Impact of parental history of substance use disorders on the clinical course of anxiety disorders
Tóm tắt
Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions. Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare. The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years. Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP), a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history. Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education. History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders. These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders. Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients' level of vulnerability to perceive scrutiny by others in social situations, and ability to maintain a long-term panic-free state.
Tài liệu tham khảo
Barnard M, McKeganey N: The impact of parental problem drug use on children: What is the problem and what can be done to help?. Addiction. 2004, 99: 552-559. 10.1111/j.1360-0443.2003.00664.x.
Clark DB, Cornelius J, Wood DS, Vanyukov M: Psychopathology risk transmission of children of parents with substance use disorders. Am J Psychiatry. 2004, 161: 689-691. 10.1176/appi.ajp.161.4.685.
Connolly GM, Casswell S, Stewart J, Silva PA, O'Brien MK: The effect of parents' alcohol problems on children's behavior as reported by parents and by teachers. Addiction. 1993, 88: 1383-1390. 10.1111/j.1360-0443.1993.tb02025.x.
Harter SL: Psychosocial adjustment of adult children of alcoholics: A review of the recent empirical literature. Clin Psychol Rev. 2000, 20: 311-337. 10.1016/S0272-7358(98)00084-1.
Lynskey MT, Fergusson DM, Horwood LJ: The effect of parental alcohol problems on rates of adolescent psychiatric disorders. Addiction. 1994, 89: 1277-1286. 10.1111/j.1360-0443.1994.tb03306.x.
Merikangas KR, Stevens DE, Fenton B, Stolar M, O'Malley S, Woods SW, Risch N: Co-morbidity and family aggregation of alcoholism and anxiety disorders. Psychol Med. 1998, 28: 773-788. 10.1017/S0033291798006941.
Schuckit MA, Smith TL, Radziminski S, Heyneman EK: Behavioral symptoms and psychiatric diagnoses among 162 children in nonalcoholic or alcoholic families. Am J Psychiatry. 2000, 157: 1881-1883. 10.1176/appi.ajp.157.11.1881.
Cuijpers P, Langendoen Y, Bijl RV: Psychiatric disorders in adult children of problem drinkers: prevalence, first onset and comparison with other risk factors. Addiction. 1999, 94: 1489-1498. 10.1046/j.1360-0443.1999.941014895.x.
Kerr AS, Hill EW: An exploratory study comparing ACOAs to non-ACOAs on current family relationships. Alcohol Treat Q. 1992, 9: 23-38. 10.1300/J020V09N01_02.
Miller SI, Tuchfeld BS: Adult children of alcoholics. Hosp Community Psychiatry. 1986, 37: 235-236.
Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano ME, Shea MT, Keller MB: Influence of psychiatric comorbidity on recovery and relapse in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. Am J Psychiatry. 2005, 162: 1179-1187. 10.1176/appi.ajp.162.6.1179.
Rodriguez BF, Weisberg RB, Pagano ME, Bruce SE, Spencer MA, Culpepper L, Keller MB: Characteristics and predictors of full and partial recovery from generalized anxiety disorder in primary care patients. J Nerv Ment Dis. 2006, 194: 91-97. 10.1097/01.nmd.0000198140.02154.32.
Zlotnick C, Rodriguez BF, Weisberg RB, Bruce SE, Spencer MA, Culpepper L, Keller MB: Chronicity in posttraumatic stress disorder (PTSD) and predictors of the course of PTSD among primary care patients. J Nerv Ment Dis. 2004, 192: 153-159. 10.1097/01.nmd.0000110287.16635.8e.
Mathew RJ, Wilson WH, Blazer DG, George LK: Psychiatric disorders in adult children of alcoholics: data from the Epidemiologic Catchment Area project. Am J Psychiatry. 1993, 150: 793-800.
Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB: Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001, 110: 585-599. 10.1037/0021-843X.110.4.585.
Rodriguez BF, Weisberg RB, Pagano ME, Machan JT, Culpepper L, Keller MB: Frequency and patterns of psychiatric comorbidity in a sample of primary care patients with anxiety disorders. Compr Psychiatry. 2004, 45: 129-137. 10.1016/j.comppsych.2003.09.005.
Yonkers KA, Bruce SE, Dyck IR, Keller MB: Chronicity, relapse, and illness – course of panic disorder, social phobia, and generalized anxiety disorder: findings in men andwomen from 8 years of follow-up. Depress Anxiety. 2003, 17: 173-179. 10.1002/da.10106.
Rodriguez BF, Bruce SE, Pagano ME, Keller MB: Relationships among psychosocial functioning, diagnostic comorbidity, and relapse of generalized anxiety disorder, panic disorder, and major depression. J Disord. 2005, 19: 752-766. 10.1016/j.janxdis.2004.10.002.
Yama MF, Tovey SL, Fogas BS, Teegarden LA: Joint consequences of parental alcoholism and childhood sexual abuse and their partial mediation by family environment. Viol Vict. 1992, 7: 313-325.
Massion A, Warshaw M, Keller M: Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. Am J Psychiatry. 1993, 150: 600-607.
Keller MB, Lavori PW, Friedman B, Nielsen E, Endicott J, McDonald-Scott P, Andreasen NC: The Longitudinal Interval Follow-Up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry. 1987, 44: 540-548.
Warshaw M, Keller M, Stout R: Reliability and validity of the longitudinal interval follow-up evaluation for assessing outcome of anxiety disorders. J Psychiatr Res. 1994, 28: 531-545. 10.1016/0022-3956(94)90043-4.
Endicott J, Andreasen N, Spitzer RL: Family History Research Diagnostic Criteria. 1978, New York: Psychiatric Institute, Biometrics Research
Kendler KS, Silberg JL, Neale MC, Kessler RC, Heath AC, Eaves JL: The family history method: whose psychiatric history is measured. Am J Psychiatry. 1991, 148: 1501-1504.
Andreasen NC, Endicott J, Spitzer RL, Winokur O: The family history method using diagnostic criteria. Arch Gen Psychiatry. 1977, 34: 1229-1235.
Zimmerman M, Coryell W, Pfohl B, Stangl D: The reliability of the family history method for psychiatric diagnoses. Arch Gen Psychiatry. 1988, 45: 320-322.
Fierman EJ, Hunt MF, Pratt LA, Warshaw MG, Yonkers KA, Peterson LG, Epstein-kaye TM, Norton HS: Trauma and posttraumatic stress disorder in subjects with anxiety disorders. Am J Psychiatry. 1993, 150: 1872-1974.
SAS Institute Inc: SAS/STAT User's Guide. Version 8. 1999, Cary, NC: SAS Institute Inc
Graham AV: From survival to recovery: growing up in an alcoholic home. Subst Abuse. 1996, 17: 65-66.
Allison PD: Survival Analysis Using the SAS System: A practical guide. 1995, Cary, NC: SAS Institute Inc