Smoking, nicotine dependence and psychiatric comorbidity--a population-based study including smoking cessation after three years

BACKGROUND: Evidence suggests that nicotine-dependent smokers are at increased risk for psychiatric comorbidity but general population data that included the number of nicotine dependence and withdrawal symptoms according to DSM-IV, the Fagerstrom Test for Nicotine Dependence (FTND), somatoform disorders and the number of psychiatric diagnoses are rare. The goal of the present study was to analyse relationships of smoking and nicotine dependence with psychiatric disease and whether psychiatric disease predicts the sustaining of smoking after three years. METHODS: Cohort study with a random adult population sample in a northern German region (N = 4075) including a baseline measurement of ever daily smokers aged 18-64 (n = 2458), a first follow-up of the current smokers at baseline (n = 1552) after 30 months and a second follow-up after 36 months. Measures included DSM-IV diagnoses by the Composite International Diagnostic Interview, FTND, smoking cessation by interview. RESULTS: Current daily smokers showed higher odds of a substance use disorder other than nicotine dependence compared with never smokers (odds ratio, OR, 4.6; confidence interval, CI, 2.9-7.2), affective (OR 1.8; CI 1.4-2.5), anxiety (OR 1.6; CI 1.2-2.0) or somatoform disorder (OR 1.4; CI 1.0-1.8). DSM-IV nicotine dependence and the FTND were positively related with the number of psychiatric diagnoses. Psychiatric comorbidity did not predict the maintenance of smoking or quitting. CONCLUSIONS: Findings of increased rates of mental disorders among smokers and nicotine-dependent smokers in the adult general population are supported by this study. The number of nicotine dependence and withdrawal symptoms are related to mental disorders. In addition, somatoform disorders show relationships with smoking similar to relationships with depressive or anxiety disorders. The intention to stop smoking should be proactively supported among these comorbid patients.     

Risk of hospitalization for psychiatric disorders among siblings and parents of probands with psychotic or affective disorders: A population-based study

Relatives of people diagnosed with psychotic and affective disorders have a higher risk of developing psychiatric disorders compared to the general population. This study examined the risk of hospitalization for psychiatric disorders among siblings and parents of patients affected with major psychiatric disorders. In this large population-based case-control study, 17,895 siblings and parents of 7671 hospitalized subjects with a diagnosis of narrowly defined schizophrenia (SZ), broadly defined SZ, schizoaffective disorder (SAD), bipolar disorder (BD) or unipolar depression (UD) were identified from the Israeli Psychiatric Hospitalization Registry and compared to 71,580 age and gender-matched controls from the Israeli Population Registry. Results indicated that siblings of people diagnosed with broadly defined SZ had a significantly higher risk of hospitalization for broadly (OR=11.06, 95% CI=7.93–15.41) and narrowly defined SZ (OR=10.59, 95% CI=6.8–16.33), SAD (OR=9.69, 95% CI=4.76–19.73), BD (OR=7.46, 95% CI=21.8–25.52), UD (OR=2.84, 95% CI=1.01–8.00), and other psychiatric disorders (OR=1.85, 95% CI=1.16–2.93), compared to controls. Siblings of patients with BD had a significantly higher risk of hospitalization for broadly defined SZ (OR=2.92, 95% CI=1.11–7.71) and for other psychiatric disorders (OR=6.67, 95% CI=2.17–20.50), compared to controls. Parents of probands with SZ were at significantly increased risk for all disorders examined, except for UD and ¨other psychiatric disorders¨, which was not significant in parents of probands with BD. This large, population-based study provides evidence for common genetic risk across different psychiatric disorders.     

Nicotine dependence and sleep quality in young adults

IntroductionMore cigarette smokers report poor sleep quality than non-smokers, but the association between nicotine dependence (ND) and sleep quality has not been well-characterized. The objective of this study was to describe the associations among frequency and intensity of cigarette smoking, ND symptoms, and sleep quality in young adults.MethodsData on past-year smoking frequency, number of cigarettes smoked in the past month, five ND indicators (i.e., withdrawal, craving, self-medication symptoms, mFTQ, ICD-10 criteria for tobacco dependence), and sleep quality (measured with the Pittsburgh Sleep Quality Index (PSQI)) were collected in 2011–12 in self-report questionnaires completed by 405 young adult smokers (mean age 24 (0.6) years; 45% male; 45% daily smokers) participating in a longitudinal investigation of the natural course of ND. Associations between indicators of cigarette smoking, ND symptoms, and sleep quality were examined in multivariable logistic regression analyses controlling for age, sex, mother's education, and alcohol use.ResultsThirty-six percent of participants reported poor sleep quality (PSQI > 5). Higher cigarette consumption (OR(95% CI), 1.03(1.001–1.05)) but not frequency of past-year smoking, more frequent withdrawal symptoms (1.05(1.004–1.10)), more frequent cravings (1.05(1.004–1.10)), higher mFTQ scores (1.14(1.02–1.27)), and endorsing more ICD-10 criteria for tobacco dependence (1.19(1.04–1.36)) were also associated with poor sleep quality.ConclusionCigarette smoking and ND symptoms are associated with poor sleep quality in young adult smokers. Advice from practitioners to cut back on number of cigarettes smoked per day and treatment of ND symptoms may improve sleep quality in young adult smokers.     

Serotonin (5-HT) precursor loading with 5-hydroxy-l-tryptophan (5-HTP) reduces locomotor activation produced by (+)-amphetamine in the rat

BackgroundFew studies have differentiated between independent and substance-induced psychiatric disorders. In this study we determine the risks associated with independent and substance-induced psychiatric disorders among a sample of 629 illicit drug users recruited from treatment and out of treatment settings.MethodsSecondary analysis of five cross-sectional studies conducted during 2000–2006. Independent and substance-induced DSM-IV psychiatric diagnoses were assessed using the Psychiatric Research Interview for Substance and Mental Disorders.ResultsLifetime prevalence of Axis I disorders other than substance use disorder (SUD) was 41.8%, with independent major depression being the most prevalent (17%). Lifetime prevalence of antisocial or borderline personality disorders was 22.9%. In multinominal logistic regression analysis (SUD only as the reference group), being female (OR 2.45; 95% CI 1.59, 3.77) and having lifetime borderline personality disorder (OR 2.45; 95% CI 1.31, 4.59) remained significant variables in the group with independent disorders. In the group with substance-induced disorders, being recruited from an out of treatment setting (OR 3.50; 95% CI 1.54, 7.97), being female (OR 2.38; 95% CI 1.24, 4.59) and the number of SUD (OR 1.31; 95% CI 1.10, 1.57) remained significant in the model. These variables were also significant in the group with both substance-induced and independent disorders, together with borderline personality disorder (OR 2.53; 95% CI 1.03, 6.27).ConclusionsIllicit drug users show high prevalence of co-occurrence of mainly independent mood and anxiety psychiatric disorders. Being female, recruited from an out of treatment setting and the number of SUD, are risk factors for substance-induced disorders.     

Psychopathology among cannabis-dependent treatment seekers and association with later substance abuse treatment

We determined the proportion of psychiatric treatments for disorders not due to substance use among a cohort of subjects (n = 3,114) seeking treatment for cannabis dependence. Data were retrieved from Danish treatment registers. Cases were compared with a representative sample, which was randomly selected from the general population according to age and gender (n = 15,570). Cannabis users were followed, and reentry into substance abuse treatment was used as an outcome deploying Cox regression analysis. The proportion of treatment for all psychiatric disorders was much higher among cases than among controls: schizophrenia (odds ratio [OR] = 7.9; 95% confidence interval [95% CI] = 6.1-10.2), bipolar disorders (OR = 4.9; 95% CI = 2.8-8.5), other affective disorders (OR = 7.6; 95% CI = 6.1-9.5), and personality disorders (OR = 17.3; 95% CI = 14.5-20.5). All in all, 40.7% of cases, compared with 5.2% of controls, had received psychiatric treatment (OR = 12.5; 95% CI = 11.3-13.8). A history of psychiatric treatment was associated with increased rates of reentry into substance abuse treatment, in general (OR = 1.35; 95% CI = 1.20-1.53), specifically for cannabis (OR = 1.26; 95% CI = 1.07-1.48) and opioid (OR = 1.56; 95% CI = 1.23-1.99) dependence. This is the first study to show that the proportion of psychiatric treatment is much elevated among subjects seeking treatment for cannabis dependence, and that a history of psychiatric problems is associated with higher rates of reentry into substance abuse treatment.     

Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment

Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [CI] = 0.040-0.587, p < .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% CI = 0.105-0.970, p < .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use.     

Using an item response model to examine the nicotine dependence construct as characterized by the HONC and the mFTQ among adolescent smokers

Despite efforts to operationalize the nicotine dependence syndrome among adolescents, little is known regarding the relative severity of dependence symptoms assessed by different measures. The current study utilized a nonparametric item response model to assess the unidimensionality of the nicotine dependence construct and relative severity of dependence symptoms characterized by the Hooked on Nicotine Checklist (HONC) and the modified Fagerström Questionnaire (mFTQ) in a sample of 109 adolescent smokers (58% female) participating in a prospective investigation of smoking self-change efforts. It was hypothesized that symptoms assessed by the HONC would be associated with lower levels of nicotine dependence severity than symptoms assessed with the mFTQ. Results indicated that HONC and mFTQ items could be linked to a single latent construct. Most HONC items captured variability at the lower range and mFTQ items made discriminations at the middle and higher end of the dependence severity continuum. Findings suggest the HONC and mFTQ may provide complementary information in assessing nicotine dependence levels in adolescent regular smokers and have implications for symptoms expression in youth.     

Prevalence of substance use in a Swiss psychiatric hospital: interview reports and urine screening

BACKGROUND: Co-morbid substance misuse is common in psychiatric disorders, has potentially severe adverse consequences and may be frequently undetected. AIMS: To measure the prevalence of substance use among patients admitted to a Swiss psychiatric hospital and to examine the potential utility of routine urine drug screening in this setting. METHOD: 266 inpatients were included. 238 patients completed the interview and 240 underwent a urine drug screening. RESULTS: Lifetime prevalence of substance use among psychiatric patients was very high for alcohol (98%; 95% CI: 96-100), benzodiazepines (86%; 95% CI: 82-91) and cannabis (53%; 95% CI: 47-60), but also for "hard drugs" like cocaine (25% ; 95% CI: 19-30) or opiates (20%; 95% CI: 15-25). Regular current use of alcohol (32%; 95% CI: 26-38) or cannabis (17%; 95% CI: 12-22) was the most frequent. Substance use was associated with male sex, younger age, unmarried status and nicotine smoking. Urine screening confirms reports from patients on recent use, and remained positive for cannabis during hospitalisation, but not for cocaine nor for opiates. CONCLUSION: Substance use is frequent among psychiatric patients. Systematic interviewing of patients about their substance use remains essential, and is usually confirmed by urine screening. Urine screening can be useful to provide specific answers about recent use.     

Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans

BackgroundAmerican Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited.MethodsThis study analyzes the co-occurrence of current and lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders in a community sample of 480 American Indian male veterans.ResultsLifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, affective and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% of the sample and significantly associated with current affective and gambling disorder.ConclusionsSubstantial co-morbidity exists between nicotine dependence and other substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended.     

Association of Family Background with Adolescent Smoking and Regular Use of Illicit Substances Among Underage Psychiatric In-Patients

ABSTRACT

This study investigated whether adolescent's family type was associated with regular smoking or the use of illicit substances (cannabis or hard drugs) among underage adolescent psychiatric in-patients. The sample consisted of 471 adolescents aged 12–17 years admitted to psychiatric hospital between April 2001 and March 2006 at Oulu University Hospital, Finland. The information on family factors and substance use was based on the Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime interview and the European modification of the Addiction Severity Index questionnaire. Compared to adolescent boys from two-parent families, those from child welfare placement were more likely to regularly use both cannabis (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.4–13.7; P = .012) and hard drugs (OR = 8.4; 95% CI = 1.7–42.1; P = .01). Among girls, no association was found between family type and the use of illicit substances. Two-parent or foster family units may protect adolescents from involvement with illicit substances. In clinical adolescent psychiatric practice more attention should be paid to family interventions and parental support.     

Addiction epidemiology in adolescents receiving inpatient psychiatric treatment

This study sought to characterize adolescent psychiatric inpatient populations from two sites and to determine correlates of substance use disorders (SUD). Screening procedures for SUD differ substantially between these sites. A retrospective review of adolescent inpatients (n=636) revealed that the populations were similar in gender, race and age. Rates of SUD at the site with a formalized SUD screening regimen were higher (39%) than those at the other site (16.5%). Similar correlates of SUD were observed across sites, including older age, legal involvement, sexual activity, childhood disruptive disorder, and tobacco use. These results suggest that SUD is a major issue in adolescent psychiatric patients. More rigorous screening for SUD and its correlates may facilitate earlier detection of substance use in this vulnerable population.     

Withdrawal symptoms over time among adolescents in a smoking cessation intervention: Do symptoms vary by level of nicotine dependence?

Nicotine dependence may be expressed differently in teens than in adults. Thus, it may not be sufficient to build diagnostic and cessation treatment strategies for teens based on adult-derived clinical and research data. This is the first study to prospectively examine the development of withdrawal symptoms by level of nicotine dependence among adolescent smokers. Forty-seven adolescent smokers completed nicotine withdrawal symptoms measures during 10 weeks of cessation treatment. Nicotine dependence was assessed at baseline using the mFTQ. Change in withdrawal symptoms over time by level of nicotine dependence was examined via mixed model ANOVA. Nicotine withdrawal in daily adolescent smokers was strongly and prospectively associated with the level of nicotine dependence. Craving was rated as the most problematic symptom at the baseline assessment. The results of this study may help guide the development of future research on diagnostic and cessation treatment strategies for teens.     

Risks of major depressive disorder and anxiety disorders among Thais with alcohol use disorders and illicit drug use: Findings from the 2008 Thai National Mental Health survey

Little is known about the risks of mood and anxiety disorders among Asians with alcohol use disorders and the effect of illicit drug use in this population. All participants from the 2008 Thai National Mental Health survey (N=17,140) were assessed for current major depressive disorder, anxiety disorders, and alcohol use disorders by using the Mini International Neuropsychiatric Interview (MINI) and were interviewed for illicit drug use within one year prior to their assessment. Logistic regression modeling was used to determine (a) whether alcohol use disorders were associated with major depressive disorder and anxiety disorders and (b) whether the use of illicit drugs increased these associations. Sex, age, marital status, region, and educational level were found to be significantly associated with major depressive disorder and anxiety disorders and were taken into account in the regression analysis. Compared with the general population, individuals with alcohol use disorders alone had significantly increased risks of major depressive disorder (OR 2.49, 95%CI 1.76-3.53 in men and OR 4.09, 95%CI 2.31-7.26 in women) and anxiety disorders (OR 2.21, 95%CI 1.46-3.36 in men and OR 4.34, 95%CI 2.35-8.03 in women). The risks became higher among individuals with both alcohol use disorders and illicit drug use (OR 3.62, 95% CI 1.64-8.01 in men and OR 11.53, 95%CI 1.32-100.65 in women for major depressive disorder, and OR 3.20, 95%CI 1.36-7.51 in men and OR 13.10, 95%CI 1.48-115.60 in women for anxiety disorders). In conclusion, alcohol use disorders were significantly associated with major depressive disorder and anxiety disorders. Illicit drug use was an important factor in increasing these associations, especially in women. Screening for depression, anxiety, and illicit drug use should be done in individuals with alcohol use disorders.     

Associations between problematic gaming and psychiatric symptoms among adolescents in two samples

The aim of the present study was to investigate associations between problematic gaming and psychiatric symptoms among adolescents. Data from adolescents in the SALVe cohort, including adolescents in Västmanland who were born in 1997 and 1999 (N = 1868; 1034 girls), and data from consecutive adolescent psychiatric outpatients in Västmanland (N = 242; 169 girls) were analyzed. Adolescents self-rated on the Gaming Addiction Identification Test (GAIT), Adult ADHD Self-Report Scale Adolescent version (ASRS-A), Depression Self-Rating Scale Adolescent version (DSRS-A), Spence Children's Anxiety Scale (SCAS), and psychotic-like experiences (PLEs). Multivariable logistic regression analyses were performed, and adjusted for sex, age, study population, school bullying, family maltreatment, and interactions by sex, with two-way interactions between psychiatric measurements. Boys had higher self-rated problematic gaming in both samples, whereas girls self-rated higher in all psychiatric domains. Boys had more than eight times the probability, odds ratio (OR), of having problematic gaming. Symptoms of ADHD, depression and anxiety were associated with ORs of 2.43 (95% CI 1.44–4.11), 2.47 (95% CI 1.44–4.25), and 2.06 (95% CI 1.27–3.33), respectively, in relation to coexisting problematic gaming. Problematic gaming was associated with psychiatric symptoms in adolescents; when problematic gaming is considered, the probability of coexisting psychiatric symptoms should also be considered, and vice versa.     

我院840例住院儿童青少年精神疾病患者用药医嘱分析

目的:调查我院住院儿童青少年精神疾病患者疾病分类及用药情况。方法:采用分层随机抽样方法抽取我院2011-2013年840例住院儿童青少年精神疾病患者用药医嘱,对患者年龄、性别、疾病诊断、用药情况进行统计、分析。结果:住院儿童青少年精神疾病患者发病率排前3位的分别是精神分裂症及分裂型障碍(55.1%)、心境障碍(9.9%)和起病于童年与少年期的行为与情绪障碍(5.1%);不能确诊的疾病分类的状态诊断约占病例数的20%。治疗精神疾病及相关药物医嘱数最多(约占68%),其中抗精神病药占到35.30%;其他药品占总用药医嘱数的约30.96%。用药例次最高的也是抗精神病药,为1 570例次;使用频次最高的是抗抑郁药(5),表明住院儿童青少年精神疾病患者使用抗抑郁药的平均次数高于其他药物。结论:目前用于治疗精神疾病的药品说明书,多数缺少儿童青少年适应证的使用信息。临床医师需评估疗效与风险后,谨慎使用治疗药物。     

Benzodiazepine therapy in psychiatric outpatients is associated with deliberate self-poisoning events at emergency departments—a population-based nested case–control study

Rationale

Deliberate self-poisoning (DSP), the most common form of deliberate self-harm, is closely associated with suicide. Identifying risk factors of DSP is necessary for implementing prevention strategies.

Objectives

This study aimed to evaluate the relationship between benzodiazepine (BZD) treatment in psychiatric outpatients and DSP cases at emergency departments (EDs).

Methods

We performed a retrospective nested case–control study of psychiatric patients receiving BZD therapy to evaluate the relationship between BZD use and the diagnosis of DSP at EDs using data from the nationwide Taiwan National Health Insurance Research Database.

Results

Regression analysis yielded an odds ratio (OR) and 95 % confidence interval (95 % CI) indicating that the use of BZDs in psychiatric outpatients was significantly associated with DSP cases at EDs (OR?=?4.46, 95 % CI?=?3.59–5.53). Having a history of DSP, sleep disorders, anxiety disorders, schizophrenia, depression, or bipolar disorder was associated with a DSP diagnosis at EDs (OR?=?13.27, 95 % CI?=?8.28–21.29; OR?=?5.04, 95 % CI?=?4.25–5.98; OR?=?3.95, 95 % CI?=?3.32–4.70; OR?=?7.80, 95 % CI?=?5.28–11.52; OR?=?15.20, 95 % CI?=?12.22–18.91; and OR?=?18.48, 95 % CI?=?10.13–33.7, respectively). After adjusting for potential confounders, BZD use remained significantly associated with a subsequent DSP diagnosis (adjusted OR?=?2.47, 95 % CI?=?1.93–3.17). Patients taking higher average cumulative BZD doses were at greater risk of DSP.

Conclusion

Vigilant evaluation of the psychiatric status of patients prescribed with BZD therapy is critical for the prevention of DSP events at EDs.     

Smoking Cessation Outcomes and Predictors Among Individuals With Co-occurring Substance Use and/or Psychiatric Disorders

Objective: Individuals with substance use and psychiatric disorders have a high prevalence of tobacco use disorders and are disproportionately affected by tobacco-related morbidity and mortality. However, it is unclear how having co-occurring disorders affects tobacco cessation. Our aim was to examine smoking cessation outcomes and relevant predictors of smoking cessation among smokers with substance use and/or psychiatric disorders. Methods: Data from medical records of 674 participants in a tobacco treatment program within mental health and addictions services in Vancouver, Canada, were analyzed. The 26-week treatment program included an 8-week structured behavioral counseling group, an 18-week support group, and 26 weeks of no-cost pharmacotherapy. Information on demographics, tobacco use and history, type of pharmacotherapy received, nicotine dependence, importance of and confidence in quitting smoking, expired carbon monoxide level, substance use and psychiatric disorder history, and total program visits were gathered. Results: Approximately 67% (n = 449) of participants had co-occurring substance use and psychiatric disorders, while 20% (n = 136) had substance use disorder only, 10% (n = 67) had psychiatric disorder only, and 3% (n = 22) had tobacco dependence only. Rates of tobacco cessation (i.e., 7-day point prevalence of abstinence verified by expired carbon monoxide of ≤8 ppm) by group in the 522 people who completed treatment were as follows: 38.2% for those with co-occurring disorders, 47.1% for those with tobacco dependence only, 47.1% for those with substance use disorder only, and 41.8% for those with psychiatric disorder only. Length of treatment was a significant predictor of smoking cessation for those with co-occurring disorders and substance use disorder only. In the final stratified multivariate analysis, for individuals with co-occurring disorders, having an opiate use disorder (as compared to an alcohol use disorder) and higher nicotine dependence scores at baseline were predictive of poor cessation outcomes, while greater length of treatment was predictive of successful smoking cessation. Conclusions: Tobacco cessation treatment for individuals with co-occurring substance use and psychiatric disorders is likely to be as effective as for smokers with either disorder alone. Treatment duration predicts success among these smokers so strategies to enhance engagement and retention are needed.     

Patterns and correlates of benzodiazepine use in the French general population

Objective To investigate the prevalence of current use of benzodiazepines (BZDs) and related drugs in the French general population and factors associated with this use.Methods National cross-sectional telephone survey conducted between 25 April 2001 and 8 May 2001 in a representative sample of non-institutionalized adults of BZD use and duration, prescriber specialty, socio-demographic data and mood and anxiety disorders, using a structured diagnostic interview. Results The prevalence of current use of BZD was 7.5%. It was higher among women (9.7%) than men (5.2%). It increased with age and was higher in the jobless (10.9). Duration of BZD use was more than 6 months in 75.9% of users and increased with age. Of the 711 (17.7%) subjects with at least one mood or anxiety disorder, 122 (17%) used BZD compared with180 (5.5%) of the 3296 subjects without mood or anxiety disorders. In multivariate analysis, factors associated with BZD use were age [odds ratio (OR): 3.6; 95% confidence interval (CI) 2.0–5.6], 6.5 (4.1–10.3) and 10.9 (6.9–17.1), respectively, for ages 35–44 years, 45–59 years and over 60 years compared with below 34 years, female gender (OR: 1.7; 95% CI 1.3–2.1), anxiety only (OR: 2.2; 95% CI 1.5–3.2), mood disorder only (OR: 4.4; 95% CI 2.7–7.1) or both mood and anxiety disorders (OR: 8.8; 95% CI 5.9–12.6). Conclusion Despite precautions, warnings and attempts to limit use, there remains a high proportion of long-term BZD users in the general French population, especially in the elderly. Our findings add to the weight of opinion that messages concerning proper use of BZDs certainly need to be clarified and amplified.     

Husbands' SUD is associated with higher levels of co-occurring but not non-co-occurring psychiatric disorders among their wives

OBJECTIVE: Substance use among husbands has been shown to be associated with higher rates of substance use and of psychiatric symptoms among their wives. However, substance use disorders (SUD) and psychiatric disorders (as opposed to substance use or psychiatric symptoms) are rarely rigorously assessed among large samples of couples, so it is unclear whether SUD among husbands are associated with SUD among their wives, and whether the wives also display a higher prevalence of co-occurring or non-co-occurring psychiatric disorders. We compared the level of SUD, of co-occurring (with SUD) psychiatric disorders, and of non-co-occurring psychiatric diagnoses among the wives of males with SUDs vs among the wives of males without SUDs. We hypothesized that the presence of SUDs among males would be associated with a higher level of SUDs, of co-occurring psychiatric disorders, and of non-co-occurring psychiatric disorders in their wives. METHOD: The subjects in this study were the spouses of adult men with a lifetime history of an SUD (SUD+ husbands, N=342) vs those with no lifetime history of an SUD (SUD- husbands, N=350). These subjects were recruited for participation in a longitudinal project designed to elucidate the etiology of substance use disorders. RESULTS: Co-occurring SUDs were five times more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands (10.2% vs 2.0%, chi-square=19.7, p=0.000). SUD/depressive disorder and SUD/anxiety disorder were both seven times more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands (19.4% vs 4.7%, chi-square=45.8, p=0.000; 14.3% vs 2.0%, chi-square=34.5, p=0.000). In contrast, non-co-occurring depressive disorders and non-co-occurring anxiety disorders were not more common among the wives of the SUD+ husbands than among the SUD- husbands. CONCLUSIONS: These findings demonstrate that SUD and co-occurring psychiatric disorders (with SUD) are more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands, but non-co-occurring ("pure") psychiatric disorders are not more common among the spouses of the SUD+ husbands.