Mental disorders as risk factors for later substance dependence
Identifieur interne : 000490 ( Ncbi/Merge ); précédent : 000489; suivant : 000491Mental disorders as risk factors for later substance dependence
Auteurs : Meyer D. Glantz ; James C. Anthony ; Patricia A. Berglund ; Louisa Degenhardt [Australie] ; Lisa Dierker ; Amanda Kalaydjian ; Kathleen R. Merikangas ; Ayelet Meron Ruscio ; Joel Swendsen [France] ; Ronald C. KesslerSource :
- Psychological medicine [ 0033-2917 ] ; 2008.
Abstract
Although mental disorders have been shown to predict subsequent substance disorders, it is unknown if substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. While experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigate this question here using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders.
Data come from the National Comorbidity Survey-Replication, a nationally representative US household survey that retrospectively assessed lifetime history and age-of-onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios.
Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders).
Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.
Url:
DOI: 10.1017/S0033291708004510
PubMed: 19046473
PubMed Central: 2705467
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<series><title level="j">Psychological medicine</title>
<idno type="ISSN">0033-2917</idno>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P2">Although mental disorders have been shown to predict subsequent substance disorders, it is unknown if substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. While experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigate this question here using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders.</p>
</sec>
<sec sec-type="methods" id="S2"><title>Methods</title>
<p id="P3">Data come from the National Comorbidity Survey-Replication, a nationally representative US household survey that retrospectively assessed lifetime history and age-of-onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P4">Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders).</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P5">Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.</p>
</sec>
</div>
</front>
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<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">1254142</journal-id>
<journal-id journal-id-type="pubmed-jr-id">6777</journal-id>
<journal-id journal-id-type="nlm-ta">Psychol Med</journal-id>
<journal-title>Psychological medicine</journal-title>
<issn pub-type="ppub">0033-2917</issn>
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<article-meta><article-id pub-id-type="pmid">19046473</article-id>
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<article-id pub-id-type="doi">10.1017/S0033291708004510</article-id>
<article-id pub-id-type="manuscript">NIHMS88824</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Mental disorders as risk factors for later substance dependence</article-title>
<subtitle>Estimates of optimal prevention and treatment benefits</subtitle>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Glantz</surname>
<given-names>Meyer D.</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="author-notes" rid="FN1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Anthony</surname>
<given-names>James C.</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Berglund</surname>
<given-names>Patricia A.</given-names>
</name>
<degrees>MBA</degrees>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Degenhardt</surname>
<given-names>Louisa</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dierker</surname>
<given-names>Lisa</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kalaydjian</surname>
<given-names>Amanda</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Merikangas</surname>
<given-names>Kathleen R.</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A6">6</xref>
<xref ref-type="author-notes" rid="FN1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ruscio</surname>
<given-names>Ayelet Meron</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Swendsen</surname>
<given-names>Joel</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A8">8</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kessler</surname>
<given-names>Ronald C.</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A9">9</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
the Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health</aff>
<aff id="A2"><label>2</label>
the Department of Epidemiology and Biostatistics, Michigan State University School of Medicine</aff>
<aff id="A3"><label>3</label>
Institute for Social Research, University of Michigan</aff>
<aff id="A4"><label>4</label>
National Drug and Alcohol Research Centre, University of New South Wales, Australia</aff>
<aff id="A5"><label>5</label>
Department of Psychology, Wesleyan University</aff>
<aff id="A6"><label>6</label>
National Institute of Mental Health</aff>
<aff id="A7"><label>7</label>
Department of Psychology, University of Pennsylvania</aff>
<aff id="A8"><label>8</label>
National Scientific Research Center (CNRS 5231), Bordeaux, France</aff>
<aff id="A9"><label>9</label>
Department of Health Care Policy, Harvard Medical School.</aff>
<author-notes><corresp id="CR1">Send correspondence to <email>ncs@hcp.med.harvard.edu</email>
. Send reprint requests to Dr. Glantz at: 6001 Executive Boulevard, Suite 5185, MSC 9589 Bethesda, MD 20892; Email: <email>mglantz@nida.nih.gov</email>
.</corresp>
<fn id="FN1"><label>*</label>
<p id="P1">The viewpoints expressed in this article do not necessarily represent those of the National Institutes of Health or the United States Department of Health and Human Services.</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>21</day>
<month>1</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="epub"><day>2</day>
<month>12</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="ppub"><month>8</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>1</day>
<month>8</month>
<year>2009</year>
</pub-date>
<volume>39</volume>
<issue>8</issue>
<fpage>1365</fpage>
<lpage>1377</lpage>
<abstract><sec id="S1"><title>Background</title>
<p id="P2">Although mental disorders have been shown to predict subsequent substance disorders, it is unknown if substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. While experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigate this question here using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders.</p>
</sec>
<sec sec-type="methods" id="S2"><title>Methods</title>
<p id="P3">Data come from the National Comorbidity Survey-Replication, a nationally representative US household survey that retrospectively assessed lifetime history and age-of-onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P4">Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders).</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P5">Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.</p>
</sec>
</abstract>
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