panic attack, and the possibility of a higher risk in active than in past smokers suggest a causal hypothesis for the smoking—panic relationship.

Investigations of causal pathways between ptsd and drug use disorders

Although numerous studies have demonstrated an association between PTSD and substance use disorders, little is known about the causal nature of this relationship. In this article, we put forth and test major causal hypotheses. Specific hypotheses to be tested include self-medication of PTSD symptoms, substance users’ high risk of exposure to traumatic events, and drug users’ increased susceptibility to PTSD following a traumatic exposure. We also examine the possibility of an indirect pathway linking drug use disorders and PTSD via a shared vulnerability. Evidence for these causal hypotheses is evaluated using Hill’s criteria for causal inference: strength, consistency, specificity, temporality, gradient, plausibility, coherence, experimental evidence, and analogy. We present data analytic strategies that exploit information about the temporal order of PTSD and drug use disorders to shed light on their causal relationship. Finally, we present findings on the PTSD/drug use disorder association from an epidemiologic study of young adults.

Neurotoxicity in young adults 20 years after childhood exposure to lead: the Bunker Hill experience.

OBJECTIVES: An epidemiological study of young adults was conducted to determine whether environmental exposure to lead during childhood was associated with current adverse neurobehavioural effects. METHODS: The exposed group consisted...

Daytime sleepiness: an epidemiological study of young adults.

Although excessive daytime sleepiness is associated with increased risks for accidents, decreased productivity, and interpersonal difficulties, information on its epidemiology is scarce. This paper examines correlates of and suspected risk factors for daytime sleepiness from a longitudinal epidemiological study of young adults. The sample consisted of 1007 randomly selected young adults from a large health maintenance organization in southeast Michigan. Data were gathered in personal interviews conducted with 97% of the sample 5.5 years after baseline. Information on sleep characteristics in the last 2 weeks, including daytime sleepiness, nocturnal sleep onset, snoring, and hours of sleep, was collected on a self-administered instrument. Psychiatric disorders were measured by the National Institute of Mental Health's Diagnostic Interview Schedule. The average length of nocturnal sleep on weekdays was 6.7 hours. Daytime sleepiness was inversely related to hours of sleep and positively related to the ease of falling asleep at night; it varied significantly by employment and marital status. Snoring was associated with increased daytime sleepiness, as was recent major depression. Factors that might increase daytime sleepiness among young adults include social factors (being single and being employed full time) and pathological conditions (frequent snoring and major depression).

Violence and psychiatric disorders: results from an epidemiological study of young adults in Israel.

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.

Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young Adults

In a longitudinal epidemiological study of young adults, we estimated the association between sleep disturbance and psychiatric disorders, cross-sectionally and prospectively. A random sample of 1200 was drawn from all 21-30-year-old members of a large health maintenance organization (HMO) in Michigan; 1007 were interviewed in 1989 and 979 were reinterviewed in 1992. Lifetime prevalence of insomnia alone was 16.6%, of hypersomnia alone, 8.2%, and of insomnia plus hypersomnia, 8%. The gender-adjusted relative risk for new onset of major depression during the follow-up period in persons with history of insomnia at baseline was 4.0 (95% confidence interval [CI] 2.2-7.0) and in persons with baseline history of hypersomnia, 2.9 (95% CI 1.5-5.6). When history of other prior depressive symptoms (e.g., psychomotor retardation or agitation, suicidal ideation) was controlled for, prior insomnia remained a significant predictor of subsequent major depression. Complaints of 2 weeks or more of insomnia nearly every night might be a useful marker of subsequent onset of major depression.

Sex differences in depression: a role for preexisting anxiety

The role of anxiety disorders in the development of sex differences in major depression is analyzed. Data come from a longitudinal epidemiologic study of young adults in the Detroit, Michigan area. The Diagnostic Interview Schedule, revised according to DSM-III-R, was used at baseline to measure lifetime psychiatric disorders and at follow-up to measure psychiatric disorders during the 3.5-year interval since baseline assessment. Consistent with previous reports, the lifetime prevalence of major depression was nearly two-fold higher in females than in males. The sex difference was primarily in major depression comorbid with anxiety disorders. Results from Cox-proportional hazards models, with time-dependent covariates, showed that prior anxiety disorder increased the risk for subsequent major depression in both sexes, with no evidence of an interaction. History of anxiety disorder, including number of prior anxiety disorders, accounted for a considerable part of the observed sex difference in major depression. Controlling for prior anxiety reduced by more than 50% the coefficient that estimates the association between gender and major depression. The results suggest that the higher occurrence of anxiety disorders in females than males beginning early in life might explain in large part the higher female risk for major depression. They emphasize the need for further research on sex differences in anxiety disorders.

Migraine, psychiatric disorders, and suicide attempts: An epidemiologic study of young adults

To determine the prevalence of migraine and the risks for psychiatric disorders and suicide attempts associated with it, we studied a random sample of 1,007 young adults from a large Health Maintenance Organization in the Detroit, MI area. The lifetime prevalence of migraine was 7% in males and 16.3% in females. The rate of migraine was higher in persons with lower education and was equal in whites and blacks. Persons with migraine were at increased risk for affective and anxiety disorders, nicotine dependence, and alcohol or illicit drug abuse or dependence. There was a consistent trend toward higher psychiatric comorbidity in migraine with aura than in migraine without aura. Coexisting anxiety, which generally preceded migraine, was associated with a marked increase in the odds of major depression. Persons with migraine had higher rates of suicide attempts than persons without migraine. The odds ratio for suicide attempts, adjusted for coexisting major depression and other psychiatric and substance use disorders, in migraine with aura was 3.0 (95% confidence interval, 1.4–6.6). The coexistence of migraine with major depression, anxiety disorders, and suicide attempts has important clinical and research implications.