National Comorbidity Survey Replication Research Articles

Psychological, physical, and sleep comorbidities and functional impairment in irritable bowel syndrome: Results from a national survey of U.S. adults.

Background/AimsPatients with irritable bowel syndrome (IBS) in referral practice commonly report mental disorders and functional impairment. Our aim was to determine the prevalence of mental, physical and sleep-related comorbidities in a nationally representative sample of IBS patients and their impact on functional impairment.MethodsIBS was defined by modified Rome Criteria based on responses to the chronic conditions section of the National Comorbidity Survey-Replication. Associations between IBS and mental, physical and sleep disorders and 30-day functional impairment were examined using logistic regression models.ResultsOf 5,650 eligible responders, 186 met criteria for IBS {weighted prevalence 2.5% (SE = 0.3)}. Age >60 years was associated with decreased odds (OR = 0.3; 95% CI:.1-.6); low family income (OR = 2.4; 95% CI:1.2–4.9) and unemployed status (OR = 2.3; 95% CI:1.2–4.2) were associated with increased odds of IBS. IBS was significantly associated with anxiety, behavior, mood disorders (ORs 1.8–2.4), but not eating or substance use disorders. Among physical conditions, IBS was associated with increased odds of headache, chronic pain, diabetes mellitus and both insomnia and hypersomnolence related symptoms (ORs 1.9–4.0). While the association between IBS and patients’ role impairment persisted after adjusting for mental disorders (OR = 2.4, 95% CI 1.5–3.7), associations with impairment in self-care, cognition, and social interaction in unadjusted models (ORs 2.5–4.2) were no longer significant after adjustment for mental disorders.ConclusionIBS is associated with socioeconomic disadvantage, comorbidity with mood, anxiety and sleep disorders, and role impairment. Other aspects of functional impairment appear to be moderated by presence of comorbid mental disorders.

General psychopathology factor and borderline personality disorder: Evidence for substantial overlap from two nationally representative surveys of U.S. adults.

A general psychopathology factor reflects an underlying liability for a wide range of mental disorders. There is suggestive evidence that borderline personality disorder (BPD) may be strongly associated with the general psychopathology factor, but there are no detailed data on the degree of overlap between the general psychopathology factor and BPD or its individual symptoms. This study examined the overlap between the general psychopathology factor and BPD using cross-sectional survey data from two nationally representative samples of U.S. adults, the National Comorbidity Survey Replication (N = 5,692) and the National Comorbidity Survey follow-up (N = 5,001). Structural equation modeling was used to fit a bifactor general psychopathology model and to examine the general psychopathology factor's associations with (a) a series of Clusters A, B, and C personality disorder symptoms including BPD symptoms and (b) a latent BPD. Results showed that the shared variance between the general psychopathology factor and a latent BPD was 56% in the National Comorbidity Survey Replication and 71% in the National Comorbidity Survey follow-up. The correlation between the general factor and BPD could be set to unity without worsening model fit, suggesting that BPD closely reflects a general liability to psychopathology. The affective features of BPD were particularly strongly associated with the general psychopathology factor. Findings are discussed with respect to the nosology of BPD and the treatment of mental disorders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Is the Black-White mental health paradox consistent across age, gender, and psychiatric disorders?

Objectives The Black-White mental health epidemiological paradox (i.e. Black Americans’ lower or similar rates of mental disorder relative to Whites) characterizes the literature on race and mental health. Yet, research has generally paid less attention to how such findings may vary across other social statuses that shape mental health. This study assessed whether the Black-White paradox is consistent across gender, age groups, and psychiatric disorders, including lifetime mood, anxiety, and substance use disorders. Method We used data from the National Comorbidity Survey-Replication (NCS-R) and National Survey of American Life (NSAL), 2001–2003 (N = 4,591 African Americans; 6,668 non-Hispanic Whites). Psychiatric disorders were measured with the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI). Binary logistic regression models were conducted to assess racial patterns of lifetime mental disorders across age and gender. Wald tests were performed to assess age and gender group differences in Black-White patterns of mental disorder. Results The Black-White mental health paradox generally extends across lifetime mood, anxiety, and substance use disorders and is consistent across age and gender groups. One exception is middle-aged (45–64 years) Black men, who had higher odds of lifetime substance use disorder relative to their White male middle-aged peers. This difference is no longer statistically significant after accounting for education and employment. We also found more similarity in mental disorders between older Blacks and Whites relative to their younger counterparts, suggesting that Black-White mental health differences are most pronounced among younger age groups. Conclusion Our findings contribute to the broader literature on the Black-White mental health paradox by demonstrating that this epidemiological pattern persists across various mental disorder types and, at times, depends on age group and gender. Given that Black-Whte differences are less pronounced among older adults, future research should consider the ways life course theory might inform our understanding of the paradox. Findings also suggest that substance use services are critical to address the needs of middle-aged Black men of lower socioeconomic status who are disproportionately affected by substance use disorder, yet have relatively lower mental health care utilization rates.

Parent’s psychopathological profiles and adolescent offspring’s substance use disorders

BackgroundSubstance use disorders (SUD) represent one of the most important public health problems which has an onset in adolescence. Although substantial data exist on adolescent substance use, studies examining the role of parental psychopathological profiles on adolescent offspring SUD are lacking. Thus, this study aimed to identify parental psychopathological profiles, and to examine the extent to which these profiles are associated with SUD in their offspring. MethodOur analytic sample comprised 5887 adolescents (48.60% boys; M = 15.07 years, SD = 1.46) from the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), whose biological parents responded to the Parent Self-Administered Questionnaire. Parental psychopathological profiles were identified by means of latent class analysis. ResultsDifferent psychopathological profiles were identified in fathers and mothers. Among fathers, two psychopathological profiles were found: “normative class” (low psychopathological symptoms and drug use) and “high psychopathology class” (high psychopathological symptoms and drug use). Among mothers, three psychopathological profiles were found: “normative class” (low psychopathological symptoms and drug use), “high psychopathology class” (high psychopathological symptoms and drug use), and “suicide class” (low psychopathological symptoms and drug use, but high on suicidal ideation or suicidal attempt). Father’s high psychopathology profile was significantly associated with adolescent’s illicit drug abuse. Mother’s high psychopathology profile was significantly associated with adolescent’s nicotine dependence, alcohol or illicit drug abuse. ConclusionsFamily-based interventions should include skills training in reducing parental SUD and other mental health problems.

Disentangling Mental Illness Labeling Effects from Treatment Effects on Well-Being

The emerging field of Mad Studies has returned attention to deficiencies of the medical model, refocusing scholars on social causes of mental health problems and on consumers’/survivors’ experiences of labeling and stigma. These themes echo issues addressed in traditional and modified labeling theories. A fundamental labeling premise is that professional categorization as “mentally ill” is a major determinant of individuals’ poorer psychological well-being. However, this relationship has not been tested appropriately because past studies frequently measured formal labeling by a person’s involvement in treatment. Treatment involvement can indicate the receipt of potentially beneficial services or harmful categorization with a stigmatizing label. Independent measures of these constructs in the National Comorbidity Survey-Replication enable reexamining traditional and modified labeling hypotheses for individuals with (N = 1,255) and without (N = 4,172) a recurrent clinical disorder. Supporting labeling theory’s central proposition, formal labeling was linked to more negative affect and disability days in both groups. These relationships were not spurious products of preexisting serious symptoms, refuting a psychiatric explanation. Treatment involvement effects differed noticeably between the groups, underscoring the need to keep treatment and labeling measures distinct.

Urban upbringing and psychiatric disorders in the United States: A racial comparison.

Studies that link urbanicity to mental health are mixed depending on outcome and context. More research is needed to examine whether the urban upbringing effect holds true across racial populations in a large and diverse country like the United States. We analyzed two large datasets that were administered contemporaneously with similar methods: The National Comorbidity Survey-Replication (NCS-R, Whites) and the National Survey of American Life (NSAL, Blacks). We ran multivariable logistic regression models to examine the associations between area of upbringing (urban/large city, other, rural) and six psychiatric disorders, controlling for sex, age, years of education and income-to-poverty ratio (and ethnicity in the NSAL). We performed these analyses in both the NCS-R and the NSAL separately. The majority (58.97%) of the White sample grew up in the 'other' category (i.e. small town, small city, or suburb of a large city), whereas a much larger percentage (39.89%) of the Black sample grew up in a large city. In the White sample, urban upbringing was not associated with any of the psychiatric disorders at a conventional level of statistical significance. In the Black sample, urban upbringing was associated with greater odds of having mood disorder, alcohol use disorder and drug use disorder, but was not significantly associated with anxiety disorders, PTSD, or eating disorders. Urban upbringing was not associated with psychiatric disorders among Whites, but was associated with greater odds of mood disorders, alcohol us disorder and drug use disorder among Blacks. Future research can elucidate how differences in urban upbringing between Whites and Blacks are linked to differences in risk for psychiatric disorders.

Urban upbringing and psychotic experiences in the United States: A racial and geographic comparison

Urban upbringing has been associated with greater risk for psychotic experiences, though research is needed to confirm whether this is true in the U.S., and whether the association depends on race, type of experience, and region of the country. We analyzed data from the National Comorbidity Survey Replication (White respondents only) and the National Survey of American Life (Black respondents). Multivariable logistic regression models found that urban upbringing was not significantly associated with lifetime psychotic experiences for Whites, but was significantly associated with lower odds for Blacks, adjusting for socio-demographic covariates and common mental disorders. Rural upbringing was associated with greater odds of lifetime auditory hallucinatory experiences for Blacks. Exploratory analyses suggested growing up in a large city or ‘other’ environment were associated with greater odds of lifetime psychotic experiences among Whites currently residing in the Northeast, but lower odds among Whites residing in the South. For Blacks currently residing in the West, rural upbringing was associated with significantly greater odds of lifetime psychotic experiences when compared with growing up in a large city. White and Blacks may have different lived experiences in urban and rural settings, calling for more race- and location- specific research to explain these diverging patterns.

Risk for Misdiagnosing Chronic Traumatic Encephalopathy in Men With Anger Control Problems.

Background: There are no validated or agreed upon criteria for diagnosing chronic traumatic encephalopathy (CTE) in a living person. In recent years, it has been proposed that anger dyscontrol represents a behavioral clinical phenotype of CTE. This is the first study to examine the specificity of the diagnostic research criteria for traumatic encephalopathy syndrome (TES, the clinical condition proposed to be CTE) in men from the US general population who have anger dyscontrol problems. It was hypothesized that a substantial percentage of these men would meet the research criteria for TES.Methods: Data from 4,139 men who participated in the National Comorbidity Survey Replication, an in-person survey that examined the prevalence and correlates of mental disorders in the United States, were included in this study. Men who were diagnosed with intermittent explosive disorder in the past year were the clinical sample of interest (n = 206; 5.0% of all men in the database), and the remaining men were used as a comparison sample. They were classified as meeting the research criteria for TES if they presented with the purported supportive clinical features of CTE (e.g., impulsivity/substance abuse, anxiety, apathy, suicidality, headache).Results: In this sample of men from the general population with intermittent explosive disorder, 27.3% met a conservative definition of the proposed research criteria for CTE (i.e., traumatic encephalopathy syndrome). If one assumes the delayed-onset criterion is present, meaning that the men in the sample are compared to former athletes or military veterans presenting with mental health problems years after retirement, then 65.0% of this sample would meet the research criteria for TES.Conclusions: These results have important implications. Using conservative criteria, at least one in four men from the general population, who have serious anger control problems, will meet the symptom criteria for TES. If one considers former athletes and military veterans with anger control problems who present many years after retirement and who experienced a documented decline in their mental health, nearly two-thirds will meet these research criteria. More research is needed to examine risks for misdiagnosing TES and to determine whether anger dyscontrol is a clinical phenotype of CTE.

The Relationship Between Burnout and Help-Seeking Behaviors, Concerns, and Attitudes of Residents.

To evaluate the relationship between help-seeking concerns and attitudes and burnout among residents. In 2019, all residents across the 4 Mayo Clinic sites were surveyed. The survey included 2 items from the Maslach Burnout Inventory, an item from the National Comorbidity Survey Replication about likelihood of seeking professional help for a serious emotional problem, and items developed to explore residents' help-seeking behaviors and concerns. Multivariable logistic regression was conducted for each outcome variable and included age, gender, specialty, postgraduate year, site, and burnout. Of the 1,146 residents to whom surveys were sent, 762 (66.5%) responded. Nearly half (342/747, 45.8%) were concerned about negative consequence to their career if they went on medical leave, and one-third (247/753, 32.8%) were reluctant to seek professional help for a serious emotional concern. Of the 437 residents who had never attended a personal health appointment during scheduled work, 34.6% (151) thought it would be difficult to tell a supervising physician they needed to miss work due to a scheduled appointment. On multivariable analysis, burnout was independently associated with reporting it would be difficult to tell a supervising physician of a need to attend an appointment (odds ratio [OR] 2.32; 95% confidence interval [CI] 1.46, 3.67; P < .001), being concerned about negative consequence to their career if they went on medical leave (OR 2.09; 95% CI 1.49, 2.93; P < .001), and reluctance to seek professional care for a serious emotional problem (OR 1.65; 95% CI 1.17, 2.34; P = .004). Barriers to self-care and help-seeking are common among residents and may be worse among those with burnout. Strategies to reduce stigma and promote a culture of well-being are needed.

Psychiatric Disorders and Substance Use Among African American Women in HIV Care.

African-American (AA) women are overrepresented among women with HIV (WWH). In the United States, psychiatric disorders are prevalent among WWH and associated with adverse outcomes. However, little research has examined psychiatric disorders among AA WWH. 315 AA women who were hazardous/heavy drinkers (HD) or moderate/non-drinkers (ND) were recruited from an HIV clinic in a study on alcohol use disorders. We compared sample prevalence of Axis-1 psychiatric diagnoses using the Structured Clinical Interview for DSM-IV with those from general population AA women in the National Comorbidity Survey-Replication (NCS-R). While 29.9% of general population AA women had any lifetime disorder, 66.9% of HD and 62.4% of ND WWH met criteria for a lifetime Axis-1 disorder. Specifically, lifetime PTSD and lifetime MDD were over threefold higher; current PTSD and current MDD respectively were 11-fold and threefold higher. PTSD was the most frequent comorbid diagnosis. HD and ND WWH did not differ in prevalence of psychiatric diagnoses despite significantly higher rates of substance use among HD women. Diagnostic evaluation and intervention for psychiatric disorders should be a priority in HIV medical care settings to improve health outcomes. Interventions should be tailored to address the particular stressors, challenges, and resiliencies among AA WWH.

Disordered Aggression and Violence in the United States.

To determine the prevalence and correlates of DSM-5 intermittent explosive disorder and related aggressive disorders in the United States. Community survey data (collected between 2001-2004) from the National Comorbidity Survey-Replication (NCS-R) and Adolescent Supplement (NCS-AS) involving 10,148 adolescents and 9,282 adults, respectively, were reanalyzed with recurrent aggressive behavior defined as 3 serious aggressive outbursts in any given year. In addition to prevalence, assessments of aggression severity, property damage, injury to others, intimate partner assault, utilization of guns and weapons to threaten, and treatment utilization for recurrent aggressive behavior were also assessed. About 17% of adolescents and 8% of adults report a pattern of recurrent aggressive outbursts within at least 1 year. Such individuals are much more aggressive and impulsive than nonaggressive controls and are more likely to engage in intimate partner assault, carry and use guns and other weapons to threaten others, and be arrested by law enforcement. Few aggressive individuals speak with health care providers about this behavior, and fewer receive treatment for aggression. Recurrent aggressive behavior is common in both adolescents and adults, with clinically significant consequences to those with this pattern and to others in their environment (ie, using guns and other weapons to threaten others). While this type of behavior can be reduced though pharmacologic/psychosocial treatment intervention, the vast majority of aggressive individuals do not engage in treatment for their aggressive behavior. Screening individuals for such behavior in one's practice may do much toward identifying this problem and bringing such individuals into treatment.

Childhood neglect and suicidal behavior: Findings from the National Comorbidity Survey Replication

BackgroundAlthough child neglect is common, there has been comparatively little research on it or its specific forms and their effects on mental health in adulthood. ObjectiveThis study aimed to examine the association between exposure to different forms of childhood neglect and lifetime suicidal behavior among a nationally representative sample of adults in the U.S. general population. MethodsData were analyzed from 5665 adults that were drawn from the National Comorbidity Survey Replication (NCS-R). Information was obtained on ‘care’, ‘supervisory’ and ‘medical’ neglect in childhood and lifetime suicidal behavior (ideation, plan, attempt). Lifetime psychiatric disorders were based on the World Mental Health - Composite International Diagnostic Interview. Logistic regression analysis was used to examine the associations. ResultsIn fully adjusted models, any neglect was associated with significantly increased odds for all forms of suicidal behavior (suicidal ideation, odds ratio [OR]: 1.80, 95 % confidence interval [CI]: 1.42–2.29; plan, OR: 2.27, 95 % CI: 1.78–2.91; attempt, OR: 2.05, 95 % CI: 1.63–2.59, all p < 0.001). In unadjusted analyses all individual forms of neglect were significantly associated with all forms of suicidal behavior. However, when all forms of neglect were included together in the fully adjusted models, care neglect was no longer significantly associated with any form of suicidal behavior. ConclusionDifferent forms of childhood neglect are associated with suicidal behavior in adults independent of common mental disorders. Future studies should focus on childhood neglect subtypes in order to better understand the effects of neglect on adult mental health.

Psychotic experiences and suicidal behavior: testing the influence of psycho-socioenvironmental factors

Research has produced inconsistent results with respect to whether the association between psychotic experiences and suicidal behavior is independent of co-occurring clinical and socioenvironmental factors, despite substantial evidence linking the two phenomena. This study tests whether a comprehensive set of demographic, socioenvironmental, and clinical variables account for the statistical association between psychotic experiences and suicidal behaviors. We utilized blocked multivariable logistic regression models to analyze the association between 12-month psychotic experiences and 12-month suicide behaviors (ideation, plan, and attempt) on a subsample (N = 2307) of the National Comorbidity Survey Replication. The models adjusted for socio-demographic characteristics, environmental factors in the form of childhood adversity, mental health service utilization, and psychiatric and substance abuse disorders. Psychotic experiences were significantly associated with suicidal ideation, even after adjusting for socio-demographics, childhood adversity. However, the significant association between psychotic experiences and suicidal ideation was not robust to the inclusion of mental health service utilization and psychiatric disorders. There was no significant association between psychotic experiences and suicide plan. Psychotic experiences were associated with a significantly increased risk of reporting suicide attempts (OR 6.52; 95% CI 1.36-31.11), even after adjusting for the full set of variables. Although psychotic experiences were not associated with suicidal ideation after statistical adjustments, psychotic experiences were associated with a significantly increased risk of suicide attempts after the inclusion of common risk factors and co-morbidities. Thus, psychotic experiences should be included in routine psychiatric assessments to identify the individuals most at risk for attempting suicide.

Childhood physical neglect and psychotic experiences: Findings from the National Comorbidity Survey Replication.

Childhood adversities have been linked to an increased risk for psychosis. However, as yet, there has been comparatively little research on the effects of neglect. This study examined the association between childhood physical neglect and psychotic experiences (PEs) in a general population sample. Data were analysed from 2308 individuals collected during the National Comorbidity Survey Replication (NCS-R). Information on lifetime PEs was collected with the WHO-CIDI Psychosis Screen. Respondents also reported on five forms of childhood neglect (went hungry, went without necessities, went unsupervised, lacked medical care, chores too difficult/dangerous). Multivariable logistic regression analysis was used to examine associations. In models adjusted for sociodemographic and psychiatric disorder variables, aggregated physical neglect scores (continuous/dichotomized) were associated with significantly increased odds for any lifetime PEs. All individual forms of neglect except went without necessities (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 0.98-1.50) were significantly associated with PEs with ORs ranging from 1.28 (95% CI: 1.08-1.51, went unsupervised) to 1.53 (95% CI: 1.19-1.97, went without medical care). In models that were further adjusted for co-occurring forms of neglect and childhood physical abuse, doing chores that were too difficult/dangerous continued to be associated with significantly increased odds for PEs (OR: 1.29, 95% CI: 1.03-1.61). Childhood physical neglect is associated with significantly increased odds for PEs in the general population. Screening for childhood adversities and PEs among potential patients may be important for the early detection of individuals at high risk for psychosis, as well as for formulating comprehensive and effective treatment plans.

Excessive sleepiness and associated symptoms in the U.S. adult population: prevalence, correlates, and comorbidity

ObjectiveThis study examined the prevalence, sociodemographic features, patterns of comorbidity, and impact on functional impairment of excessive sleepiness (Ex.S) and associated symptoms in a nationally representative sample of adults using the National Comorbidity Survey Replication (NCS-R) dataset. MethodsParticipants ≥18 years (n = 5,962) were queried about their sleep using the Composite International Diagnostic Interview (CIDI). Specifically, respondents were questioned about feeling sleepy during the day and falling asleep in permissive situations, feelings of insufficient sleep despite adequate time in bed, and/or difficulty waking up. Those endorsing daytime sleepiness and at least one additional symptom were considered to have Ex.S plus associated symptoms. Associations between Ex.S plus associated symptoms and sociodemographics, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) mental disorders, chronic physical conditions, and functional impairment were examined. ResultsThe prevalence of Ex.S plus associated symptoms in U.S. adults was 23.34% (standard error [SE] = 0.88) and significantly co-occurred with insomnia-related symptoms after adjusting for confounders (Odds ratio [OR] = 5.65; 95% confidence interval [CI] = 4.55-7.02). The presence of Ex.S and associated symptoms was more common in women, particularly younger women, those with lower family income, and the unemployed (all P<.001). After controlling for demographic characteristics and other confounders, Ex.S plus associated symptoms was associated with having a DSM-IV mental disorder (OR = 4.25; 95% CI = 3.53-5.10), a chronic physical condition (OR = 2.57; 95% CI = 1.94-3.42) and greater disability (P<.001). ConclusionEx. S with associated symptoms was common, frequently co-occurred with other mental and physical conditions, and was associated with substantial disability. Dissipation of some associations after controlling for insomnia-related symptoms indicated that physical-mental comorbidity and disability were greater among individuals with more pervasive sleep disturbances.

Psychotic experiences and accidents, injuries, and poisonings among adults in the United States

Psychotic experiences (PEs) have been linked to an increased risk for accidents and injuries. However, this association remains little researched in many countries. To address this research gap, the current study used cross-sectional data from the United States to examine the association between PEs and accidents, injuries, and poisoning in a general population sample. Data were analyzed from 2274 individuals who completed the psychosis screen as part of the National Comorbidity Survey Replication (NCS-R). Information was obtained on PEs (hallucinations and delusions) and the experience of past 12-month accidents, injuries, and poisoning. Logistic regression analysis was used to examine the association while adjusting for demographic variables and common mental disorders (CMDs). In a fully adjusted model past 12-month PEs were associated with almost three times higher odds for reporting accidents, injuries, and poisoning (odds ratio [OR]: 2.97, 95% confidence interval [CI]: 1.13–7.74). The results of this study indicate that PEs are associated with higher odds for accidents and injuries among adults in the United States. Research is now needed to determine the direction of this association and the factors linked to it.

Risk of Misdiagnosing Chronic Traumatic Encephalopathy in Men With Depression.

In recent years, it has been proposed that depression represents one clinical subtype of chronic traumatic encephalopathy (CTE). This is the first study to examine the specificity of the research criteria for the clinical diagnosis of CTE in men with depression from the general population. Data from the National Comorbidity Survey Replication, an in-person survey that examined the prevalence and correlates of mental disorders in the United States, were used for this study. Men diagnosed as having a major depressive episode in the past 30 days were included (N=101; mean age=39.4 years, SD=12.9, range=18-71). They were deemed to meet research criteriafor CTE if they presented with the purported supportive clinical features of CTE (e.g., impulsivity and substance abuse, anxiety, apathy, suicidality, and headache). Approximately half of the sample (52.5%) met the proposed research criteria for CTE (i.e., traumatic encephalopathy syndrome). If one accepts the delayed-onset criterion as being present, meaning that the men in the sample were presenting with depression years after retirement from sports or the military, then 83.2% of this sample would meet the research criteria for diagnosis. The clinical problems attributed to CTE, such as depression, suicidality, anxiety, anger control problems, and headaches, co-occurred in this sample of men with depression from the general population-illustrating that these problems are not specific or unique to CTE. More research is needed to determine whether depression is, in fact, a clinical subtype of CTE.

Prevalence and correlates of self-harm among a sample of repeat DUI offenders

Background: Driving under the influence of alcohol or other substances (DUI) and suicide are both persistent but potentially preventable public health problems. DUI offenders, particularly those who have repeatedly offended, report elevated risk for many suicide risk factors. However, researchers have not systematically studied associations between repeat DUI and suicide.Methods: Out of a population of 729 repeat DUI offenders, 207 were asked about lifetime suicidal thoughts and behaviors (STB) and lifetime instances of DUI as an attempt at self-harm. We calculated rates of DUI as self-harm and compared lifetime STB rates to rates observed in the National Comorbidity Survey Replication (NCS-R). In addition, we examined associations between known risk factors of STB (e.g. psychiatric disorders, marital status) and lifetime STB outcomes among repeat DUI offenders.Results: Nearly 4% of repeat DUI offenders reported that at least one past experience of DUI was a deliberate attempt to take their own life and an additional 3.4% reported that at least one past experience of DUI was a form of non-suicidal self-injury (NSSI). Rates of lifetime STB all were significantly higher among repeat DUI offenders than NCS-R respondents. For repeat DUI offenders, several risk factors (e.g. race/ethnicity, age, anxiety disorders, NSSI) shared significant relationships with at least one lifetime STB outcome.Conclusion: An exclusive focus on drinking habits and problems is insufficient to address mental health risk among repeat DUI offenders, who might require specialized services designed to address STB.

Abstract P279: Marijuana Use, Multiple Sleep Characteristics, and Hypertension Among White, Black, and Hispanic Adults in the United States

Introduction: Prior studies have found an association between marijuana use and hypertension. However, few consider the role of sleep as an explanatory factor or race/ethnicity as a moderator. Our objective was to investigate associations between marijuana use, sleep characteristics, and hypertension in a multiethnic population. Hypothesis: We hypothesized that the marijuana use and sleep association would vary by race/ethnicity and sleep would partially explain associations between marijuana use and hypertension. Methods: We used National Comorbidity Survey-Replication cross-sectional data (2001-2003) from white, black, and Hispanic participants aged ≥18 years who reported no current abuse of cocaine or prescription drugs. Participants self-reported marijuana use, multiple sleep characteristics (insomnia symptoms, early awakening, daytime sleepiness), and a physician’s diagnosis of hypertension (yes vs. no). Using Poisson regression with robust variance and sampling weights, we estimated the prevalence of poor sleep characteristics among participants who reported current or former use to never use adjusting for age, sex, and race/ethnicity. Sleep characteristics were added to adjusted models for associations between use and hypertension. Race/ethnicity*marijuana use interaction terms were tested for all models. Results: Among 3,928 participants, mean age±SE was 45±0.49 years, 79% were white, 11% black, and 10% Hispanic. Current users were younger (32±0.49 years), more likely to report black (17%) or Hispanic (13%) race/ethnicity and insomnia symptoms (31%), and less likely to report hypertension (12%) compared to former (40.6±0.45 years, 9.6% black, 9.9% Hispanic, 26% insomnia, 20% hypertension) and never (51.1±0.79 years, 10% black, 9.9% Hispanic, 22% insomnia, 29% hypertension) users. Estimates were similar across marijuana use categories for early awakening (16%) and daytime sleepiness (34%). Former and current marijuana use was associated with 22% (whites) to 38% (blacks) and 33% (Hispanics) to 85% (blacks, prevalence ratio (PR)=1.85 [95% confidence interval: 1.06-3.23]) higher prevalence of insomnia symptoms as well as 32% (blacks) to 49% (whites) and 46% (blacks) to 77% (whites, PR=1.77 [1.29-2.44]) higher prevalence of early awakening (p race/ethnicity*marijuana use &lt;0.05). Across all races/ethnicities, marijuana use was similarly associated with higher prevalence of daytime sleepiness (PR former =1.17 [1.03-1.33], PR current =1.20 [1.00-1.43]). Former marijuana use was associated with higher prevalence of hypertension only among blacks (PR=1.46 [1.04-2.05]) and sleep characteristics explained approximately 2% of this association on average. Conclusions: Marijuana use was associated with poor sleep and relationships varied by race/ethnicity, but relationships between marijuana use and hypertension were not explained by sleep.

Mental and substance use disorders among legal intervention injury cases in California, 2005–2014

Police use of force is an important public health issue in the US. Recent high-profile incidents suggest a potential link between mental disorders and police use of force, however little research has examined their co-occurrence in the general population. We aimed to assess the overall association between specific mental and substance use disorders (MSUDs) and nonfatal legal intervention injury. We identified nonfatal legal intervention injury cases (n = 90,099) and MSUD diagnoses from all hospital and emergency department (ED) records in California between 2005 and 2014. Age-, sex-, and race-standardized MSUD prevalence estimates among legal intervention injury cases, stratified by inpatient status, were compared to general US population-based estimates from the National Comorbidity Survey Replication. Compared to the general US population, nonaffective psychoses, mood disorders, alcohol use disorders, and drug use disorders were substantially overrepresented among inpatient legal intervention injuries (prevalence difference [PD]: 19.2%, (95% confidence interval [CI]: 18.0, 20.4); PD: 15.3%, (95% CI: 13.9, 16.7); PD: 21.1%, (95% CI: 19.8, 22.4); PD: 29.7%, (95% CI: 28.4, 31.0), respectively). Associations for all except mood disorders were similar but attenuated among ED injury cases. In contrast, anxiety disorders were underrepresented in both inpatient and ED injury cases. Results for mood disorders and suicidal ideation were mixed. In summary, MSUDs characterized by more overt behavioral symptoms were substantially overrepresented among legal intervention injury cases. Findings support the potential importance of interventions to improve treatment and law enforcement recognition of such disorders. Additional research should disentangle the complex relationship between MSUDs and legal intervention injury.