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Epidemiology of Comorbid Psychiatric and Addictive Disorders Kathleen Ries Merikangas, Ph.D.

Explore key epidemiological data on comorbidity between mental disorders and substance use, implications for classification, treatment, and genetics research.

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Epidemiology of Comorbid Psychiatric and Addictive Disorders Kathleen Ries Merikangas, Ph.D.

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  1. Epidemiology of Comorbid Psychiatric and Addictive Disorders Kathleen Ries Merikangas, Ph.D. Senior Investigator APA, May 4, 2004

  2. Kevin P. Conway, Ph.D. Deputy Branch Chief Epidemiology Research Branch

  3. Goals • Identify key patterns emerging from epidemiologic data on drug/mental disorder comorbidity • Briefly discuss implications of a heterogeneous phenotype for classification, treatment, and genetics research

  4. Goal 1 Key patterns from epidemiologic data • Comorbidity is the rule rather than the exception • Cross-cultural findings show that the magnitude of comorbidity is more similar than are the differences in baseline prevalence • Risk for drug dependence > drug abuse • Risk varies by mental disorder (Anxiety < Mood < ASPD) • Risk varies by gender (female > male) • Risk varies somewhat by specific drug disorder and number of drug disorders

  5. Lifetime Prevalence and Odds Ratios of Mental Disorders by Substance Use Disorder: ECA Alcohol Drug Comorbid Disorder % O.R. % O.R. Any mental 36.6 2.3 53.1 4.5 Schizophrenia 3.8 3.3 6.8 6.2 Affective 13.4 1.9 26.4 4.7 Anxiety 19.4 1.5 28.3 2.5 Antisocial 14.3 21.0 17.8 13.8 (Regier et al., JAMA 264:2511-2518, 1990)

  6. Goal 1 Key patterns from epidemiologic data • Comorbidity is the rule rather than the exception • Cross-cultural findings show that the magnitude of comorbidity is more similar than are the differences in baseline prevalence • Risk for drug dependence > drug abuse • Risk varies by mental disorder (Anxiety < Mood < ASPD) • Risk varies by gender (female > male) • Risk varies somewhat by specific drug disorder and number of drug disorders

  7. Lifetime Prevalence of Drug Dependence and Mood DisorderInternational Consortium on Psychiatric Epidemiology (Merikangas et al., Addictive Behaviors, 1998)

  8. Lifetime Comorbidity of Drug Dependence and Mood DisorderInternational Consortium on Psychiatric Epidemiology (Merikangas et al., Addictive Behaviors, 1998)

  9. Population Attributable Risk of Drug Dependence due to Prior Mental Disorders: International Consortium on Psychiatric Epidemiology Kessler et al., Psychiatria Fennica, 32 (suppl 2): 62-79, 2001

  10. Lifetime Prevalence of Mood Disorder among Puerto Rican Probands with Drug Dependence: PreliminaryResults from a Migrant Family Study % (Conway, Swendsen, Canino, & Merikangas, in preparation)

  11. Goal 1 Key patterns from epidemiologic data • Comorbidity is the rule rather than the exception • Cross-cultural findings show that the magnitude of comorbidity is more similar than are the differences in baseline prevalence • Risk for drug dependence > drug abuse • Risk varies by mental disorder (Anxiety < Mood < ASPD) • Risk varies by gender (female > male) • Risk varies somewhat by specific drug disorder and number of drug disorders

  12. Lifetime Comorbidity by Drug Abuse and Dependence: ECA O.R.Abuse Dependence Any Anxiety 2.3 2.6 Phobia 2.1 2.2 Panic 1.4 4.4 OCD 3.2 3.6 Any Mood 4.1 4.4 Bipolar 5.2 8.3 MDD 3.3 3.7 Dysthymia 3.6 3.6 Antisocial5.2 15.6 (Regier et al., JAMA 264:2511-2518, 1990.)

  13. Lifetime Anxiety and Mood Comorbidity by Drug Use, Abuse, and Dependence: International Consortium on Psychiatric Epidemiology (median odds ratio across sites) Use Abuse Dependence Anxiety 1.9 2.5 4.0 Mood 2.2 3.1 3.5

  14. Goal 1 Key patterns from epidemiologic data • Comorbidity is the rule rather than the exception • Cross-cultural findings show that the magnitude of comorbidity is more similar than are the differences in baseline prevalence • Risk for drug dependence > drug abuse • Risk varies by mental disorder (Anxiety < Mood < ASPD) • Risk varies by gender (female > male) • Risk varies somewhat by specific drug disorder and number of drug disorders

  15. Lifetime Comorbidity by Specific Drug Use Disorder: NESARC Anxiety Mood ASPD O.R.M F M F M F Any Drug 3.0 2.9 3.8 4.1 8.1 17.1 Marijuana 2.8 2.7 3.5 3.8 7.5 14.0 Cocaine 3.0 2.7 4.0 4.2 7.5 18.0 Amphetamine 3.7 4.1 4.6 5.6 9.2 16.9 Hallucinogen 3.2 4.0 5.0 6.5 10.8 16.9 Opioid 3.3 4.2 5.2 7.5 9.9 16.1 Sedative 4.1 4.2 5.5 7.1 9.1 17.6 Tranquilizer 3.8 6.8 5.6 7.1 11.2 20.3 (Conway, Compton, & Grant, in preparation)

  16. Lifetime Mood and/or Anxiety Comorbidity by Multiple Drug Use Disorders: NESARC (Conway, Compton, & Grant, in preparation)

  17. Goal 2 • Identify key patterns emerging from epidemiologic data on drug/mental disorder comorbidity • Briefly discuss implications of a heterogeneous phenotype for classification, treatment, and genetics research

  18. The Phenotype “Probably the single most important aspect of studies of complex diseases is the phenotype, which may well be multidimensional.” P. Michael Conneally, 2002 ASHG Presidential Address

  19. 4.0 Anxiety 5 10 15 20 25 Pathways to Substance Disorders through Psychopathology: Yale Family Study (Relative Risk) Conduct 6.0 ADHD 5.0 Conduct Phobia 2.0 Depression Bipolar 5.0 Age

  20. Relative Risk of Daily Smoking by Preexisting Psychiatric Disorders (NCS) Any Active Past MDD 1.51.6 0.6 Dysthymia 1.61.6 1.5 Agoraphobia 1.3 1.4 0.1 GAD 1.92.1 ne Simple Phobia 1.61.5 0.9 Social Phobia 1.51.32.8 Panic Disorder 0.9 0.9 1.7 PTSD 2.12.0 2.5 (Breslau, Novak, & Kessler, Biol Psychiatry 2004)

  21. Conventional Definition: Dichotomous Drug abuse = 0 Risk Drug abuse = 1 Disorder

  22. Antisocial/Substance Biological Diathesis Age of Onset of Drug Problems Langbehn et al., DAD, 69: 151-167, 2003

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