Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders--findings from the Netherlands Mental Health Survey and Incidence Study.
BACKGROUND
Little is known about the temporal sequencing of psychiatric disorders. The aim of this study was to obtain insight into patterns of co-occurrence of DSM-III-R mood disorders in relation to anxiety and substance use disorders, their temporal sequencing and the sociodemographic and long-term vulnerability predictors of this temporal sequencing.


METHODS
Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a psychiatric epidemiological study in a representative sample of 7,076 adults aged 18-64.


RESULTS
Of those who had ever experienced a mood disorder, 46 % of males and 57 % of females had a history of anxiety disorders, and 43 % and 15 % of substance use disorders. Mood disorders were associated with all anxiety and substance use disorders, except with alcohol abuse among males. In the majority of anxiety-comorbid cases, the mood disorder arose after the anxiety disorder; the pattern for substance use-comorbid disorders was more variable. Deviation from the usual sequence of major depression and anxiety disorders was more often seen among females, subjects with a higher educational level, subjects who experienced childhood parental divorce, and subjects who experienced childhood emotional neglect.


CONCLUSIONS
When comorbid with anxiety disorders, mood disorders clearly tend to be secondary. Few of the studied demographic factors, familial vulnerability factors and childhood life events predict the sequencing of mood disorders in relation to other disorders.
de Graaf
R
R
Monitoring and Epidemiology Department, Netherlands Institute of Mental Health and Addiction, P. O. Box 725, 3500 AS Utrecht, The Netherlands.
Bijl
R V
RV
Spijker
J
J
Beekman
A T F
AT
Vollebergh
W A M
WA
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000453:epidemiology*; D015897:Comorbidity; D003625:Data Collection; D017831:Diagnosis, Dual (Psychiatry); D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology*; D013997:Time Factors