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

Suvi Virtanen, Ralf Kuja-Halkola, David Mataix-Cols, Nitya Jayaram-Lindström, Brian M. D'Onofrio, Henrik Larsson, Christian Ruck, Jaana Suvisaari, Paul Lichtenstein, Antti Latvala

Research output: Contribution to journalArticleScientificpeer-review

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.
Original languageEnglish
Article number0033291719001788
JournalPsychological Medicine
Volume50
Issue number10
Pages (from-to)1706-1715
Number of pages10
ISSN0033-2917
DOIs
Publication statusPublished - Jul 2020
MoE publication typeA1 Journal article-refereed

Fields of Science

  • 3124 Neurology and psychiatry
  • 515 Psychology
  • Alcohol
  • anxiety
  • cohort
  • depression
  • drug
  • family study
  • genetic
  • substance use
  • twins
  • ALCOHOL-USE DISORDERS
  • DRUG-USE DISORDERS
  • POSTTRAUMATIC-STRESS-DISORDER
  • NATIONAL EPIDEMIOLOGIC SURVEY
  • ENVIRONMENTAL RISK-FACTORS
  • DSM-IV MOOD
  • PSYCHIATRIC-DISORDERS
  • MENTAL-HEALTH
  • PREVALENCE
  • LIFETIME

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