234804 Antisocial behavioral syndromes and treatment for major mood disorders: Results from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

Monday, October 31, 2011

Risė B. Goldstein, PhD, MPH , Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
Howard B. Moss, MD , Office of the Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD
Attila J. Pulay, MD , Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
Bridget F. Grant, PhD, PhD , Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
Associations of psychiatric comorbidity, including personality disorders, with mental health and addiction treatment utilization are well documented. However, a recent review unexpectedly found rates of antisocial personality disorder (ASPD) among patients in treatment, including clinical trials, for major mood disorders that were less than, equal to, or only slightly higher than those in the general population. We performed both cross-sectional (Wave 1 lifetime) and longitudinal (three-year follow-up between Waves 1 and 2) analyses of treatment seeking for major depressive disorder (MDD) and bipolar I and II disorders (BP I/II) in the National Epidemiologic Survey on Alcohol and Related Conditions among respondents diagnosed at baseline with ASPD, syndromal antisocial behavior in adulthood without conduct disorder before age 15 (AABS), or no antisocial syndrome. Among those with lifetime MDD at Wave 1, AABS but not ASPD was associated with reduced odds of any depression treatment before Wave 1 after adjustment for sociodemographic and clinical predisposing, enabling, and need characteristics. Antisocial syndromes were not associated with treatment for bipolarity before Wave 1 among respondents with Wave 1 lifetime BP I/II, nor did they predict mood disorder treatment between Waves 1 and 2 among respondents with prevalent MDD or BP I/II during the three-year follow-up interval. These findings offer limited evidence for antisociality-related disparities in mood disorder treatment overall. However, discrepancies between our findings and reports from clinical samples may reflect selection biases associated with tertiary care settings as well as exclusion of individuals with ASPD from many clinical trials.

Learning Areas:
Epidemiology
Other professions or practice related to public health
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
(1) Describe cross-sectional and prospective associations of DSM-IV antisocial personality disorder (ASPD), and syndromal levels of antisocial behavior since 15 without conduct disorder before age 15 (AABS), with treatment utilization for major depressive disorder and bipolar I and II disorders in U.S. general population adults. (2) Identify possible explanations for discrepancies between unexpectedly low prevalences of antisocial syndromes among patients in treatment for major mood disorders and overall lack of associations of antisociality with mood disorder treatment among affected individuals in a large, nationally representative general population sample.

Keywords: Mental Health Services, Psychiatric Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My career focus for over 20 years has been the application of state-of-the-art methodology to the study of the epidemiology of mental disorders, including major mood disorders, syndromes of antisocial behavior (e.g., antisocial personality disorder [ASPD] and syndromal antisocial behavior in adulthood without history of conduct disorder before age 15 [AABS]), and their comorbidity and familial aggregation with other psychiatric and substance use disorders. Related to this focus, I have also investigated patterns of help seeking for specific mental and addictive disorders and their associations with additional psychiatric comorbidity. I have served as an ad hoc reviewer for over 15 years for a wide range of psychiatric and public health journals. My most recent publications and professional presentations include examinations of the longitudinal course of ASPD and AABS; associations of antisocial behavioral syndromes with the clinical characteristics of posttraumatic stress disorder, alcohol and other drug use disorders, chronic medical illnesses, and obesity; and treatment utilization for alcohol use disorders.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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