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Epidemiology of Co-Occurring Disorders: Annotated Bibliography

Co-Occurring Mental Health and Substance Use Disorders

Alegría AA, Hasin DS, Nunes EV, Liu SM, Davies C, Grant BF, Blanco C. (2010). Comorbidity of generalized anxiety disorder and substance use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 71(9):1187-95.

This study found that a co-occurring generalized anxiety disorder-substance use disorder (GAD-SUD) accounted for approximately half of the lifetime prevalence of GAD, and that the GAD-SUD group also exhibited other psychological comorbidities.

Booth BM, Walton MA, Barry KL, Cunningham RM, Chermack ST, Blow FC. (2011). Substance use, depression, and mental health functioning in patients seeking acute medical care in an inner-city ED. J Behav Health Serv Res. 38(3):358-72.

This study of over 5,600 adult emergency department patients found high rates of clinical depression (over 20 percent), alcohol and substance use/dependence (15 percent) with significant comorbidity among substance use and mental health disorders.

Ding K, Yang J, Cheng G, Schiltz T, Summers KM, Skinstad AH. (2011). Hospitalizations and hospital charges for co-occurring substance use and mental disorders. J Subst Abuse Treat. 40(4):366-75.

This study analyzed 5 years of the Nationwide Inpatient Sample, a nationally representative hospital discharge dataset, examining length of stay and hospital charges. The authors found that 44% of patients who were hospitalized with alcohol- or substance-related disorders were diagnosed with co-occurring mental disorders. Co-occurring mental health and substance use disorders were associated with longer stays in the hospital.

Kessler, R.C., Berglund, P.A., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 593-602.

This detailed report of data from the NCS-R shows that approximately 46 percent of Americans will meet DSM-IV criteria for an anxiety, mood, impulse-control, or substance use disorder during their lifetime, including the possibility of comorbidities (mostly appearing over time).

Kessler, R.C., Chiu, W.T., Demler, O., Merikangas, K. R., Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 617-627.

A companion report from the same data source, this focuses on the reported prior-year incidence of anxiety, mood, impulse or substance use disorders. In particular the report found a significant degree of comorbidity of DSM-IV disorders, including the classification of three "highly comorbid" groups comprising 7 percent of the U.S. adult population.

Kessler RC, Cox BJ, Green JG, Ormel J, McLaughlin KA, Merikangas KR, Petukhova M, Pine DS, Russo LJ, Swendsen J, Wittchen HU, Zaslavsky AM. (2011). The effects of latent variables in the development of comorbidity among common mental disorders. Depression and Anxiety. 28(1):29-39.

This statistical analysis of comorbidities of 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders recorded in NCS-R data suggests that there may be internalizing and externalizing disorders or common causal pathways in NCS-R comorbid DSM-IV cases that emerge in the model as latent variables.

Lemke S, Schaefer JA. (2010). VA nursing home residents with substance use disorders: Mental health comorbidities, functioning, and problem behaviors. Aging Ment Health. 14(5):593-602.

This study, which focused on over 27,000 residents of VA nursing homes, found significant statistical associations among substance use and dementia, serious mental illness, depressive disorders, and post-traumatic stress disorder. The patients with substance use disorders also had higher incidences of tobacco use, injury, AIDS/hepatitis, pulmonary disease,and digestive disorders.

Petrakis IL, Rosenheck R, Desai R. (2011). Substance use comorbidity among veterans with posttraumatic stress disorder and other psychiatric illness. Am J Addict. 20(3):185-9.

This study of over 1 million cases from the administrative data sets of the U.S. Department of Veterans Affairs found that for all VA patients with diagnosed mental disorders, 21 percent had comorbid substance diagnoses.

SAMHSA. (2010). Results from the 2009 National Survey on Drug Use and Health: Mental health findings. Office of Applied Studies, NSDUH Series H-39, No. SMA 10-4609. Retrieved August 11, 2011, from http://oas.samhsa.gov/NSDUH/2k9NSDUH/MH/2K9MHResults.pdf (PDF - 652Kb)

This most recent report of SAMHSA's National Survey on Drug Use and Health (NSDUH) includes a wealth of tabular information including data on co-occurring disorders. The survey report shows that 25.7% of all adults with serious mental illness have a co-occurring substance abuse or dependency issue, and 19.7% of all adults with any mental illness have issues with substance abuse or dependency.

Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. (2010). Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord. 24(4):412-26.

This article, an outgrowth of a research program to analyze potential revisions to personality disorder (PD) classifications in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), found that the suggested revisions brought PD prevalence closer in line with U.S. and U.K. epidemiological studies — and also found strong statistical associations between the revised PD diagnoses and alcohol, drug, or tobacco dependence.

Other Significant Comorbidities

Colton C.W. and Manderscheid, R.W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, April 2006.

Using data from public mental health agencies in eight states for 1997 through 2000, the authors compared the mortality of public mental health clients with that of state general populations. In every case the researchers found that public mental health clients had an elevated relative risk of death compared to general populations, representing lost decades of potential life nationwide for these persons. Major mental illness exacerbated these results, meaning that these clients died at younger ages and lost more years of life even relative to those with diagnoses of non-major mental illnesses. Causes of death themselves were not atypical compared to the general population, and included heart disease and cancer in addition to cerebrovascular, respiratory, and lung diseases.

Daniel, J., Honey, W., Landen, M., et al. (2005). Mental health in the United States: health risk behaviors and conditions among persons with depression — New Mexico, 2003. Morbidity and Mortality Weekly Report (39): 989-91.

This illustrative report shows that depression in adults can lead to a significantly greater likelihood of health risk factors such as a lack of physical activity, smoking, binge drinking, obesity, high blood pressure, high cholesterol, and poor health.

De Hert, M., Correll, C.U., Bobes, J. et al. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10:52-77.

The authors of this study performed an analysis of over 40 years of medical references in published journals, and report on evidence relating to specific physical comorbidities and risk factors among persons with severe mental illness.