title: Childhood maltreatment, personality disorders and 3-year persistence of adult alcohol and nicotine dependence in a national sample.
abstract: OBJECTIVE
  Persistent cases of alcohol and nicotine dependence are associated with considerable morbidity and mortality, and are predicted by childhood maltreatment and personality disorders. Our aim was to test whether personality disorders (individually or conjointly) mediate the relationship between childhood maltreatment and the persistence of dependence.
  
  
  METHODS
  Personality disorders, modeled dimensionally, were tested as mediators of the relationship between childhood maltreatment and the 3-year persistence of alcohol and nicotine dependence in participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had current alcohol and nicotine dependence in their baseline interview. Individual personality disorders were assessed in separate models. Then, those that were significant were examined jointly in multiple mediator models to determine their total and unique effects.
  
  
  METHODS
  A large, nationally representative US survey.
  
  
  METHODS
  Participants ≥ 18 years who completed baseline and 3-year follow-up NESARC interviews who had baseline alcohol dependence (n = 1172; 68% male) or nicotine dependence (n = 4017; 52.9% male).
  
  
  METHODS
  Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-IV) measures of childhood maltreatment, personality disorders and alcohol/nicotine dependence.
  
  
  RESULTS
  Individual models indicated that many personality disorders mediated the relationship between childhood maltreatment and the 3-year persistence of alcohol and nicotine dependence (each explaining 6-46% of the total effect, Ps < 0.05). In multiple mediator models, borderline and antisocial symptoms remained significant mediators, each explaining 20-37% of the total effect (Ps < 0.01).
  
  
  CONCLUSIONS
  Personality disorder symptoms (especially borderline and antisocial) help explain the association between childhood maltreatment and persistent alcohol and nicotine dependence.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.|New York State Psychiatric Institute, New York, NY, USA.|Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Elliott
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Malka
authors.initials: M
authors.lastname: Stohl
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA.|Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.|Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Wall
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Keyes
authors.affiliation: Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.|Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Skodol
authors.affiliation: Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Eaton
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA.|Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
authors.forename: Dvora
authors.initials: D
authors.lastname: Shmulewitz
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.|Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY, USA.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Goodwin
authors.affiliation: Laboratory of Epidemiology and Biometry, National Institute of Alcohol Abuse and Alcoholism, Rockville, MD, USA.
authors.forename: Bridget F
authors.initials: BF
authors.lastname: Grant
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.|New York State Psychiatric Institute, New York, NY, USA.|Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Hasin
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology*; D011446:Prospective Studies; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Alcohol; child abuse; child neglect; childhood maltreatment; chronic; mediation; nicotine; persistence; personality disorders; substance dependence