Munich-Composite International Diagnostic Interview Research Articles

Alcohol and Nicotine Dependence and Time to Death in a General Adult Population: A Mortality Cohort Study

Introduction: Findings from general population studies are lacking in regard to the co-occurrence of alcohol and nicotine dependence in relation to later mortality. The aim of this study was to analyze potential interactions of risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and time until the first cigarette is smoked in the morning after awakening in the prediction of mortality. Methods: This study analyzed a random sample of the general population in Northern Germany, which comprised adults aged 18–64 years. Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning after awakening were assessed for the period of 1996–1997 by applying the Munich-Composite International Diagnostic Interview. Data about all-cause mortality were gathered for the period of 2017–2018 and analyzed using Cox proportional hazards models. Results: Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning were associated with each other and predicted the time to death. Among participants with a former alcohol dependence, 29.59% had a current nicotine dependence. Participants who had ever been dependent on alcohol at some point in their life before and currently smoked their first cigarette in the morning within 30 min or less after awakening had a hazard ratio of 5.28 (95% confidence interval: 3.33–8.38) for early death compared to low-risk alcohol consumers who had never smoked. Conclusion: Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning may have a cumulative impact on time to death. The findings suggest that it could be beneficial to provide support for quitting both risky alcohol drinking and tobacco smoking among nondependent individuals in addition to supporting remission from dependence.

Behavior-related health risk factors, mental disorders and mortality after 20 years in a working aged general population sample

Mortality is predicted by the sum of behavior-related health risk factors (BRFs: tobacco smoking, alcohol drinking, body overweight, and physical inactivity). We analyzed degrees and combinations of BRFs in their relation to mortality and adjusted for mental disorders. In a random sample of the general population in northern Germany aged 18–64, BRFs and mental disorders had been assessed in 1996–1997 by the Munich Composite International Diagnostic Interview. A sum score including eight ranks of the behavior-related health risk factors was built. Death and its causes were ascertained 2017–2018 using residents’ registration files and death certificates. Relations of the sum score and combinations of the BRFs at baseline with all-cause, cancer, and cardiovascular mortality 20 years later were analyzed. The sum score and combinations predicted all-cause, cardiovascular and cancer mortality. The odds ratio of the sum score was 1.38 (95% confidence interval 1.31–1.46) after adjustment for age, gender, and mental disorder. In addition to the BRFs, mood, anxiety or somatoform disorders were not related to mortality. We concluded that the sum score and combinations of behavior-related health risk factors predicted mortality, even after adjustment for mental disorders.

Internet Use Disorders: Subjective Importance of Online Friends in the Context of Real-Life Social Support and Comorbid Mental Disorders

Introduction: Previous studies analyzing friendships with people only known through the Internet mainly focused on quantitative aspects (e.g., the number of online friends or the time spent with them). Little is known about the perceived quality of online compared to real-life friends in individuals with an Internet use disorder (IUD). This study aimed to analyze associations of the increased subjective importance of online friends and IUD by controlling for the perceived real-life social support and comorbid mental disorders. Methods: Based on a general population sample, 192 participants who were screened positive for risky Internet use took part in face-to-face clinical diagnostic interviews. IUD was assessed using the structure of the Munich-Composite International Diagnostic Interview (M-CIDI) and the adapted criteria of Internet gaming disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The number and the increased subjective importance of online compared to real-life friends were assessed with the Online and Real-Life Friends scale (ORLF), real-life social support was assessed with the Berlin Social Support Scales (BSSS), and comorbidity was assessed with the M-CIDI. Data were analyzed with binary regression models. Results: Of 192 participants with risky Internet use, 39 participants (19 men; age M = 29.9, SD = 12.2) fulfilled the criteria of IUD in the last 12 months. IUD was not associated with the number or perceived social support of online friends per se. In multivariate analyses, IUD was associated with increased subjective importance of online friends, independently from comorbid anxiety or mood disorders. However, when controlling for real-life social support, associations of IUD and increased subjective importance of online friends were no longer present. Conclusion: These findings highlight the necessity of therapeutic interventions aimed at strengthening social skills and engaging in real-life relationships in the prevention and therapy of IUD. Due to the small sample size and the cross-sectional analysis, however, further research is needed.

Severity of alcohol dependence and mortality after 20years in an adult general population sample.

ObjectivesTo estimate mortality on grounds of the severity of alcohol dependence which has been assessed by two approaches: the frequency of alcohol dependence symptoms (FADS) and the number of alcohol dependence criteria (NADC).MethodsA random sample of adult community residents in northern Germany at age 18 to 64 had been interviewed in 1996. Among 4075 study participants at baseline, for 4028 vital status was ascertained 20 years later. The FADS was assessed by the Severity of Alcohol Dependence Scale among the 780 study participants who had one or more symptoms of alcohol dependence or abuse and vital status information. The NADC was estimated by the Munich Composite International Diagnostic Interview among 4028 study participants with vital status information. Cox proportional hazard models were used.ResultsThe age‐adjusted hazard ratio for the FADS (value range: 0–79) was 1.02 (95% confidence interval, CI: 1.016–1.028), for the NADC (value range: 0–7) it was 1.25 (CI: 1.19–1.32).ConclusionsThe FADS and NADC predicted time to death in a dose‐dependent manner in this adult general population sample.

Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT

BackgroundMajor depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group.MethodsIn the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment.DiscussionTo our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment.Trial registrationIdentifier on clinicaltrials.gov: NCT03287362; September, 12, 2017

Parental emotional warmth interacts with traumatic life events in predicting the onset of obsessive-compulsive disorder

Adverse life events increase the risk of obsessive-compulsive disorder (OCD). Parental rearing may serve as a protective factor in the face of adversity. We investigated whether parental rearing moderates the association between adverse life events and the subsequent first onset of OCD. A representative sample of individuals (aged 14–24 years) was followed for over 10 years (N = 2210). OCD and any adverse life event, that is, any separation event or any traumatic life event, were assessed using the Munich-Composite International Diagnostic Interview. Parental rearing was assessed by self-report, using the Questionnaire of Recalled Parental Rearing Behavior. Both maternal (risk ratio, RR = 0.08, 95% confidence interval, CI [0.02, 0.31]) and paternal (RR = 0.16, 95% CI [0.03, 0.89]) emotional warmth moderated the association between any adverse life event and OCD. Maternal (RR = 0.16, 95% CI [0.03, 0.77]) and paternal (RR = 0.17, 95% CI [0.04, 0.78]) emotional warmth interacted specifically with any traumatic life event but not with any separation event in predicting OCD. We did not find any interactions with parental overprotection or rejection in predicting OCD. Parental emotional warmth may be a protective factor for OCD among individuals who experience traumatic life events. Future studies should evaluate whether interventions enhancing parental emotional warmth among those who experience traumatic life events can prevent OCD.

Suicidality in relation to depressive symptoms and psychological distress in adults aged 30 to 101 years in a population-based study in Finland

BackgroundScreening for suicidality has importance in terms of public health. We investigated which specific items of psychological distress best predicted suicidality in a population-based sample. MethodsA random sample of adults aged 30–101 years, being representative of the general population living in Finland, attended a health examination survey (Health 2011). We analyzed (n = 4373) the total scores on the General Health Questionnaire (GHQ-12) and the Beck Depression Inventory (BDI-13), as well as alcohol use, depressive and anxiety disorders as assessed with the Munich-Composite International Diagnostic Interview (M-CIDI) among the participants. We assigned the participants having suicidality on the basis of the self-harm item on the BDI-13, and analyzed which of the items of the GHQ-12 were significant predictors of suicidality. ResultsAfter adjusting for background variables, five items of the GHQ-12 remained as significant predictors for suicidality: items 11, 9, 4, 6, and 5 in this descending order. LimitationsThe definition of suicidality was based on only a single item of the BDI-13. ConclusionsCertain items of the GHQ-12 demonstrated strong associations with suicidality, and the GHQ-12 or a brief version of it might be used as a screening instrument for suicidality.

Prevalence, Onset, and Course of Suicidal Behavior Among Adolescents and Young Adults in Germany

Suicidal behavior is a leading cause of death among adolescents and young adults. In light of the ideation-to-action framework, the delineation of frequency and temporal characteristics of such behavior during this developmental period is crucial. To provide lifetime and 12-month prevalence estimates of suicidal behavior, including ideation, plan, and attempt, in adolescents and young adults of the general population, and to provide information about age at onset, temporal characteristics of suicidal behavior, including duration (number of years between onset and last occurrence) and frequency (number of episodes), and transition patterns across suicidal behaviors. A cross-sectional epidemiological study was conducted in a random community sample of 1180 adolescents and young adults aged 14 to 21 years assessed in 2015 to 2016 in Dresden, Germany. Data analysis was performed from October 2018 to March 2019. Lifetime and 12-month suicidal behavior (ideation, plan, and attempt) were assessed with a standardized diagnostic interview (Munich-Composite International Diagnostic Interview) by trained clinical interviewers. The onset, frequency, and duration of suicidal behavior were assessed by questionnaire. Of the 1180 participants (495 male [weighted percentage, 51.7%]; mean [SD] age, 17.9 [2.3] years), 130 participants (10.7%; 95% CI, 9.0%-12.8%), 65 participants (5.0%; 95% CI, 3.9%-6.5%), and 41 participants (3.4%; 95% CI, 2.4%-4.7%) reported lifetime suicidal ideation, plan, and attempt, respectively. Any lifetime suicidal behavior was reported by 138 participants (11.5%; 95% CI, 9.7%-13.7%). Age-specific cumulative incidence estimates indicated an increase in suicidal behavior during adolescence, starting at age 10 years (<1%), increasing slightly until the age of 12 years (2.2%), and then increasing sharply thereafter until age 20 years (13.5%). There were different patterns among female and male participants for ideation, plan, and attempt, with an overall higher incidence among female participants for ideation (hazard ratio, 1.51; 95% CI, 1.02-2.22; P = .04), for plan (hazard ratio, 3.31; 95% CI, 1.72-6.36; P < .001), and, among those older than 14 years, for attempt (hazard ratio, 3.07; 95% CI, 1.11-8.49; P = .03). Of those with suicidal ideation, 66.0% reported persistent or recurrent ideation over more than 1 year with 75.0% reporting more than 1 episode. Of the participants with lifetime suicidal ideation, 47.0% reported a suicide plan and 23.9% reported a suicide attempt. The transition to suicide plan or attempt occurred mainly in the year of onset of suicidal ideation or plan; of those who transitioned, 74.9% transitioned from ideation to plan, 71.2% transitioned from ideation to attempt, and 85.4% transitioned from plan to attempt in the same year. There is an urgent public health need for timely identification of suicidal behavior in adolescents and young adults to terminate persistent or recurrent suicidal tendencies and to interrupt the ideation-to-action transition.

Objectively measured sedentary time and mental and cognitive health: Cross-sectional and longitudinal associations in The Rotterdam Study

IntroductionBased on studies using self-reported sitting time, sedentary behavior has been suggested as a risk factor for poor mental health and cognition. However, it remains unclear whether objectively measured sedentary behavior is longitudinally associated with depression, anxiety disorders or cognition. MethodsIn the population-based Rotterdam Study, cross-sectional and longitudinal associations of objectively assessed sedentary time with depressive symptoms, anxiety disorders and cognition were assessed among 1841 participants (mean follow-up: 5.7 years). Participants wore a wrist actigraph for seven days between 2004 and 2007 to assess sedentary time (hours/day). Depression, anxiety disorders and cognition were assessed twice between 2004 and 2014. Depressive symptoms were continuously measured with the Centre for Epidemiologic Studies-Depression scale (CES-D) and a diagnoses of anxiety disorder (n = 147) was obtained by interview, using an adapted version of the Munich Composite International Diagnostic Interview (M-CIDI). Cognition was assessed using a test-battery. Linear regression was performed for all continuous outcomes, and logistic regression for all binary outcomes. ResultsIn analyses adjusted for age, sex, cohort and time awake only, 1 h/day more sedentary time was cross-sectionally associated with a 0.25 point (95% confidence interval (95%CI): 0.08, 0.41) higher CES-D score, 1.11 (95%CI: 1.01, 1.21) higher odds of anxiety disorder, and 0.03 (95%CI: 0.05, -0.01) lower global cognition score. After adjustment for confounders, these associations no longer remained. Sedentary time at baseline was not associated longitudinally with changes in depressive symptoms, anxiety disorders and cognition. ConclusionsNo support was found for an association between actigraphically measured sedentary time and mental health or cognition. All observed associations were explained by confounders, in particular, disability, occupational status and smoking. The previously reported association between sitting time and mental health might reflect residual confounding, bias of subjective measures, or the social context of sedentary behavior.

Specific traumatic events elevate the risk of a suicide attempt in a 10-year longitudinal community study on adolescents and young adults.

Traumatic events (TEs) have been associated with suicide attempts (SAs). However, the empirical status of some TEs is inconclusive. This also concerns community adolescents and young adults, known to be a high-risk group for SAs. We examined associations between (a) a range of prior TEs (physical attack, rape/sexual abuse, serious accident, and witnessing somebody else experiencing a TE) and a subsequent SA, and (b) the number of prior TEs and an SA, and (c) we estimated attributable proportions of SAs, in relation to each TE. Over a 10-year period, the Early Developmental Stages of Psychopathology (EDSP) study prospectively assessed community members, aged 14-24years at baseline. Starting with 3021 subjects, each individual was assessed up to four times. Assessment was based on the Munich-Composite International Diagnostic Interview. Temporal associations were estimated using the Cox model with time-dependent covariates. Attributable proportions were based on the results of the Cox models. All four TEs elevated the risk for a subsequent SA, adjusting for confounders. Highest risk was found for the combined TE rape/sexual abuse. Results showed that 56-90% of SAs could be attributed to TEs in the exposed group; on the population level, attributable proportions ranged between 6.9% and 23.5%. Different TEs have been shown to elevate the risk of an SA in a young community sample. Our results suggest that both health professionals and health policy decision-makers consider specific TEs and the number of prior TEs as risk factors for SAs.

Assignment of Alcoholic Beverages in the Munich Composite International Diagnostic Interview (M-CIDI): an Online Survey Among German Students and Non-students

The objective of this study is to investigate whether the materials presented during alcohol consumption assessment sufficiently aid interviewees in categorizing the beverages they consumed during their lifetime. In the cross-sectional “AF-CIDI” online survey, N = 162 adult drinkers (61% female, 40% non-students) aged 27 ± 8.2 years assigned beverages names to one of ten categories of the Munich Composite International Diagnostic Interview (M-CIDI) supplementary list. Eighty percent of these 4465 laymen beverage assignments were correctly classified in accordance with expert assignments. Assignment correctness was associated with confidence, and, to a smaller degree, exposure, prevalence, utility of examples, and age group. Alcohol by volume (ABV) estimates based on subjective classifications differed 2.7 points on average from CIDI-based ABVs, which in turn differed 3.6 points on average from real ABVs measured with Fourier transform infrared spectroscopy. Beverages with low lifetime prevalences (≤ 25%) were frequently misclassified. This understudied response bias might be part of the well-known underreporting phenomenon.

Changes in prevalence and correlates of alcohol-use disorders in Finland in an 11-year follow-up

Aims: This study aimed to examine changes in prevalence and correlates of alcohol-use disorders (AUD) between 2000 and 2011. We also explored the impact of using multiple imputation on prevalence estimates, to address survey nonresponse.Methods: The study used a Finnish nationally representative survey of adults aged 30 years and older in 2000 and in 2011. The Munich Composite International Diagnostic Interview (M-CIDI) was used to diagnose AUD in 6005 persons in 2000 (response rate 75%) and 4381 in 2011 (response rate 55%). Multiple imputation using sociodemographic, health, and registry-linked data on mental health hospitalizations was compared with weights to account for nonresponse.Results: Prevalence of 12-month AUD in Finland decreased from 4.6% (95% CI 4.0–5.1) in 2000 to 2.0% in 2011 (95% CI 1.6–2.4). Lifetime AUD prevalence decreased from 10.8% (95% CI 9.9–11.6) to 7.5% (CI 95% 6.8–8.3) from 2000 to 2011. The reduction was observed for people aged 30–64 years. At both time points, AUD prevalence was higher among individuals aged 30–64, men and those unmarried, widowed or divorced. The observed prevalence changes can be partly attributed to reporting and selection bias. The latter was addressed by multiple imputation.Conclusions: Alcohol use disorders appear to have decreased in Finland from 2000 to 2011, especially for the 30–64 years age group. Males, younger adults and those unmarried, widowed or divorced had a higher risk of AUD.

Interplay between RGS2 and childhood adversities in predicting anxiety and depressive disorders: Findings from a general population sample

It remains unresolved whether childhood adversities interact with genetic variation in regulator of G-protein signaling 2 (RGS2) rs4606 in predicting various anxiety and depressive disorders and whether diagnostic specificity exists in these interactions. The genotype of RGS2 rs4606 was determined for N=2,263 adults with European ancestry from the Study of Health in Pomerania. Lifetime anxiety and depressive disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were assessed with the Munich Composite International Diagnostic Interview (DIA-X/M-CIDI). Childhood adversities were assessed with the Childhood Trauma Questionnaire (CTQ, when participants were aged 29-89). Logistic regressions adjusted for sex and age revealed that rs4606 interacted with total childhood adversity in predicting each diagnostic outcome except for panic disorder and generalized anxiety disorder, uncorrected and corrected for multiple testing (odds ratio [OR]=1.06-1.16). That is, carriers of the GG (vs. CC/CG) genotype were at decreased risk for anxiety and/or depression in the presence of low, but at increased risk in the presence of high total childhood adversity. Respective gene-environment (G×E) interactions were found for (a) comorbid anxiety and depressive disorders (OR=1.13), but neither pure anxiety nor pure depressive disorders and (b) pure/temporally primary anxiety disorders (OR=1.07), but not pure/temporally primary depressive disorders. The G×E interaction remained associated with depressive disorders after introducing pure/temporally primary anxiety disorders as additional predictor (OR=1.09). rs4606 alters the risk of developing a range of anxiety but also depressive disorders after childhood adversities. A complex risk pattern of genotype, environmental factors, and preexisting anxiety contributes to subsequent depression development.

Prevalence and correlates of ICD-11 adjustment disorder: Findings from the Zurich Adjustment Disorder Study

Background/Objective: The 11th revision of the International Classification of Diseases (ICD-11) will provide a new definition of adjustment disorder (AjD). The aim of the present study is to report on prevalence and correlates of ICD-11 AjD in a high-risk sample. Method: Three hundred thirty persons who had lost their job involuntarily were sampled by local job centres. The Munich Composite International Diagnostic Interview was administered with a new AjD module. Associations between AjD and correlates were investigated with logistic regression analyses. Results: 27.3% of the participants reported the AjD core symptom pattern. 13.8% men and 17.2% women met diagnostic guidelines of ICD-11 AjD. Prevalence increased with age and exposure to multiple stressors. The AjD core symptom pattern was associated with various sociodemographic correlates (e. g., lower financial household budget), whereas the full ICD-11 diagnosis including the exclusion algorithm was not. Regarding work-related factors, AjD occurred with a lower probability if the last job position had higher responsibilities and more general confidence for the future. Conclusions: ICD-11 AjD has a high prevalence among persons who lost their jobs involuntarily. Healthcare professionals should be aware of this problem. Research to investigate the ICD-11 AjD concept in the general populations and other subpopulations is needed.

Assessment of subjective emotional valence and long-lasting impact of life events: development and psychometrics of the Stralsund Life Event List (SEL)

BackgroundLife events (LEs) are associated with future physical and mental health. They are crucial for understanding the pathways to mental disorders as well as the interactions with biological parameters. However, deeper insight is needed into the complex interplay between the type of LE, its subjective evaluation and accompanying factors such as social support. The “Stralsund Life Event List” (SEL) was developed to facilitate this research.MethodsThe SEL is a standardized interview that assesses the time of occurrence and frequency of 81 LEs, their subjective emotional valence, the perceived social support during the LE experience and the impact of past LEs on present life. Data from 2265 subjects from the general population-based cohort study “Study of Health in Pomerania” (SHIP) were analysed. Based on the mean emotional valence ratings of the whole sample, LEs were categorized as “positive” or “negative”. For verification, the SEL was related to lifetime major depressive disorder (MDD; Munich Composite International Diagnostic Interview), childhood trauma (Childhood Trauma Questionnaire), resilience (Resilience Scale) and subjective health (SF-12 Health Survey).ResultsThe report of lifetime MDD was associated with more negative emotional valence ratings of negative LEs (OR = 2.96, p < 0.0001). Negative LEs (b = 0.071, p < 0.0001, β = 0.25) and more negative emotional valence ratings of positive LEs (b = 3.74, p < 0.0001, β = 0.11) were positively associated with childhood trauma. In contrast, more positive emotional valence ratings of positive LEs were associated with higher resilience (b = − 7.05, p < 0.0001, β = 0.13), and a lower present impact of past negative LEs was associated with better subjective health (b = 2.79, p = 0.001, β = 0.05). The internal consistency of the generated scores varied considerably, but the mean value was acceptable (averaged Cronbach’s alpha > 0.75).ConclusionsThe SEL is a valid instrument that enables the analysis of the number and frequency of LEs, their emotional valence, perceived social support and current impact on life on a global score and on an individual item level. Thus, we can recommend its use in research settings that require the assessment and analysis of the relationship between the occurrence and subjective evaluation of LEs as well as the complex balance between distressing and stabilizing life experiences.

Interplay between COMT Val158Met, childhood adversities and sex in predicting panic pathology: Findings from a general population sample

BackgroundThe single nucleotide polymorphism rs4680 of the catechol-O-methyltransferase (COMT) gene has been implicated to be involved in the etiopathogenesis of panic. However, it remains unresolved whether rs4680 modifies the risk-association between early life stress and subsequent development of panic pathology. MethodsThe genotype of rs4680 was determined for n = 2242 adults with European ancestry from the Study of Health in Pomerania (SHIP, a regional longitudinal cohort study from northeastern Germany). Lifetime fearful spells, panic attacks and panic disorder were assessed according to DSM-IV in 2007–2010 (when participants were aged 29–89) using the Munich Composite International Diagnostic Interview (DIA-X/M-CIDI). Childhood adversities were assessed with the Childhood Trauma Questionnaire (CTQ). ResultsLogistic regressions with interaction terms (adjusted for sex and age) revealed that rs4680 interacted with total childhood adversity, emotional abuse and physical abuse in predicting panic disorder: Respective childhood adversities predicted panic disorder in carriers of the Val/Met or Met/Met genotype, but not Val/Val genotype. Moreover, a 3-way interaction was found between rs4680, emotional abuse and sex in predicting panic attacks: Emotional abuse predicted panic attacks among male carriers of the Val/Val genotype and female carriers of the Val/Met or Met/Met genotype, but not among male carriers of the Val/Met or Met/Met genotype or female carriers of the Val/Val genotype. LimitationsGenotype data were derived by imputation. Childhood adversities and panic were assessed retrospectively. ConclusionsEspecially (female) carriers of the Val/Met or Met/Met genotype of rs4680 might profit from targeted early interventions to prevent the onset of panic after childhood adversities.

Obsessive-compulsive disorder and the risk of subsequent mental disorders: A community study of adolescents and young adults.

Comorbidity of obsessive-compulsive disorder (OCD) with other mental disorders has been demonstrated repeatedly. Few longitudinal studies, however, have evaluated the temporal association of prior OCD and subsequent mental disorders across the age period of highest risk for first onset of mental disorders. We examined associations between prior OCD and a broad range of subsequent mental disorders and simulated proportions of new onsets of mental disorders that could potentially be attributed to prior OCD, assuming a causal relationship. Data from 3,021 14- to 24-year-old community subjects were prospectively collected for up to 10 years. DSM-IV OCD and other DSM-IV mental disorders were assessed with the Munich-Composite International Diagnostic Interview. We used adjusted time-dependent proportional hazard models to estimate the temporal associations of prior OCD with subsequent mental disorders. Prior OCD was associated with an increased risk of bipolar disorders (BIP; [hazard ratio, HR=6.9, 95% confidence interval, CI, (2.8,17.3)], bulimia nervosa [HR=6.8 (1.3,36.6)], dysthymia [HR=4.4 (2.1,9.0)], generalized anxiety disorder (GAD; [HR=3.4 (1.1,10.9)], and social phobia [HR=2.9 (1.1,7.7)]). Of these outcome disorders, between 65 and 85% could be attributed to OCD in the exposed group, whereas between 1.5 and 7.7% could be attributed to OCD in the total sample. This study provides strong evidence that prior OCD is associated with an increased risk of subsequent onset of BIP, bulimia nervosa, dysthymia, GAD, and social phobia among adolescents and young adults. Future studies should evaluate if early treatment of OCD can prevent the onset of these subsequent mental disorders.

The Cannabis Abuse Screening Test and the DSM-5 in the general population: Optimal thresholds and underlying common structure using multiple factor analysis.

The Cannabis Abuse Screening Test (CAST) aims at screening the problematic use of cannabis. It has never been validated against the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and its relationships with this latter have never been studied. We used a probabilistic telephone survey collected in 2014 (1351 past-year cannabis users aged 15-64) implementing the CAST and a DSM-5 adaptation of the Munich Composite International Diagnostic Interview assessing cannabis use disorders. Data were weighted, and CAST items were considered categorical. Factorial structures were assessed with confirmatory factor analyses; the relationships between the instruments were studied with multiple factor analysis (MFA). One factor for the DSM-5 and two correlated factors for the CAST were the best confirmatory factor analyses solutions. The CAST thresholds for screening moderate/severe and severe cannabis use disorders were 5 (sensitivity=78.2% and specificity=79.6%) and 8 (sensitivity=86.0% and specificity=86.7%), respectively. The MFA identified two orthogonal dimensions: The first was equally shared by both instruments; the second was the second CAST dimension (extreme frequencies of use before midday and alone, memory problems, and reproaches from friends/family). The CAST structure and screening properties were confirmed. The MFA explains its screening performances by its first dimension and identified the problematic patterns (the second dimension) that are not captured by the DSM-5.

Mental disorders and the risk for the subsequent first suicide attempt: results of a community study on adolescents and young adults

Adolescents and young adults represent the high-risk group for first onset of both DSM-IV mental disorders and lifetime suicide attempt (SA). Yet few studies have evaluated the temporal association of prior mental disorders and subsequent first SA in a young community sample. We examined (a) such associations using a broad range of specific DSM-IV mental disorders, (b) the risk of experiencing the outcome due to prior comorbidity, and (c) the proportion of SAs that could be attributed to prior disorders. During a 10-year prospective study, data were gathered from 3021 community subjects, 14–24 years of age at baseline. DSM-IV disorders and SA were assessed with the Munich-Composite International Diagnostic Interview. Cox models with time-dependent covariates were used to estimate the temporal associations of prior mental disorders with subsequent first SA. Most prior mental disorders showed elevated risk for subsequent first SA. Highest risks were associated with posttraumatic stress disorder (PTSD), dysthymia, and nicotine dependence. Comorbidity elevated the risk for subsequent first SA, and the more disorders a subject had, the higher the risk for first SA. More than 90% of SAs in the exposed group could be attributed to PTSD, and over 30% of SAs in the total sample could be attributed to specific phobia. Several DSM-IV disorders increase the risk for first SA in adolescents and young adults. Several promising early intervention targets were observed, e.g., specific phobia, nicotine dependence, dysthymia, and whether a young person is burdened with comorbid mental disorders.

Assessing the interplay of childhood adversities with more recent stressful life events and conditions in predicting panic pathology among adults from the general population

BackgroundAlthough research suggests that (a) childhood adversities and more recent stressful life events/conditions are risk factors for panic pathology and that (b) early life stress increases vulnerability to later psychopathology, it remains unclear whether childhood adversities amplify the association between more recent stressful life events/conditions and panic pathology. MethodsData were derived from a general population sample (Study of Health in Pomerania, SHIP). Lifetime panic pathology was assessed with the Munich Composite International Diagnostic Interview (M-CIDI). Childhood adversities (emotional, physical and sexual abuse; emotional and physical neglect) were assessed with the Childhood Trauma Questionnaire (CTQ). More recent separation/loss events and long-lasting stressful conditions were assessed with the Stralsund Life Event List (SEL). Individuals with lifetime panic pathology (fearful spell, panic attack or panic disorder, N = 286) were compared to controls without any psychopathology (N = 286, matched for sex and age). ResultsConditional logistic regressions revealed that childhood adversities as well as more recent separation/loss events and long-lasting stressful conditions were associated with panic pathology (OR 1.1–2.5). Moreover, more recent separation/loss events - but not long-lasting stressful conditions - interacted statistically with each of the examined childhood adversities except for sexual abuse in predicting panic pathology (OR 1.1–1.3). That is, separation/loss events were associated more strongly with panic pathology among individuals with higher childhood adversities. LimitationsData were assessed retrospectively and might be subject to recall biases. ConclusionsFindings suggest that early childhood adversities amplify the risk of developing panic pathology after experiencing separation or loss events.