Co-occurrence patterns of anxiety, depression and alcohol use disorders

  • Naomar Almeida-Filho
  • Ines Lessa
  • Lucélia Magalhães
  • Maria Jenny Araújo
  • Estela Aquino
  • Jair de Jesus Mari
ORIGINAL PAPER

Abstract

Co-occurrence of anxiety and depressive symptoms with alcohol consumption/abuse was analyzed in a sample of 2,302 adults in Bahia, Brazil. A cross-sectional household survey collected self-reported information on social and personal health, as well as individual psychological status, with standardized techniques and trained examiners. Twelve-month prevalence was 15% for anxiety, 12% for depressive disorders and 7% for alcohol abuse/dependence. Symptom co-occurrence was more frequent for depression (94% of cases co-occurring with other diagnoses), followed by anxiety disorders (82%), and alcoholism (only 20%). There was a 74% proportion of anxiety symptoms among depressed, and a 61% proportion of depressed among anxiety sufferers. The combination of depression plus anxiety was the most prevalent in both gender groups, ranging from 17% for women to 5% for men. Comorbid combinations of alcoholism yielded low prevalences, the smallest (around 1%) being the triple combo alcoholism+anxiety+depression. Gender ratios increased substantially in the absence of comorbidity, reaching peaks in depression (F:M ratio = 13.8) and alcoholism (M:F ratio = 11.8). Set component analyses indicate strong overlapping of anxiety and depression and complementarity between depression and alcoholism, modulated by gender (women depressed, men alcoholic).

Keywords

comorbidity anxiety alcoholism depression depressive spectrum 

References

  1. 1.
    Almeida-Filho N, Lessa I, Magalhaes L, Araujo MJ, Aquino E, James SA, Kawachi I (2004) Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity, and social class. Soc Sci Med 59:1339–1353CrossRefPubMedGoogle Scholar
  2. 2.
    Almeida-Filho N, Lessa I, Magalhaes L, Araujo MJ, Aquino E, James SA, Kawachi I (2005) Social inequality and alcohol consumption-abuse in Bahia, Brazil—interactions of gender, ethnicity and social class. Soc Psychiatry Psychiatr Epidemiol 40:214-222CrossRefPubMedGoogle Scholar
  3. 3.
    Almeida-Filho N, Mari JJ, Coutinho E, Andreoli S, Fernandes J, França J (1997) Brazilian multicentric study of psychiatric morbidity: methodological features and prevalence estimates. Br J Psychiatry 171:524–529CrossRefPubMedGoogle Scholar
  4. 4.
    Andreoli SB, Almeida-Filho N, Coutinho ES, Mari JJ (2000) Psychiatric cases identification by multi-step epidemiological studies: methods, problems and applicability. Rev Saude Publica 34:475–483CrossRefPubMedGoogle Scholar
  5. 5.
    Andreoli SB, Blay SL, Almeida-Filho N, Coutinho ES, Mari JJ (1994) The factor structure of the QMPA—Adult Psychiatry Morbidity Questionnaire—in a community sample of Brazilian cities. Rev Saude Publica 28:249–260CrossRefPubMedGoogle Scholar
  6. 6.
    Andrews G, Henderson S, Hall W (2001) Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. Br J Psychiatry 178:145–153CrossRefPubMedGoogle Scholar
  7. 7.
    Angst J (1999) Modern epidemiology of anxiety: results of the Zurich cohort study. Hum Psychopharmacol Clin Exp 14:29–37CrossRefGoogle Scholar
  8. 8.
    Angst J, Dobler-Mikola A (1985) The Zurich Study-VI. A continuum from depression to anxiety disorders? Eur Arch Psychiatr Neurol Sci 235:179–186CrossRefGoogle Scholar
  9. 9.
    Angst J, Merikangas K (1997) The depressive spectrum: diagnostic classification and course. J Affect Disord 45:31–40CrossRefPubMedGoogle Scholar
  10. 10.
    Angst J, Sellaro R, Merikangas K (2000) Depressive spectrum diagnoses. Compr Psychiatry 41(2, suppl 1):39–47CrossRefPubMedGoogle Scholar
  11. 11.
    Angst J, Vollrath M, Merikangas K, Ernst C (1990) Comorbidity of anxiety and depression in the Zurich Cohort Study of young adults. In: JD Maser, CR Cloninger (eds) Comorbidity of mood and anxiety disorders. American Psychiatric, Washington, pp 123–137Google Scholar
  12. 12.
    Angst J, Gamma A, Endrass J, Rössler W, Ajdacic-Gross V, Eich D, Herrell R, Merikangas KR (2006) Is the association of alcohol use disorders with major depressive disorder a consequence of undiagnosed bipolar-II disorder? Eur Arch Psychiatr Clin Neurosci 256(7):452–57CrossRefGoogle Scholar
  13. 13.
    Ayuso-Mateos JL, Vázquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard O, Casey P, Wilkinson C, Lasa L, Page H, Dunn G, Wilkinson G, ODIN Group (2001) Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatr 179:308–316CrossRefGoogle Scholar
  14. 14.
    Bucholz KK (1999) Nosology and epidemiology of addictive disorders and their comorbidity. Psychiatr Clin North Am 22:221–240CrossRefPubMedGoogle Scholar
  15. 15.
    Cadoret RJ, Winokur G, Langbehn D, Troughton E, Yates WR, Stewart MA (1996) Depression spectrum disease, I: The role of gene-environment interaction. Am J Psychiatr 153:892–899PubMedGoogle Scholar
  16. 16.
    Conway KP, Compton W, Stinson FS, Grant BF (2006) Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatr 67:247–257CrossRefGoogle Scholar
  17. 17.
    Cornelius JR, Bukstein O, Salloum I, Clark D (2003) Alcohol and psychiatric comorbidity. Recent Dev Alcohol 16:361–374CrossRefPubMedGoogle Scholar
  18. 18.
    Coutinho E, Almeida-Filho N, Mari JJ, Rodrigues L (1996) Minor psychiatric morbidity and internal migration in Brazil. Soc Psychiatry Psychiatr Epidemiol 31:173–179CrossRefGoogle Scholar
  19. 19.
    de Graaf R, Bijl RV, Smit F, Vollebergh WA, Spijker J (2002) Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. Am J Psychiatry 159:620–629CrossRefPubMedGoogle Scholar
  20. 20.
    Farrell M, Howes S, Taylor C, Lewis G, Jenkins R, Bebbington P, Jarvis M, Brugha T, Gill B, Meltzer H (1998) Substance misuse and psychiatric comorbidity: an overview of the OPCS National Psychiatric Morbidity Survey. Addict Behav 23:909–918CrossRefPubMedGoogle Scholar
  21. 21.
    Goldberg D (1996) A dimensional model for common mental disorders. Br J Psychiatry 168(Suppl 30):44–49Google Scholar
  22. 22.
    Grant BF (2000) Theoretical and observed subtypes of DSM-IV alcohol abuse and dependence in a general population sample. Drug Alcohol Depend 60:287–293CrossRefPubMedGoogle Scholar
  23. 23.
    Grant BF, Harford TC (1995) Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey. Drug Alcohol Depend 39:197–206CrossRefPubMedGoogle Scholar
  24. 24.
    Griffin JM, Fuhrer R, Stansfeld S, Marmot M (2002) The importance of low control at work and home on depression and anxiety: do these effects vary by gender and social class? Soc Sci Med 54:783–798CrossRefPubMedGoogle Scholar
  25. 25.
    Helzer JE, Burnam A, McEvoy LT (1991) Alcohol use and dependence. In: LN Robins DA Regier (eds) Psychiatric disorders in America: the epidemiologic catchment area study. The Free Press, New York, pp 81–115Google Scholar
  26. 26.
    Jenkins R, Bebbington P, Brugha T, Farrell M, Gill B, Lewis G, Meltzer H, Petticrew M (1997) The national psychiatric morbidity surveys of Great Britain - strategies and methods. Psychol Med 27:765–774CrossRefPubMedGoogle Scholar
  27. 27.
    Kandel DB, Huang FY, Davies M (2001) Comorbidity between patterns of substance use dependence and psychiatric syndromes. Drug Alcohol Depend 64:233–241CrossRefPubMedGoogle Scholar
  28. 28.
    Kaufman J, Charney D (2000) Comorbidity of mood and anxiety disorders. Depress Anxiety 12(Suppl 1):69–76CrossRefPubMedGoogle Scholar
  29. 29.
    Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ (1993) Major depression and phobias: the genetic and environmental sources of comorbidity. Psychol Med 23:361–371CrossRefPubMedGoogle Scholar
  30. 30.
    Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E, Jin R, Pennell BE, Walters EE, Zaslavsky A, Zheng H (2004) The US National Comorbidity Survey Replication (NCS-R): design and field procedures. Int J Methods Psychiatr Res 13:69–92CrossRefPubMedGoogle Scholar
  31. 31.
    Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19Google Scholar
  32. 32.
    Kessler RC, Ormel J, Demler O, Stang PE (2003) Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: results from the National Comorbidity Survey. J Occup Environ Med 45:1257–1266CrossRefPubMedGoogle Scholar
  33. 33.
    Kessler RC, Zhao S, Blazer DG, Swartz M (1997) Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord 45:19–30CrossRefPubMedGoogle Scholar
  34. 34.
    Knibbe RA, Bloomfield K (2001) Alcohol consumption estimates in surveys in Europe: comparability and sensitivity for gender differences. Subst Abus 22:23–38PubMedGoogle Scholar
  35. 35.
    Lima AMV, Azevedo ES (1991) Factor-VIII-C, ABO blood groups and black admixture in a Brazilian sample. Hum Biol 63:77–83PubMedGoogle Scholar
  36. 36.
    Lukassen J, Beaudet MP (2005) Alcohol dependence and depression among heavy drinkers in Canada. Soc Sci Med 61:1658–1667CrossRefPubMedGoogle Scholar
  37. 37.
    Merikangas KR, Angst J (1995) Comorbidity and social phobia: evidence from clinical, epidemiologic and genetic studies. Eur Arch Psychiatry Clin Neurosci 244:297–303CrossRefPubMedGoogle Scholar
  38. 38.
    Merikangas KR, Angst J, Eaton W, Canino G, Rubio-Stipec M, Wacker H, Wittchen HU, Andrade L, Essau C, Whitaker A, Kraemer H, Robins LN, Kupfer DJ (1996) Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. Br J Psychiatry 30(Suppl):58–67Google Scholar
  39. 39.
    Merikangas KR, Mehta RL, Molnar BE, Walters EE, Swendsen JD, Aguilar-Gaziola S, Bijl R, Borges G, Caraveo-Anduaga JJ, DeWit DJ, Kolody B, Vega WA, Wittchen HU, Kessler RC (1998) Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology. Addict Behav 23:893–907CrossRefPubMedGoogle Scholar
  40. 40.
    Merikangas K, Zhang H, Avenevoli S, Acharyya S, Neuenschwander M, Angst J (2003) Longitudinal trajectories of depression and anxiety in a prospective community study. The Zurich cohort study. Arch Gen Psychiatry 60:993–1000CrossRefPubMedGoogle Scholar
  41. 41.
    Murray RP, Connett JE, Tyas S, Bond R, Ekuma O, Silversides CK, Barnes GE (2002) Alcohol volume, drinking pattern, and cardiovascular disease morbidity and mortality: is there a U-shaped function? Am J Epidemiol 155:242–248CrossRefPubMedGoogle Scholar
  42. 42.
    Raimo EB, Schuckit MA (1998) Alcohol dependence and mood disorders. Addict Behav 23:933–946CrossRefPubMedGoogle Scholar
  43. 43.
    Rehm J, Greenfield TK, Walsh G, Xie X, Robson L, Single E (1999) Assessment methods for alcohol consumption, prevalence of high risk drinking and harm: a sensitivity analysis. Int J Epidemiol 28:219–224CrossRefPubMedGoogle Scholar
  44. 44.
    Santana V (1982) Epidemiological survey of mental disorders in a neighborhood of Salvador, Bahia. Série de Estudos em Saúde 3(suppl.):1–122Google Scholar
  45. 45.
    Santana VS, Almeida-Filho N, Rocha CO, Matos AS (1997) Proxy informant reliability and bias in epidemiological research: analysis of a screening questionnaire for mental disorders. Rev Saude Publica 31:556–565CrossRefPubMedGoogle Scholar
  46. 46.
    Torgersen S (1990) Comorbidity of major depression and anxiety disorders in twin pairs. Am J Psychiatry 147:1199–1202PubMedGoogle Scholar
  47. 47.
    Vaillant GE (1993) Is alcoholism more often the cause or the result of depression? Harvard Rev Psychiatry 1:94–99CrossRefGoogle Scholar
  48. 48.
    Wittchen HU (1996) Critical issues in the evaluation of comorbidity of psychiatric disorders. Br J Psychiatry 30(Suppl):9–16Google Scholar
  49. 49.
    Wittchen HU, Essau CA (1993) Comorbidity and mixed anxiety/depressive disorders: is there epidemiologic evidence? J Clin Psychiatry 54(Suppl):9–15PubMedGoogle Scholar
  50. 50.
    Yen IH, Kaplan G (1999) Poverty area residence and changes in depression and perceived health status: evidence from the Alameda County Study. Int J Epidemiol 28:90–94CrossRefPubMedGoogle Scholar
  51. 51.
    Zilberman ML, Tavares H, Blume SB, el-Guebaly N (2003) Substance use disorders: sex differences and psychiatric comorbidities. Can J Psychiatry 48:5–13PubMedGoogle Scholar

Copyright information

© Springer 2007

Authors and Affiliations

  • Naomar Almeida-Filho
    • 1
  • Ines Lessa
    • 2
  • Lucélia Magalhães
    • 2
  • Maria Jenny Araújo
    • 2
  • Estela Aquino
    • 2
  • Jair de Jesus Mari
    • 3
  1. 1.Palácio da Reitoria – Universidade Federal da BahiaSalvadorBrazil
  2. 2.Instituto de Saúde ColetivaUniversidade Federal da BahiaSalvadorBrazil
  3. 3.Department of PsychiatryEscola Paulista de Medicina, Universidade Federal de São PauloSão PauloBrazil

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