Risk Factors for First-Incidence Alcohol Use Disorders in Depressive and Anxiety Patients

1. Depressive and anxiety disorders predicting first-incidence of alcohol use disorders Lynn Boschloo VU Medical Center, Amsterdam, The Netherlands Netherlands Study of Depression and Anxiety H

2. Introduction Methods Results Conclusion PREVIOUS CROSS-SECTIONAL STUDIES Alcohol use disorders are highly prevalent in depressed and/or anxious persons. [e.g., De Graaf et al., 2003; Hasin et al.,2007; Boschloo et al., 2011] Depressive and/or anxiety disorders often precede alcohol dependence. [e.g., Merikangas et al. 1998; Boschloo et al. 2011]

3. Introduction Methods Results Conclusion PREVIOUS PROSPECTIVE STUDIES Do depressive and/or anxiety disorders predictfirst-incidence of alcohol use disorders? - Positive [Marquenie et al., 2007] - Negative [Crum and Pratt, 2001; Zimmerman et al., 2003] - Mixed [Kushner et al., 1999; Merikangas et al., 2008; Buckner and Turner 2009]

4. Introduction Methods Results Conclusion EXPLANATIONS FOR CONFLICTING RESULTS Small samples Heterogeneity of depressive/anxiety disorders - Status: Remitted versus current disorders - Type: Specific disorders - Severity: Number of disorders

5. RESEARCH QUESTIONS Introduction Methods Results Conclusion • Do depressive and/or anxiety disorders predict first-incidence of • alcohol abuse? • alcohol dependence? • Is this association conditional on the: • status of disorder? • type of disorder? • severity? • What are other risk factors?

6. Introduction Methods Results Conclusion NESDA • NEtherlands Study of Depression and Anxiety • Naturalistic cohort study • n=2,981: ♀1,979, ♂1,002, 18-65 years • 19% the community; 54% primary care; 27% outpatient mental health care organizations

7. DESIGN Introduction Methods Results Conclusion Current analyses: N=2,676 89.8% Response rate: 80.6% Response rate: 87.1% N=2,981 N=2,402 N=2,596 Interview Interview Interview baseline 2 year 4 year [Penninx et al., 2008; Lamers et al., 2011]

8. Introduction Methods Results Conclusion OUTCOME • First-incidence of DSM-IV alcohol abuse (CIDI) - Exclusion: Baseline alcohol use disorder (n=714) - Exclusion: Alcohol dependence during FU (n=52) • First-incidence of DSM-IV alcohol dependence (CIDI) - Exclusion: Baseline alcohol dependence (n=405)

9. Introduction Methods Results Conclusion PREDICTOR CIDI-based DSM-IV diagnosis of: • Depressive disorder: - Major depressive disorder - Dysthymia • Anxiety disorder: - Generalized anxiety disorder - Social phobia - Panic disorder - Agoraphobia

10. Introduction Methods Results Conclusion PREDICTOR • Status of disorder: - Remitted disorder - Current disorder (<6 months) • Type of disorder: - Specific depressive and anxiety disorders • Severity: - Number of disorders

11. OTHER POTENTIAL RISK FACTORS Introduction Methods Results Conclusion • Sociodemographics • Vulnerability - Family history - Childhood trauma - Recent life events - Personality • Addiction-related factors - Subthreshold alcohol problems - Illicit drug use - Smoking status

12. OVERALL FIRST-INCIDENCE RATES Introduction Methods Results Conclusion

13. RESEARCH QUESTIONS Introduction Methods Results Conclusion • Do depressive and/or anxiety disorders predict first-incidence of • alcohol abuse? • alcohol dependence? • Is this association conditional on the: • status of disorder? • type of disorder? • severity? • What are other risk factors?

14. FIRST-INCIDENCE OF ALCOHOL ABUSE Introduction Methods Results Conclusion

15. RESEARCH QUESTIONS Introduction Methods Results Conclusion • Do depressive and/or anxiety disorders predict first-incidence of • alcohol abuse? • alcohol dependence? • Is this association conditional on the: • status of disorder? • type of disorder? • severity? • What are other risk factors?

16. FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion

17. RESEARCH QUESTIONS Introduction Methods Results Conclusion • Do depressive and/or anxiety disorders predict first-incidence of • alcohol abuse? • alcohol dependence? • Is this association conditional on the: • status of disorder? • type of disorder? • severity? • What are other risk factors?

18. FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion

19. RESEARCH QUESTIONS Introduction Methods Results Conclusion • Do depressive and/or anxiety disorders predict first-incidence of • alcohol abuse? • alcohol dependence? • Is this association conditional on the: • status of disorder? • type of disorder? • severity? • What are other risk factors?

20. FIRST-INCIDENCE OF ALCOHOL DEPENDENCE Introduction Methods Results Conclusion

21. RESEARCH QUESTIONS Introduction Methods Results Conclusion • Do depressive and/or anxiety disorders predict first-incidence of • alcohol abuse? • alcohol dependence? • Is this association conditional on the: • status of disorder? • type of disorder? • severity? • What are other risk factors?

22. OTHER RISK FACTORS Introduction Methods Results Conclusion

23. INDEPENDENT RISK FACTORS Introduction Methods Results Conclusion

24. Introduction Methods Results Conclusion CONCLUSIONS Depressive/anxiety disorders predicted first-incidence of alcohol dependence, but not alcohol abuse. Conditional on status of disorder • Current disorder: Yes • Remitted disorder: No Not conditional on type of disorder Conditional on severity

25. Introduction Methods Results Conclusion CONCLUSIONS Independent risk factors: • Number of depressive/anxiety disorders • Subthreshold alcohol problems • Recent negative life events?

26. THANK YOU! Lynn Boschloo, MSc Nicole Vogelzangs, PhD Johannes H. Smit, PhD Wim van den Brink, MD, PhD Dick J Veltman, MD, PhD Aartjan TF Beekman, MD, PhD Brenda WJH Penninx, PhD Netherlands Study of Depression and Anxiety www.nesda.nl funded through the mental health program of the Netherlands Organization for Health Research (ZonMW) and matching funds from participating institutes