Comorbid Patterns with Alcohol Use Disorders

此修订的R01申请是对计划公告(PA-07-071)的响应 对现有酒精流行病学数据的分析。这个应用程序的总体目标是评估 酒精使用障碍(AUD)合并焦虑和情绪状况，以检查是否过渡到 酒精依赖是通过出现特定的精神障碍和症状而改变的，如果这些 性别和种族-民族亚群之间的模式不同。尽管之前基于人群和临床 研究提供了酒精、情绪和焦虑并存的证据。 精神障碍，几乎没有对这些共同发生的模式进行评估，它们与 向酒精依赖的转变，以及这些模式是否对特定的人口亚群有所不同。 使用全国酒精及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、发生率和强度 和障碍(恐慌、社交恐惧症、特定恐惧症和广泛性焦虑症)，以及2)情绪症状 以及精神障碍(严重抑郁、心境恶劣、躁狂和轻躁)。此外，使用国家统计局的数据 纵向酒精流行病学调查(NLAES)，3)我们的目标是评估患病率和共存率 酗酒和对重度抑郁症的依赖的趋势在以下两年间发生了变化 NLAES(1991-92)，以及第一波(2001-02)和第二波NESARC(2004-05)。使用生存分析，4)我们 打算评估(A)AUD的发病年龄，(B)过度饮酒的首发症状，和(C)酒精 使用开始因存在以及焦虑和情绪状况的类型而异。使用潜在类分析，5)我们 还旨在研究焦虑和情绪障碍与过度饮酒模式的关系 症状，并使用潜在的过渡分析来评估过渡到酒精依赖的模式。在……里面 此外，对于每个具体目标，我们将审查对这些协会的双向评估。这个 拟议的分析应该会加深我们对酒精的共病模式和关系的理解， 焦虑、情绪症状和精神障碍。潜在地评估这些并存情况的模式 将提高我们识别高危人群的能力，这可能为早期预防和 干预努力。酒精、情绪和焦虑症共同构成了一些最大的 全世界的精神和物质使用状况。然而，检查这些条件之间的关系的能力 在基于总体的样本中(减少潜在的选择偏差)，提供DSM-IV诊断标准，在 一个足够大的样本来评估性别和种族亚群之间潜在的不同联系 到目前为止，这方面的研究还相当有限。拟议的分析应该会填补我们对这些问题理解上的许多空白。 同时出现的情况。

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.