Comorbid Patterns with Alcohol Use Disorders

此修订后的R 01申请是为了响应计划公告（PA-07-071）的“中学 分析现有的酒精流行病学数据”。该应用程序的总体目标是评估 酒精使用障碍（AUD）与焦虑和情绪状况共病，以检查是否过渡到 酒精依赖是由特定的精神疾病和症状的存在改变，如果这些 不同性别和种族-族裔亚组之间的模式不同。尽管先前基于人群和临床的 研究提供了酒精与情绪和焦虑共病的证据 然而，对于这些并发症的模式，它们与疾病的关系， 过渡到酒精依赖，以及这些模式是否因人口的特定亚群而异。 使用全国酒精和相关疾病流行病学调查（NESARC）数据集，我们建议 1）评估AUD与焦虑症状的共病患病率、发生率和关联强度 和障碍（恐慌症、社交恐惧症、特定恐惧症和广泛性焦虑症），和2）情绪症状 和精神障碍（重性抑郁症、心境恶劣、躁狂和轻躁狂）。此外，使用国家数据 纵向酒精流行病学调查（NLAES），3）我们的目的是评估是否患病率和共病 酒精滥用和依赖与重性抑郁症的趋势已经改变， NLAES（1991-92），以及第1波（2001-02）和第2波NESARC（2004-05）。使用生存分析，4）我们 旨在评估（a）AUD发作年龄，（B）过度饮酒的首次症状，和（c）酒精 使用启动根据焦虑的存在和类型以及情绪状况而变化。使用潜在类别分析，5）我们 同时也旨在研究焦虑和情绪障碍与过度饮酒模式之间的关系 症状，并使用潜在的过渡分析，以6）评估过渡到酒精依赖的模式。在 此外，7）对于每个特定目标，我们将检查这些关联的双向评估。的 所提出的分析应该进一步加深我们对酒精的共病模式和关系的理解， 焦虑和情绪症状和障碍。评估这些合并症的模式可能 将提高我们识别高危人群的能力，从而为早期预防提供目标， 干预努力。酒精，情绪和焦虑症共同构成了一些最大的群体， 精神和物质的使用情况。然而，检查这些条件之间关系的能力 在基于人群的样本中（减少潜在的选择偏差），提供DSM-IV诊断标准， 足够大的样本，以评估性别和种族-民族亚组之间潜在的不同关联 到目前为止是相当有限的。拟议的分析应填补我们对这些问题的理解中的许多空白。 共同发生的条件。

This revised R01 application is in response to the Program Announcement (PA-07-071) for "Secondary Analysis of Existing Alcohol Epidemiology Data". The overall goals for this application are to assess patterns of alcohol use disorders (AUD) with comorbid anxiety and mood conditions, to examine whether transition to alcohol dependence is altered by the presence of specific psychiatric disorders and symptoms, and if these patterns differ among gender and race-ethnicity subgroups. Although prior population-based and clinical studies have provided evidence for the comorbid occurrence of alcohol and with both mood and anxiety disorders, there have been little assessment of patterns of these co-occurrences, their relationship with transition to alcohol dependence, and whether these patterns differ for specific subgroups of the population. Using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) dataset, we propose to 1) assess the comorbid prevalence, incidence and strength of association of AUD with anxiety symptoms and disorders (panic, social phobia, specific phobia and generalized anxiety disorder), and 2) mood symptoms and disorders (major depression, dysthymia, mania, and hypomania). In addition, using data from the National Longitudinal Alcohol Epidemiologic Survey (NLAES), 3) we aim to assess whether prevalence and comorbid trends of alcohol abuse and dependence with major depression have changed during the intervals between the NLAES (1991-92), and with wave 1 (2001-02) and wave 2 NESARC (2004-05). Using survival analyses, 4) we intend to assess whether age of (a) onset of AUD, (b) first symptom of excessive alcohol use, and (c) alcohol use initiation varies by presence and type of anxiety and mood condition. Using latent class analysis, 5) we also aim to examine the relationship of anxiety and mood disorders with patterns of excessive alcohol use symptoms, and using latent transition analyses to 6) assess patterns of transition to alcohol dependence. In addition, 7) for each specific aim, we will examine the bidirectional assessment of these associations. The proposed analyses should further our understanding of the comorbid patterns and relationships of alcohol, anxiety and mood symptoms and disorders. Assessment of patterns of these comorbid conditions potentially will improve our ability to identify high risk groups which may provide targets for early prevention and intervention efforts. Alcohol, mood and anxiety disorders together constitute some of the largest groups of mental and substance use conditions worldwide. Yet, the ability to examine the relationship of these conditions in a population-based sample (reducing potential selection biases), providing DSM-IV diagnostic criteria, within a sample large enough to assess potentially diverse associations among gender and race-ethnicity subgroups until now has been quite limited. The proposed analyses should fill in many gaps in our understanding of these co-occurring conditions.