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)

Lynn Boschloo, Nicole Vogelzangs, Johannes H Smit, Wim van den Brink, Dick J Veltman, Aartjan T F Beekman, Brenda W J H Penninx

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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.

Original languageEnglish
Pages (from-to)233-242
Number of pages10
JournalJournal of affective disorders
Issue number1-3
Early online date19 Jan 2011
Publication statusPublished - Jun 2011


  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Alcoholism/epidemiology
  • Anxiety Disorders/epidemiology
  • Chi-Square Distribution
  • Cohort Studies
  • Comorbidity
  • Depressive Disorder/epidemiology
  • Female
  • Humans
  • Interview, Psychological
  • Logistic Models
  • Male
  • Marital Status
  • Middle Aged
  • Netherlands/epidemiology
  • Risk Factors
  • Sex Factors
  • Young Adult

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