Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders: findings from the Netherlands Study of Depression and Anxiety (NESDA)

INTRODUCTION: This study examines comorbidity of alcohol abuse and alcohol dependence as well as its risk indicators among anxious and/or depressed persons, also considering temporal sequencing of disorders.

METHODS: Baseline data from the Netherlands Study of Depression and Anxiety (NESDA) were used, including 2329 persons with lifetime DSM-IV anxiety (social phobia, generalized anxiety disorder, panic disorder, and agoraphobia) and/or depressive (major depressive disorder and dysthymia) disorders and 652 controls. Lifetime diagnoses of DSM-IV alcohol abuse and dependence were established, as well as information about socio-demographic, vulnerability, addiction-related and anxiety/depression-related characteristics. Temporal sequencing of disorders was established retrospectively, using age of onset.

RESULTS: Of persons with combined anxiety/depression 20.3% showed alcohol dependence versus 5.5% of controls. Prevalence of alcohol abuse was similar across groups (± 12%). Independent risk indicators for alcohol dependence among anxious and/or depressed persons were male gender, vulnerability factors (family history of alcohol dependence, family history of anxiety/depression, openness to experience, low conscientiousness, being single, and childhood trauma), addiction-related factors (smoking and illicit drug use) and early anxiety/depression onset. Persons with secondary alcohol dependence were more neurotic, more often single and lonelier, while persons with primary alcohol dependence were more often male and more extravert.

DISCUSSION: Alcohol dependence, but not abuse, is more prevalent in anxious and/or depressed persons. Persons with comorbid alcohol dependence constitute a distinct subgroup of anxious and/or depressed persons, characterized by addiction-related habits and vulnerability. However, considerable variation in characteristics exists depending on temporal sequencing of disorders. This knowledge may improve identification and treatment of those anxious and/or depressed patients who are additionally suffering from alcohol dependence.