Comorbid Patterns with Alcohol Use Disorders

描述（由申请人提供）：此修订的R 01申请是对“现有酒精流行病学数据的二次分析”项目公告（PA-07-071）的回应。本申请的总体目标是评估酒精使用障碍（AUD）与共病焦虑和情绪状况的模式，以检查向酒精依赖的转变是否因特定精神疾病和症状的存在而改变，以及这些模式是否在性别和种族-民族亚组之间存在差异。尽管先前的基于人群的临床研究提供了酒精与心境障碍和焦虑障碍共病的证据，但很少评估这些共病的模式，其与向酒精依赖过渡的关系，以及这些模式是否因特定人群而异。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与焦虑症状和障碍（恐慌，社交恐怖症，特定恐怖症和广泛性焦虑症）的共病患病率，发病率和关联强度，以及2）情绪症状和障碍（重度抑郁症，心境恶劣，躁狂症和轻躁狂）。此外，使用来自全国纵向酒精流行病学调查（NLAES）的数据，3）我们旨在评估在NLAES（1991-92）、第1波（2001-02）和第2波NESARC（2004-05）之间，酒精滥用和依赖与重性抑郁症的患病率和共病趋势是否发生了变化。使用生存分析，4）我们打算评估（a）AUD发作的年龄，（B）过度饮酒的首次症状，和（c）开始饮酒的年龄是否因焦虑和情绪状况的存在和类型而异。使用潜在类别分析，5）我们还旨在检查焦虑和情绪障碍与过度饮酒症状模式的关系，并使用潜在转换分析来评估向酒精依赖过渡的模式。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。建议的分析应进一步了解共病模式和酒精，焦虑和情绪症状和障碍的关系。对这些合并症模式的评估可能会提高我们识别高危人群的能力，这可能会为早期预防和干预工作提供目标。酒精、情绪和焦虑症共同构成了全世界最大的精神和药物使用状况群体。然而，在一个足够大的样本中检查这些条件之间的关系的能力（减少潜在的选择偏差），提供DSM-IV诊断标准，以评估性别和种族-民族亚组之间的潜在多样性关联，直到现在一直是非常有限的。拟议的分析应填补我们对这些共同发生的条件的理解中的许多空白。公共卫生相关性：焦虑和情绪问题是世界上最常见的心理健康障碍之一。这些问题可能会增加其他情况发生的机会，如酒精成瘾。使用从最大的调查之一收集的信息来评估美国居民中这些症状的存在，我们将研究不同群体的这些关系，以帮助了解一些人是否或多或少容易受到这些条件的影响。这项研究旨在评估情绪，焦虑和饮酒行为之间可能发生的复杂关系，希望更好地了解这些关系将有助于我们确定预防和干预这些疾病的改进方法。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Anxiety and mood problems are among the most common mental health disorders worldwide. These problems may increase the chance that other conditions occur such as addictions to alcohol. Using information gathered from one of the largest surveys to evaluate the presence of these symptoms among residents of the United States, we will study these relationships by different groups, in order to help understand if some individuals are more or less vulnerable to these conditions. This study aims to evaluate the complex relationships that may be occurring between mood, anxiety and drinking behavior with the hope that understanding these relationships better will help us identify improved methods for preventing and intervening with these conditions.