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Comorbidity of substance misuse with anxiety-related and depressive disorders: a genetically informative population study of 3 million individuals in Sweden

  • Suvi Virtanen (a1) (a2), Ralf Kuja-Halkola (a2), David Mataix-Cols (a3) (a4), Nitya Jayaram-Lindström (a3) (a4), Brian M. D'Onofrio (a2) (a5), Henrik Larsson (a2) (a6), Christian Rück (a3) (a4), Jaana Suvisaari (a7), Paul Lichtenstein (a2) and Antti Latvala (a1) (a2)...

Abstract

Background

Causes of the comorbidity of substance misuse with anxiety-related and depressive disorders (anxiety/depression) remain poorly known. We estimated associations of substance misuse and anxiety/depression in the general population and tested them while accounting for genetic and shared environmental factors.

Methods

We studied individuals born in Sweden 1968–1997 (n = 2 996 398) with follow-up in nationwide register data for 1997–2013. To account for familial effects, stratified analyses were conducted within siblings and twin pairs. Substance misuse was defined as ICD-10 alcohol or drug use disorder or an alcohol/drug-related criminal conviction. Three dimensions of ICD-10 anxiety and depressive disorders and a substance misuse dimension were identified through exploratory factor analysis.

Results

Substance misuse was associated with a 4.5-fold (95% CI 4.50–4.58) elevated risk of lifetime generalized anxiety/depression, 4.7-fold (95% CI 4.63–4.82) elevated risk of panic disorder and agora/social phobia, and 2.9-fold elevated risk of phobias/OCD (95% CI 2.82–3.02) as compared to those without substance misuse. The associations were attenuated in within-family analyses but we found elevated risks in monozygotic twin pairs discordant for substance misuse as well as significant non-shared environmental correlations. The association between anxiety/depression and substance misuse was mainly driven by generalized anxiety/depression, whereas other anxiety/depression dimensions had minor or no independent associations with substance misuse.

Conclusions

Substance misuse and anxiety/depression are associated at the population level, and these associations are partially explained by familial liabilities. Our findings indicate a common genetic etiology but are also compatible with a potential partially causal relationship between substance misuse and anxiety/depression.

Copyright

Corresponding author

Author for correspondence: Suvi Virtanen, E-mail: suvi.virtanen@helsinki.fi

References

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Comorbidity of substance misuse with anxiety-related and depressive disorders: a genetically informative population study of 3 million individuals in Sweden

  • Suvi Virtanen (a1) (a2), Ralf Kuja-Halkola (a2), David Mataix-Cols (a3) (a4), Nitya Jayaram-Lindström (a3) (a4), Brian M. D'Onofrio (a2) (a5), Henrik Larsson (a2) (a6), Christian Rück (a3) (a4), Jaana Suvisaari (a7), Paul Lichtenstein (a2) and Antti Latvala (a1) (a2)...

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