National Comorbidity Survey Replication Study Research Articles

Culture-centered approaches: the relevance of assessing emotional health for Latinos with type 2 diabetes

ObjectiveWithin Latino culture, there is a belief that strong emotions can cause diabetes. Because of this belief and evidence regarding the bi-directional relationship between depression and diabetes, the objectives of...

Distal and Proximal Religiosity as Protective Factors for Adolescent and Emerging Adult Alcohol Use.

Data from emerging adults (ages 18–29, N = 900) in the National Comorbidity Survey Replication Study was used to examine the influence of childhood and emerging adult religiosity and religious-based decision-making, and childhood adversity, on alcohol use. Childhood religiosity was protective against early alcohol use and progression to later abuse or dependence, but did not significantly offset the influence of childhood adversity on early patterns of heavy drinking in adjusted logistic regression models. Religiosity in emerging adulthood was negatively associated with alcohol use disorders. Protective associations for religiosity varied by gender, ethnicity and childhood adversity histories. Higher religiosity may be protective against early onset alcohol use and later development of alcohol problems, thus, should be considered in prevention programming for youth, particularly in faith-based settings. Mental health providers should allow for integration of clients’ religiosity and spirituality beliefs and practices in treatment settings if clients indicate such interest.

Patterns and Predictors of Antipsychotic usage among U.S. Adults: A National Co-Morbidity Survey Replication Study

The primary objective was to study patterns of antipsychotic usage among adults with mental health disorders in the U.S. using a national survey. The secondary objective was to examine patient and provider factors associated with antipsychotic usage. Data from the National Co-Morbidity Survey Replication study (NCS-R) of 2001-2003 was used to examine the prevalence of antipsychotic use among adults 18 years or older. Patient-reported adherence and effectiveness were reported. Multiple logistic regression analysis was used to determine the statistically significant determinants of antipsychotic use. Antipsychotic medications were used by 99 of 9282 (1.06%) NCS-R participants in the previous year. Among antipsychotic users, 42 (42.4%) used typical agents and 57 (57.6%) used atypical agents. Males over 65 (compared to age 18-45), non-white race, prescription by a psychiatrist, and presence of mood disorders were statistically significant predictors of increased antipsychotic use among patients with mental disorders, in the adjusted model. Mean adherence among typical users (17.78 ± 1.53 days) was less than atypical users (24.04 ± 0.82 days). No statistically significant difference in perceived effectiveness was found. In conclusion, these analysis shows that approximately 1% of Americans used antipsychotics within the past year, mostly using atypical over typical agents. Male, over 65, non-white race, prescription by a psychiatrist, and presence of mood disorders were the significant predictors of antipsychotic use.

Substance use disorders increase the odds of subsequent mood disorders

BackgroundThere is a well-known association between mood disorders and substance use disorders (SUD), but little research has been conducted on SUDs as risk factors for the development of subsequent mood disorders. MethodsWe analyzed data from the National Comorbidity Survey Replication study. Diagnoses were determined using DSM-IV criteria. Odds ratios (aORs) of subsequently developing mood disorders were adjusted for age, sex and race/ethnicity. ResultsData from 5217 individuals were included (6.6% male; mean age 45.3 years; 72.6% White, 11.2% Black, 12.5% Hispanic and 3.7% other). Subsequent mood disorders developed in 26.4% of individuals with primary adolescent-onset SUD (12–17 years), 21.7% of those with SUD onset at 18–25 years, and 14.0% of those with SUD onset between the ages of 26 and 34 years. The mean lagtime between SUD onset and development of a mood disorder was about 11 years. Controlling for demographic variables, the aORs of developing a mood disorder in these three age groups were 2.44, 3.65, and 3.25. Substance dependence was associated with higher odds of mood disorders than was abuse. Among the specific mood disorders, the increased odds of developing bipolar disorder were particularly high among individuals with drug dependence. ConclusionsIndividuals with adolescent and young adult-onset SUD had increased odds of developing a secondary mood disorder. This indicates that adolescents and young adults with SUD should be closely monitored for both positive and negative mood symptoms. SUD treatment and aftercare offer opportunities for the early identification of secondary mood disorders.

Risk factors for secondary substance use disorders in people with childhood and adolescent-onset bipolar disorder: Opportunities for prevention

BackgroundCompared to other mental illnesses, bipolar disorder is associated with a disproportionately high rate of substance use disorders (SUDs), and the co-occurrence is associated with significant morbidity and mortality. Early diagnosis of primary bipolar disorder may provide opportunities for SUD prevention, but little is known about the risk factors for secondary SUD among individuals with bipolar disorder. The purposes of this study were to describe the population of people with childhood and adolescent-onset primary bipolar disorder, and to identify risk factors for secondary SUD in this population. MethodsUsing data collected from the National Comorbidity Survey Replication study, we identified 158 individuals with childhood-onset (<13years) or adolescent-onset (13–18years) primary bipolar disorder (I, II or subthreshold). Survival analysis was used to identify risk factors for SUD. ResultsCompared to adolescent-onset, people with childhood-onset bipolar disorder had increased likelihoods of attention deficit hyperactivity disorder (ADHD) (adjusted odds ratio=2.81) and suicide attempt (aOR=3.61). Males were more likely than females to develop SUD, and did so at a faster rate. Hazard ratios of risk factors for SUD were: lifetime oppositional defiant disorder (2.048), any lifetime anxiety disorder (3.077), adolescent-onset bipolar disorder (1.653), and suicide attempt (15.424). SUD was not predicted by bipolar disorder type, family history of bipolar disorder, hospitalization for a mood episode, ADHD or conduct disorder. ConclusionsAs clinicians struggle to help individuals with bipolar disorder, this study provides information that might be useful in identifying individuals at higher risk for SUD. Future research can examine whether targeting these risk factors may help prevent secondary SUD.

Exposure to Interpersonal Violence and Its Associations With Psychiatric Morbidity in a U.S. National Sample: A Gender Comparison.

We examine gender differences in population rates of various types of interpersonal violence in a U.S. national sample and investigate gender as a moderator of the associations between interpersonal violence and lifetime mental disorders and suicide attempts. Data were drawn from the National Comorbidity Survey-Replication study; 5,692 women and men completed interviews assessing lifetime exposure to nine types of interpersonal violence, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) mental health diagnoses, and suicide attempts. Approximately 46% of women and 42% of men reported one or more types of interpersonal violence. Women were more likely to experience kidnapping, physical assault by an intimate partner, rape, sexual assault, and stalking, whereas men were more likely to experience mugging or physical assault by someone other than parents or an intimate partner. Interpersonal violence was associated with risk for many mental disorders and attempted suicide. Although women were at higher risk for several forms of interpersonal violence, the impact of interpersonal violence on mental health outcomes did not vary by gender. It is clearly important to identify and provide mental health treatment to women after interpersonal violence exposure. Findings also underscore the need for prevention and intervention efforts for women and men, including routine screening for interpersonal violence by health care providers and appropriate treatment to address mental health conditions.

Psychopathology before surgery in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) Psychosocial Study

BackgroundCurrent and previous psychopathology in bariatric surgery candidates is believed to be common. Accurate prevalence estimates, however, are difficult to obtain given that bariatric surgery candidates often wish to appear psychiatrically healthy when undergoing psychiatric evaluation for approval for surgery. Also, structured diagnostic assessments have been infrequently used. MethodsThe present report concerned 199 patients enrolled in the Longitudinal Assessment of Bariatric Surgery study, who also participated in the Longitudinal Assessment of Bariatric Surgery-3 psychopathology substudy. The setting was 3 university hospitals, 1 private not-for-profit research institute, and 1 community hospital. All the patients were interviewed independently of the usual preoperative psychosocial evaluation process. The patients were explicitly informed that the data would not be shared with the surgical team unless certain high-risk behaviors, such as suicidality, that could lead to adverse perioperative outcomes were reported. ResultsMost of the patients were women (82.9%) and white (nonwhite 7.6%, Hispanic 5.0%). The median age was 46.0 years, and the median body mass index was 44.9 kg/m2. Of the 199 patients, 33.7% had ≥1 current Axis I disorder, and 68.8% had ≥1 lifetime Axis I disorder. Also, 38.7% had a lifetime history of a major depressive disorder, and 33.2% had a lifetime diagnosis of alcohol abuse or dependence. All these rates were much greater than the population-based prevalence rates obtained for this age group in the National Comorbidity Survey–Replication Study. Also, 13.1% had a lifetime diagnosis and 10.1% had a current diagnosis of a binge eating disorder. ConclusionThe current and lifetime rates of psychopathology are high in bariatric surgery candidates, and the lifetime rates of affective disorder and alcohol use disorders are particularly prominent. Finally, binge eating disorder is present in approximately 1 in 10 bariatric surgery candidates.

Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study.

The comorbidity of posttraumatic stress disorder (PTSD) and eating disorders (EDs) is high among women but has been understudied in men. Little is known about the association between partial or subthreshold PTSD and EDs among women or men. This study included PTSD and ED data from male (n = 2,382) and female (n = 3,310) National Comorbidity Survey-Replication study participants. The vast majority of women and men with anorexia nervosa, bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma. Rates of PTSD were significantly higher among women and men with BN and BED. Subthreshold PTSD was more prevalent than threshold PTSD among women with BN and women and men with BED. Interpersonal forms of trauma, PTSD, and subthreshold/partial PTSD, were prevalent among men and women with EDs. Findings highlight the importance of assessing for trauma and PTSD in ED patients.

Norms for Performance in the Workplace in Healthy People: Data from the National Comorbidity Survey Replication Study

IntroductionPsychiatric conditions affect multiple areas of psychosocial functioning, including functioning in the workplace. The purpose of this study was to establish norms for absenteeism (work days missed due to mental or physical illness) and work performance (quality of work performed when at work) for healthy individuals. We selected 300 individuals without psychiatric or medical conditions from the National Comorbidity Survey Replication study (NCS-R). Absenteeism and work performance were assessed using the NCS-R version of the Health and Work Performance Questionnaire (HPQ). Employees missed an average of 5.1 days of work in the past year. Absenteeism varied across occupations, with performers of routine tasks, office clerks, and professionals exhibiting the greatest variance in days missed. Work performance ratings were skewed toward high performance ratings and did not differ across occupations. Gender, age, race/ethnicity, and education level did not substantially moderate absenteeism and work performance norms.DiscussionSkewed ratings for work performance are consistent with previous findings using the HPQ. This may reflect a general tendency that individuals rate themselves favorably when they compare themselves to others. This study provides normative tables for absenteeism and work performance in individuals without psychiatric or medical conditions, against which individuals with such conditions may be compared.

Headaches and sleep problems among adults in the United States: Findings from the National Comorbidity Survey–Replication Study

Several studies have demonstrated an association between headache and disturbed sleep. None have examined this association across the headache spectrum. Our goal was to determine whether migraine and migraine with aura differ from nonmigraine headache in terms of associated insomnia complaints or severity of sleep problems. A probability sample of US adults was used. A structured interview administered by trained interviewers was used. Diagnostic criteria for migraine and migraine with aura were based on the International Headache Society classification. The presence or absence of four forms of sleep disturbance associated with an insomnia diagnosis was ascertained. There was a significant association between frequent severe headache, including migraine with and without aura, and disordered sleep. Adults with headache reported more frequently difficulty initiating sleep (odds ratio [confidence interval] = 2.0 [1.6-2.5]), difficulty staying asleep (2.5 [2.1-3]), early morning awakening (2.0 [1.7-2.5]) and daytime fatigue (2.6 [2.2-3.2]) and also were more than twice as likely to report three or more of these symptoms(2.5 [2-3.1]) compared to the individuals without headache. Adults with severe headache are at significantly higher risk of also suffering from sleep problems, when compared with the general population, regardless of specific headache type. Optimal treatment of headache must include investigation for sleep disorders and vice versa.

Bipolar Disorder Patient Care Opportunities: Let's Answer the Call

Bipolar disorder is a brain illness with complexities in its composition and treatment. Results from the National Comorbidity Survey Replication study estimate the lifetime prevalence of bipolar spectrum illnesses to be 4.5%. These patients were also reported to have their illnesses frequently treated suboptimally and to be at risk of suffering extensive disability. Pharmacists are in a key position to deliver important pharmacy care services to patients who have bipolar disorder and receive treatments in need of close monitoring. Described here are the results of this study and opportunities for pharmacists to support this important patient population.

Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Prevalence of Generalized Anxiety Disorder in General Practice in Denmark, Finland, Norway, and Sweden

Prevalence of Generalized Anxiety Disorder in General Practice in Denmark, Finland, Norway, and Sweden