title: Risk factors for incidence and persistence of disability in chronic major depression and alcohol use disorders: longitudinal analyses of a population-based study.
abstract: BACKGROUND
  Major depression and alcohol use disorders are risk factors for incidence of disability. However, it is still unclear whether a chronic course of these health conditions is also prospectively associated with incidence of disability. The aim of the present study was, first, to confirm whether chronic major depression (MD) and alcohol use disorders (AUD) are, respectively, risk factors for persistence and incidence of disability in the general population; and then to analyze the role of help-seeking behavior in the course of disability among respondents with chronic MD and chronic AUD.
  
  
  METHODS
  Data from two assessments in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Disability was measured by eight domains of the Short Form 12 Health Survey version 2 (SF-12). Generalized estimating equations and logistic regression models were run to estimate risk factors for persistence and incidence of disability, respectively.
  
  
  RESULTS
  Analyses conducted on data from the US general population showed that chronic MD was the strongest risk factor for incidence and persistence of disability in the social functioning, emotional role and mental health domains. Chronic AUD were risk factors for incidence and persistence of disability in the vitality, social functioning, and emotional role domains. Within the group of chronic MD, physical comorbidity and help-seeking were associated with persistent disability in most of the SF-12 domains. Help-seeking behavior was also associated with incidence of problems in the mental health domain for the depression group. Regarding the AUD group, comorbidity with physical health problems was a strong risk factor for persistence of disability in all SF-12 domains. Help-seeking behavior was not related to either persistence or incidence of disability in the chronic alcohol group.
  
  
  CONCLUSIONS
  Chronic MD and chronic AUD are independent risk factors for persistence and incidence of disability in the US general population. People with chronic MD seek help for their problems when they experience persistent disability, whereas people with chronic AUD might not seek any help even if they are suffering from persistent disability.
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. maria.cabello@uam.es.|Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain. maria.cabello@uam.es.|Instituto de Investigación Sanitaria Princesa (IP), La Princesa University Hospital, Madrid, Spain. maria.cabello@uam.es.
authors.forename: María
authors.initials: M
authors.lastname: Cabello
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. felix.caballero@uam.es.|Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain. felix.caballero@uam.es.|Instituto de Investigación Sanitaria Princesa (IP), La Princesa University Hospital, Madrid, Spain. felix.caballero@uam.es.
authors.forename: Francisco Félix
authors.initials: FF
authors.lastname: Caballero
authors.affiliation: Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland. chatterjis@who.int.
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
authors.affiliation: Disability and Rehabilitation Unit Coordinator, World Health Organization, Geneva, Switzerland. ciezaa@who.int.
authors.forename: Alarcos
authors.initials: A
authors.lastname: Cieza
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. joseluis.ayuso@uam.es.|Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain. joseluis.ayuso@uam.es.|Instituto de Investigación Sanitaria Princesa (IP), La Princesa University Hospital, Madrid, Spain. joseluis.ayuso@uam.es.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Ayuso-Mateos
mesh_terms: D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D000437:Alcoholism / Q000453:epidemiology*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D014481:United States / Q000453:epidemiology