title: Gender-specific effects of comorbid depression and anxiety on the propensity to drink in negative emotional states.
abstract: Depression and anxiety are often comorbid with alcoholism and contribute to craving and relapse. We aimed to estimate the prevalence of life-time diagnoses of major depressive disorder (MDD), substance-induced depression (SID), anxiety disorder (AnxD) and substance-induced anxiety (SIA), the effects of these comorbidities on the propensity to drink in negative emotional states (negative craving), and test whether these effects differ by sex.
  
  
  
  Secondary analyses of baseline data collected in a single-arm study of pharmacogenetic predictors of acamprosate response.
  
  
  
  Academic medical center and affiliated community-based treatment programs in the American upper mid-west.
  
  
  
  A total of 287 males and 156 females aged 18-80 years, meeting DSM-IV criteria for alcohol dependence.
  
  
  
  The primary outcome measure was 'propensity to drink in negative emotional situations' (determined by the Inventory of Drug Taking Situations) and the key predictors/covariates were sex and psychiatric comorbidities, including MDD, SID, AnxD and SIA (determined by Psychiatric Research Interview of Substance and Mood Disorders).
  
  
  
  The prevalence of the MDD, SID and AnxD was higher in females compared with males (33.1 versus 18.4%, 44.8 versus 26.4% and 42.2 versus 27.4%, respectively; P < 0.01, each), while SIA was rare (3.3%) and did not differ by sex. Increased propensity to drink in negative emotional situations was associated with comorbid MDD (β = 6.6, P = 0.013) and AnxD (β = 4.8, P = 0.042) as well as a SID × sex interaction effect (P = 0.003), indicating that the association of SID with propensity to drink in negative emotional situations differs by sex and is stronger in males (β = 7.9, P = 0.009) compared with females (β = -6.6, P = 0.091).
  
  
  
  There appears to be a higher prevalence of comorbid depression and anxiety disorders as well as propensity to drink in negative emotional situations in female compared with male alcoholics. Substance-induced depression appears to have a sex-specific effect on the increased risk for drinking in negative emotional situations in males.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Karpyak
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Biernacka
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Geske
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.|Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.
authors.forename: Osama A
authors.initials: OA
authors.lastname: Abulseoud
authors.affiliation: Fountain Centers, Mayo Clinic Health System, Albert Lea, MN, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brunner
authors.affiliation: Addiction Recovery Services, Mayo Clinic Health System, Austin, MN, USA.|Piedmont Medical Center, Rock Hill, SC, USA.
authors.forename: Mohit
authors.initials: M
authors.lastname: Chauhan
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Hall-Flavin
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.|Regions Hospital, St Paul, MN, USA.
authors.forename: Kriste A
authors.initials: KA
authors.lastname: Lewis
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Larissa L
authors.initials: LL
authors.lastname: Loukianova
authors.affiliation: Department of Psychiatry, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Melnyk
authors.affiliation: Department of Family Medicine, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Onsrud
authors.affiliation: Department of Psychiatry, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Proctor
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Terry D
authors.initials: TD
authors.lastname: Schneekloth
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michelle K
authors.initials: MK
authors.lastname: Skime
authors.affiliation: Addiction Recovery Services, Mayo Clinic Health System, Austin, MN, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Wittkopp
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Mrazek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology*; D001007:Anxiety / Q000139:chemically induced / Q000453:epidemiology*; D001008:Anxiety Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000139:chemically induced / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000453:epidemiology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
keywords: Alcohol use disorder; anxiety; craving; depression; gender; substance-induced