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Introduction: This study presents nationally representative data on the prevalence, correlates, psychiatric comorbidity and treatment (including pharmacological and nonpharmacological) among electronic nicotine delivery system (ENDS) users., Methods: Face-to-face interviews in the National Epidemiologic Survey on Alcohol and Related Conditions-III., Results: Prevalences of 12-month and lifetime ENDS use were 3.8% (SE=0.14) and 5.4% (SE=0.17). Odds of ENDS use were greater among men than women, regardless of timeframe. Rates were lower among Blacks, Hispanics and Asians/Pacific Islanders relative to Whites. Odds of 12-month and lifetime ENDS use was also higher among younger (<65years) than older (≥65years) individuals and higher among individuals with high school education relative to these with some college education. Odds of 12-month and lifetime ENDS use was also higher among individuals with incomes <$70,000.00 compared with those with incomes≥$70,000.00 and higher among the previously married relative to those who were currently married. Associations between 12-month ENDS use and severe nicotine use disorder were strong, whereas associations with other substance use disorders and borderline and antisocial personality disorders were modest (AORs=1.3-2.6). Rates of treatment seeking to cut down or quit tobacco or nicotine use (12-month, 25.0% (SE=1.6); lifetime, 24.4% (SE=1.4)) were low., Conclusions: ENDS use is substantially comorbid, especially with nicotine use disorder. Virtually all ENDS users smoked cigarettes. Research is needed to understand their role in smoking cessation, adverse effects on bodily systems and their potential for addiction and comorbidity., (Copyright © 2017. Published by Elsevier B.V.)

Narcissistic personality disorder (NPD) shows high rates of comorbidity with mood, anxiety, substance use, and other personality disorders. Previous bivariate comorbidity investigations have left NPD multivariate comorbidity patterns poorly understood. Structural psychopathology research suggests that two transdiagnostic factors, internalizing (with distress and fear subfactors) and externalizing, account for comorbidity among common mental disorders. NPD has rarely been evaluated within this framework, with studies producing equivocal results. We investigated how NPD related to other mental disorders in the internalizing-externalizing model using diagnoses from a nationally representative sample (N = 34,653). NPD was best conceptualized as a distress disorder. NPD variance accounted for by transdiagnostic factors was modest, suggesting its variance is largely unique in the context of other common mental disorders. Results clarify NPD multivariate comorbidity, suggest avenues for classification and clinical endeavors, and highlight the need to understand vulnerable and grandiose narcissism subtypes' comorbidity patterns and structural relations.

Background and Aims: 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., Design: 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., Setting: A large, nationally representative US survey., Participants: 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)., Measurements: Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-IV) measures of childhood maltreatment, personality disorders and alcohol/nicotine dependence., Findings: 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., (© 2016 Society for the Study of Addiction.)

Importance: Current information on the prevalence and sociodemographic and clinical profiles of individuals in the general population with DSM-5 drug use disorder (DUD) is limited. Given the present societal and economic context in the United States and the new diagnostic system, up-to-date national information is needed from a single uniform data source., Objective: To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, disability, and treatment of DSM-5 DUD diagnoses overall and by severity level., Design, Setting, and Participants: In-person interviews were conducted with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional representative survey of the United States. The household response rate was 72%; person-level response rate, 84%; and overall response rate, 60.1%. Data were collected April 2012 through June 2013 and analyzed from February through March 2015., Main Outcomes and Measures: Twelve-month and lifetime DUD, based on amphetamine, cannabis, club drug, cocaine, hallucinogen, heroin, nonheroin opioid, sedative/tranquilizer, and/or solvent/inhalant use disorders., Results: Prevalences of 12-month and lifetime DUD were 3.9% and 9.9%, respectively. Drug use disorder was generally greater among men, white and Native American individuals, younger and previously or never married adults, those with lower education and income, and those residing in the West. Significant associations were found between 12-month and lifetime DUD and other substance use disorders. Significant associations were also found between any 12-month DUD and major depressive disorder (odds ratio [OR], 1.3; 95% CI, 1.09-1.64), dysthymia (OR, 1.5; 95% CI, 1.09-2.02), bipolar I (OR, 1.5; 95% CI, 1.06-2.05), posttraumatic stress disorder (OR, 1.6; 95% CI, 1.27-2.10), and antisocial (OR, 1.4; 95% CI, 1.11-1.75), borderline (OR, 1.8; 95% CI, 1.41-2.24), and schizotypal (OR, 1.5; 95% CI, 1.18-1.87) personality disorders. Similar associations were found for any lifetime DUD with the exception that lifetime DUD was also associated with generalized anxiety disorder (OR, 1.3; 95% CI, 1.06-1.49), panic disorder (OR, 1.3; 95% CI, 1.06-1.59), and social phobia (OR, 1.3; 95% CI, 1.09-1.64). Twelve-month DUD was associated with significant disability, increasing with DUD severity. Among respondents with 12-month and lifetime DUD, only 13.5% and 24.6% received treatment, respectively., Conclusions and Relevance: DSM-5 DUD is a common, highly comorbid, and disabling disorder that largely goes untreated in the United States. These findings indicate the need for additional studies to understand the broad relationships in more detail; estimate present-day economic costs of DUDs; investigate hypotheses regarding etiology, chronicity, and treatment use; and provide information to policy makers about allocation of resources for service delivery and research. Findings also indicate an urgent need to destigmatize DUD and educate the public, clinicians, and policy makers about its treatment to encourage affected individuals to obtain help., Competing Interests: Disclosures: None reported.

The DSM approach to personality disorder (PD) diagnoses has been criticized for using arbitrary thresholds. The present study evaluated one dimensional approach with ordered threshold categories of severity by examining associations with several measures of disability and Axis I disorders for 10 PDs in the general population. Data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions, Waves 1 and 2. Respondents were categorized according to PD criteria as follows: "no symptoms" for having no positive criteria, "subthreshold" for having at least one positive criterion but below the DSM-IV threshold, "at-threshold" for meeting the DSM-IV threshold and additionally having one or two more positive criteria, and "suprathreshold" for meeting the DSM-IV threshold plus three or more positive criteria. Findings from this national study provide support for dimensional approaches to diagnostic classifications for the majority of PDs and suggest that mild levels of severity indeed have clinical significance.

Background: Among individuals with anxiety disorders, comorbid personality disorders (PDs) increase cross-sectional symptom severity and decrease functioning. Little is known, however, about how PDs influence the course of anxiety disorders over time. The purpose of this study was to examine the effect of PDs on the persistence of four anxiety disorders in a nationally representative sample in the United States., Methods: Two waves of data were collected on 34,653 participants, 3 years apart. At both waves, participants were evaluated for generalized anxiety disorder (GAD), social and specific phobias, and panic disorder. Predictors of persistence included all DSM-IV PDs. Control variables included demographics, comorbid PDs, age at onset of the anxiety disorder, number of prior episodes, duration of the current episode, treatment history, and cardinal symptoms of exclusionary diagnoses for each anxiety disorder., Results: Any PD, two or more PDs, borderline PD, schizotypal PD, mean number of PD criteria met, and mean number of PDs diagnosed predicted the persistence of all four anxiety disorders. Narcissistic PD predicted persistence of GAD and panic disorder. Schizoid and avoidant PDs also predicted persistence of GAD. Finally, avoidant PD predicted persistence of social phobia. Particular patterns of cross-cluster PD comorbidity were strong predictors of the persistence of individual anxiety disorders as well., Conclusions: In this national sample, a variety of PDs robustly predicted the persistence of anxiety disorders over 3 years, consistent with the results of recent prospective clinical studies. Personality psychopathology should be assessed and addressed in treatment for all patients with anxiety disorders., (© 2014 Wiley Periodicals, Inc.)

Childhood maltreatment increases the risk for adult personality disorders (PDs), but several PDs or maltreatment types co-occur. Specificity of maltreatment-personality associations is poorly understood. Using a representative US population sample, we identified specific associations between maltreatment types (sexual, physical and emotional abuse and physical and emotional neglect) and PDs after controlling for basic demographics, parental psychopathology, co-occurring maltreatment types and comorbid PD. We then examined interactions of gender and maltreatment in predicting PDs. Each maltreatment type significantly predicted three-four PDs. Borderline and schizotypal PDs were most strongly predicted by sexual abuse, antisocial by physical abuse and avoidant and schizoid by emotional neglect. Specific vulnerabilities differ by gender; maltreated boys may respond with attention seeking and girls with social withdrawal. Findings highlight the importance of evaluating all forms of maltreatment even when they co-occur and can inform development of interventions to prevent personality pathology in at-risk children., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Although associations between personality disorders and psychiatric disorders are well established in general population studies, their association with liability dimensions for externalizing and internalizing disorders has not been fully assessed. The purpose of this study is to examine associations between personality disorders (PDs) and lifetime externalizing and internalizing Axis I disorders., Methods: Data were obtained from the total sample of 34,653 respondents from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drawing on the literature, a 3-factor exploratory structural equation model was selected to simultaneously assess the measurement relations among DSM-IV Axis I substance use and mood and anxiety disorders and the structural relations between the latent internalizing-externalizing dimensions and DSM-IV PDs, adjusting for gender, age, race/ethnicity, and marital status., Results: Antisocial, histrionic, and borderline PDs were strong predictors for the externalizing factor, while schizotypal, borderline, avoidant, and obsessive-compulsive PDs had significantly larger effects on the internalizing fear factor when compared to the internalizing misery factor. Paranoid, schizoid, narcissistic, and dependent PDs provided limited discrimination between and among the three factors. An overarching latent factor representing general personality dysfunction was significantly greater on the internalizing fear factor followed by the externalizing factor, and weakest for the internalizing misery factor., Conclusion: Personality disorders offer important opportunities for studies on the externalizing-internalizing spectrum of common psychiatric disorders. Future studies based on panic, anxiety, and depressive symptoms may elucidate PD associations with the internalizing spectrum of disorders., (Published by Elsevier Ltd.)

The purpose of this study was to evaluate the psychometric properties of DSM-IV symptom criteria for assessing personality disorders (PDs) in a national population and to compare variations in proposed symptom coding for social and/or occupational dysfunction. Data were obtained from a total sample of 34,653 respondents from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). For each personality disorder, confirmatory factor analysis (CFA) established a 1-factor latent factor structure for the respective symptom criteria. A 2-parameter item response theory (IRT) model was applied to the symptom criteria for each PD to assess the probabilities of symptom item endorsements across different values of the underlying trait (latent factor). Findings were compared with a separate IRT model using an alternative coding of symptom criteria that requires distress/impairment to be related to each criterion. The CFAs yielded a good fit for a single underlying latent dimension for each PD. Findings from the IRT indicated that DSM-IV PD symptom criteria are clustered in the moderate to severe range of the underlying latent dimension for each PD and are peaked, indicating high measurement precision only within a narrow range of the underlying trait and lower measurement precision at lower and higher levels of severity. Compared with the NESARC symptom coding, the IRT results for the alternative symptom coding are shifted toward the more severe range of the latent trait but generally have lower measurement precision for each PD. The IRT findings provide support for a reliable assessment of each PD for both NESARC and alternative coding for distress/impairment. The use of symptom dysfunction for each criterion, however, raises a number of issues and implications for the DSM-5 revision currently proposed for Axis II disorders (American Psychiatric Association, 2010).

Individual personality disorders (PD) are grouped into three clusters in the DSM-IV (A, B, and C). There is very little empirical evidence available concerning the validity of this model in the general population. The current study included all 10 of the DSM-IV PD assessed in Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Confirmatory factor analysis was used to evaluate three plausible models of the structure of Axis II personality disorders (the current hierarchical DSM-IV three-factor model in which individual PD are believed to load on their assigned clusters, which in turn load onto a single Axis II factor; a general single-factor model; and three independent factors). Each of these models was tested in both the total and also separately for gender. The higher order DSM-IV model demonstrated good fit to the data on a number of goodness-of-fit indices. The results for this model were very similar across genders. A model of PD based on the current DSM-IV hierarchical conceptualization of a higher order classification scheme received strong empirical support through confirmatory factor analysis using a number of goodness-of-fit indices in a nationally representative sample. Other models involving broad, higher order personality domains such as neuroticism in relation to personality disorders have yet to be tested in epidemiologic surveys and represent an important avenue for future research.

Objectives: To present findings on the prevalence, correlates, and psychiatric comorbidity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition posttraumatic stress disorder (PTSD) and partial PTSD in a nationally representative sample of U.S. older adults., Design, Setting, and Participants: Face-to-face interviews with 9,463 adults age 60 years and older in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions., Measurements: Sociodemographic correlates; worst stressful experiences; comorbid lifetime mood, anxiety, substance use, and personality disorders; psychosocial functioning; and suicide attempts., Results: Lifetime prevalences ± standard errors of PTSD and partial PTSD were 4.5% ± 0.25 and 5.5% ± 0.27, respectively. Rates were higher in women (5.7% ± 0.37 and 6.5% ± 0.39) than in men (3.1% ± 0.31 and 4.3% ± 0.37). Older adults with PTSD most frequently identified unexpected death of someone close, serious illness or injury to someone close, and their own serious or life-threatening illness as their worst stressful events. Older adults exposed to trauma but without full or partial PTSD and respondents with partial PTSD most often identified unexpected death of someone close, serious illness or injury to someone close, and indirect experience of 9/11 as their worst events. PTSD was associated with elevated odds of lifetime mood, anxiety, drug use, and borderline and narcissistic personality disorders and decreased psychosocial functioning. Partial PTSD was associated with elevated odds of mood, anxiety, and narcissistic and schizotypal personality disorders and poorer psychosocial functioning relative to older adults exposed to trauma but without full or partial PTSD., Conclusions: PTSD among older adults in the United States is slightly more prevalent than previously reported and is associated with considerable psychiatric comorbidity and psychosocial dysfunction. Partial PTSD is associated with significant psychiatric comorbidity, particularly with mood and other anxiety disorders.

Aims: DSM-IV drug use disorders, a major public health problem, are highly comorbid with other psychiatric disorders, but little is known about the role of this comorbidity when studied prospectively in the general population. Our aims were to determine the role of comorbid psychopathology in the 3-year persistence of drug use disorders., Design and Setting: Secondary data analysis using waves 1 (2001-02) and 2 (2005-05) of the National Epidemiologic Survey on Alcohol and Related Conditions., Participants: Respondents with current DSM-IV drug use disorder at wave 1 who participated in wave 2 (n = 613)., Measurements: Alcohol Use Disorders and Associated Disabilities Interview Schedule IV (AUDADIS-IV) obtained DSM-IV Axis I and II diagnoses. Persistent drug use disorder was defined as meeting full criteria for any drug use disorder between waves 1 and 2., Findings: Drug use disorders persisted in 30.9% of respondents. No Axis I disorders predicted persistence. Antisocial [odds ratio (OR) = 2.75; 95% confidence interval (CI): 1.27-5.99], borderline (OR = 1.91; 95% CI: 1.06-3.45) and schizotypal (OR = 2.77; 95% CI: 1.42-5.39) personality disorders were significant predictors of persistent drug use disorders, controlling for demographics, psychiatric comorbidity, family history, treatment and number of drug use disorders. Deceitfulness and lack of remorse were the strongest antisocial criteria predictors of drug use disorder persistence, identity disturbance and self-damaging impulsivity were the strongest borderline criteria predictors, and ideas of reference and social anxiety were the strongest schizotypal criteria predictors., Conclusions: Antisocial, borderline and schizotypal personality disorders are specific predictors of drug use disorder persistence over a 3-year period., (Published 2011. This article is a U.S. Government work and is in the public domain in the USA.)

Background: While it is well known that personality disorders are associated with trauma exposure and PTSD, limited nationally representative data are available on DSM-IV personality disorders that co-occur with posttraumatic stress disorder (PTSD) and partial PTSD., Methods: Face-to-face interviews were conducted with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression analyses controlling for sociodemographics and additional psychiatric comorbidity evaluated associations of PTSD and partial PTSD with personality disorders., Results: Prevalence rates of lifetime PTSD and partial PTSD were 6.4% and 6.6%, respectively. After adjustment for sociodemographic characteristics and additional psychiatric comorbidity, respondents with full PTSD were more likely than trauma controls to meet criteria for schizotypal, narcissistic, and borderline personality disorders (ORs = 2.1-2.5); and respondents with partial PTSD were more likely than trauma controls to meet diagnostic criteria for borderline (OR = 2.0), schizotypal (OR = 1.8), and narcissistic (OR = 1.6) PDs. Women with PTSD were more likely than controls to have obsessive-compulsive PD. Women with partial PTSD were more likely than controls to have antisocial PD; and men with partial PTSD were less likely than women with partial PTSD to have avoidant PD., Conclusions: PTSD and partial PTSD are associated with borderline, schizotypal, and narcissistic personality disorders. Modestly higher rates of obsessive-compulsive PD were observed among women with full PTSD, and of antisocial PD among women with partial PTSD., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: The primary objective of this study was to prospectively examine the role of Avoidant Personality Disorder (AvPD) as a determinant in the outcome of Generalized Social Anxiety Disorder (GSAD) using Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions 3 years later., Method: This study analyzed data from Waves 1 and 2 of the NESARC (n = 34,653). GSAD was operationalized based on the DSM-IV definitions of this SAD subtype., Results: Logistic regression analyses indicated that AvPD significantly predicted the persistence of GSAD, even after adjusting for a number of important sociodemographic variables and other psychiatric comorbidity. AvPD did not significantly predict outcome in non-generalized SAD., Conclusions: AvPD can influence the course of GSAD in adulthood. Specific personality dimensions may underlie and explain the similarities between AvPD and GSAD. Self-criticism could be a shared feature of both AvPD and GSAD and could represent an important psychological marker of poor prognosis in comorbid GSAD and AvPD., (© 2011 Wiley-Liss, Inc.)

Objective: The purpose of this study was to examine the effects of specific personality disorder comorbidity on the course of major depressive disorder in a nationally representative sample., Method: Data were drawn from 1,996 participants in a national survey. Participants who met criteria for major depressive disorder at baseline in face-to-face interviews (in 2001-2002) were reinterviewed 3 years later (in 2004-2005) to determine persistence and recurrence. Predictors included all DSM-IV personality disorders. Control variables included demographic characteristics, other axis I disorders, family and treatment histories, and previously established predictors of the course of major depressive disorder., Results: A total of 15.1% of participants had persistent major depressive disorder, and 7.3% of those who remitted had a recurrence. Univariate analyses indicated that avoidant, borderline, histrionic, paranoid, schizoid, and schizotypal personality disorders all elevated the risk for persistence. With axis I comorbidity controlled, all personality disorders except histrionic personality disorder remained significant. With all other personality disorders controlled, borderline and schizotypal disorders remained significant predictors. In final, multivariate analyses that controlled for age at onset of major depressive disorder, the number of previous episodes, duration of the current episode, family history, and treatment, borderline personality disorder remained a robust predictor of major depressive disorder persistence. Neither personality disorders nor other clinical variables predicted recurrence., Conclusions: In this nationally representative sample of adults with major depressive disorder, borderline personality disorder robustly predicted persistence, a finding that converges with recent clinical studies. Personality psychopathology, particularly borderline personality disorder, should be assessed in all patients with major depressive disorder, considered in prognosis, and addressed in treatment.

This study examined the prevalence of nicotine dependence (ND) and its associations with DSM-IV personality disorders (PDs) among current smokers (n=7078), controlling for sociodemographic characteristics and comorbid Axis I and II disorders. Data were derived from a nationally representative sample of the U.S. population. Although all PDs were significantly associated with ND when sociodemographic factors were controlled, only schizotypal, borderline, narcissistic and obsessive-compulsive PDs were associated with ND after adding controls for Axis I and other Axis II disorders. These associations remained significant after controlling for degree of smoking exposure. The results suggest that both shared and PD-specific pathogenetic factors underlie these PD-ND associations. Implications are also discussed in terms of the relationship between personality features of schizotypal, borderline, narcissistic and obsessive-compulsive PDs and the self-medication hypothesis and the role of neurotransmission., (Published by Elsevier Ireland Ltd.)

Objectives: To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of narcissistic personality disorder (NPD) among men and women., Method: Face-to-face interviews with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions conducted between 2004 and 2005 in the United States., Results: Prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than for women (4.8%). NPD was significantly more prevalent among black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults. NPD was associated with mental disability among men but not women. High co-occurrence rates of substance use, mood, and anxiety disorders and other personality disorders were observed. With additional comorbidity controlled for, associations with bipolar I disorder, post-traumatic stress disorder, and schizotypal and borderline personality disorders remained significant, but weakened, among men and women. Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women and between NPD and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive personality disorders among men. Dysthymic disorder was significantly and negatively associated with NPD., Conclusions: NPD is a prevalent personality disorder in the general U.S. population and is associated with considerable disability among men, whose rates exceed those of women. NPD may not be as stable as previously recognized or described in the DSM-IV. The results highlight the need for further research from numerous perspectives to identify the unique and common genetic and environmental factors underlying the disorder-specific associations with NPD observed in this study.

Objective: Little is known about the fundamental structure of core personality disorder psychopathology in the general population. The current study employed confirmatory factor analysis to evaluate competing models of patterns of personality disorder diagnoses in a nationally representative sample., Method: DSM-IV and alternate models of the structure of personality disorder psychopathology were evaluated using data from the National Epidemiologic Survey on Alcohol and Related Conditions conducted between 2001 and 2002 (N = 43,093). Dimensional versus categorical representations of DSM-IV personality disorder structure were also tested. Face-to-face interviews were conducted in the United States. Participants were community-based respondents aged 18 years and older. Diagnoses and dimensional scores were made for antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid personality disorders., Results: Multiple goodness-of-fit indicators provided support for a DSM-IV-based hierarchical model of personality disorders. In this model, the individual personality disorders were viewed as belonging to 1 of 3 latent factors or clusters (A, B, or C). In all of the models, the individual personality disorders were allowed to be an indicator for only a single latent cluster, and errors were not allowed to correlate with each other. In turn, these 3 clusters were viewed as comprising a single higher-order "Axis II personality disorder factor." The DSM-IV model was largely invariant across gender, Axis I comorbidity, and treatment-seeking status. A dimensionally based form of assessment of the DSM-IV personality disorders produced excellent goodness-of-fit indicators and produced low Akaike information criterion values (which are indicative of better-fitting models)., Conclusions: The results from this confirmatory factor analysis in a large, nationally representative mental health survey supported the DSM-IV hierarchical organization of Axis II personality disorders. This model was significantly superior to viable alternative models of Axis II personality psychopathology. There was also evidence to suggest this model could obtain even stronger support if a dimensionally based form of diagnostic assessment was adopted in place of the dichotomous form of assessment (presence/absence) of personality disorders currently in use in the DSM-IV.

The objective of this study was to determine the prevalence and co-occurrence of DSM-IV personality disorders (PDs) among individuals with current DSM-IV mood and anxiety disorders in the US population and among individuals who sought treatment for such mood or anxiety disorders. Face-to-face interviews were conducted with 43,093 individuals, 18 years and older, in the National Institute on alcohol abuse and alcoholism's 2001-2002 National epidemiologic survey on alcohol and related conditions (NESARC). Odds ratios (ORs) were calculated to determine the prevalence and associations between current DSM-IV axis I and axis II disorders. Associations between mood, anxiety and PDs were all positive and statistically significant. Avoidant and dependent PDs were more strongly related to mood and anxiety disorders than other PDs. Associations between obsessive-compulsive PD and mood and anxiety disorders were significant, but much weaker. Paranoid and schizoid PDs were most strongly related to dysthymia, mania, panic disorder with agoraphobia, social phobia and generalized anxiety disorder, while histrionic and antisocial PDs were most strongly related to mania and panic disorder with agoraphobia. Results of this study highlight the need for further research on overlapping symptomatology, factors giving rise to the associations and the treatment implications of these disorders when comorbid.

The objective of this study was to determine the co-occurrence of 7 of the 10 Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision ( DSM-IV-TR ) personality disorders (PDs) in the US population. Face-to-face interviews were conducted with 43 093 respondents in the National Institute on Alcohol Abuse and Alcoholism's 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of the US population. Odds ratios were calculated to determine associations among PDs. All associations among PDs were positive and statistically significant. PDs were significantly associated with other PDs within the same cluster, in addition to being highly associated with PDs of other DSM-IV PD clusters. Co-occurrence between DSM-IV PDs is pervasive in the US general population. Future research is needed on the creation of dimensional representations of DSM-IV PDs as an adjunct to categorical diagnoses.

Objective: To present nationally representative data on the prevalence, sociodemographic correlates, and disability of 7 of the 10 DSM-IV personality disorders., Method: The data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version, and associations between personality disorders and sociodemographic correlates were determined. The relationship between personality disorders and 3 emotional disability scores (Short-Form 12, version 2) was also examined., Results: Overall, 14.79% of adult Americans (95% CI = 14.08 to 15.50), or 30.8 million, had at least 1 personality disorder. The most prevalent personality disorder in the general population was obsessive-compulsive personality disorder, 7.88% (95% CI = 7.43 to 8.33), followed by paranoid personality disorder 4.41% (95% CI = 4.12 to 4.70), antisocial personality disorder 3.63% (95% CI = 3.34 to 3.92), schizoid personality disorder 3.13% (95% CI = 2.89 to 3.37), avoidant personality disorder 2.36% (95% CI = 2.14 to 2.58), histrionic personality disorder 1.84% (95% CI = 1.66 to 2.02), and dependent personality disorder 0.49% (95% CI = 0.40 to 0.58). The risk of avoidant, dependent, and paranoid personality disorders was significantly greater among women than men (p <.05); the risk of antisocial personality disorder was greater among men compared with women (p <.05); and no sex differences were observed in the risk of obsessive-compulsive, schizoid, or histrionic personality disorders. In general, risk factors for personality disorders included being Native American or black, being a young adult, having low socioeconomic status, and being divorced, separated, widowed, or never married. Avoidant, dependent, schizoid, paranoid, and antisocial personality disorders (p <.02 to p <.0001) were each statistically significant predictors of disability. Obsessive-compulsive personality disorder was inconsistently related to disability. In contrast, disability was not significantly different among individuals with histrionic personality disorder compared with those without the disorder., Conclusion: Personality disorders are prevalent in the general population and are generally highly associated with disability. This study highlights the need to develop more effective and targeted prevention and intervention initiatives for personality disorders.

Background: Very little information is available on the co-occurrence of different personality disorders (PDs) and alcohol and drug use disorders in the US population., Objective: To present national data on sex differences in the co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol and drug use disorders and 7 of the 10 DSM-IV PDs., Design: Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43 093)., Setting: The United States and the District of Columbia, including Alaska and Hawaii., Participants: Household and group-quarters residents, aged 18 years and older., Results: Among individuals with a current alcohol use disorder, 28.6% (95% confidence interval [CI], 26.7-30.6) had at least 1 PD, whereas 47.7% (95% CI, 43.9-51.6) of those with a current drug use disorder had at least 1 PD. Further, 16.4% (95% CI, 15.1-17.6) of individuals with at least 1 PD had a current alcohol use disorder and 6.5% (95% CI, 5.7-7.3) had a current drug use disorder. Associations between PDs and alcohol and drug use disorders were overwhelmingly positive and significant (P <.05). Overall, alcohol use disorders were most strongly related to antisocial (odds ratio [OR], 4.8; 95% CI, 4.1-5.6), histrionic (OR, 4.7; 95% CI, 3.8-5.8), and dependent (OR, 3.0; 95% CI, 1.9-4.8) PDs. Drug use disorders also were more highly associated with antisocial (OR, 11.8; 95% CI, 9.7-14.3), histrionic (OR, 8.0; 95% CI, 6.0-10.7), and dependent (OR, 11.6; 95% CI, 7.1-19.1) PDs. Associations between obsessive-compulsive, histrionic, schizoid, and antisocial PDs and specific alcohol and drug use disorders were significantly stronger (P <.04) among women than men, whereas the association between dependent PD and drug dependence was significantly greater (P <.04) among men than women., Conclusions: The co-occurrence of PDs with alcohol and drug use disorders is pervasive in the US population. Results highlight the need for further research on the underlying structure of these disorders and the treatment implications of these disorders when comorbid.

Background: Little is known about the sociodemographic profiles, the intensity of drinking, the severity of alcohol use disorder (AUD), and psychopathology among individuals with specific patterns of concurrent alcohol and drug use and AUD and other drug use disorders (DUDs) comorbidity.Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. We examined sociodemographic correlates and psychopathology among individuals with specific patterns of concurrent use of alcohol and drug and AUD-DUD comorbidity relative to alcohol use or AUD only, respectively, using multinomial logistic regression. We also examined whether concurrent alcohol and drug use and AUD-DUD comorbidity increased the intensity of drinking and severity of AUD, respectively.Results: The majority (62.0%) of past-year drinkers used only alcohol. The 12-month prevalence of AUD only was 53.5%. Individuals with concurrent use of alcohol and drugs and AUD-DUD comorbidity were more likely to be men, younger, never/previously married, with lower education and income (odds ratios (ORs) ≥ 1.2). Concurrent use of alcohol and drugs and AUD- DUD comorbidity groups were more likely to experience psychopathology than the alcohol use only and AUD only groups, respectively (ORs ≥ 1.3). The intensity of drinking was greater among the concurrent use groups relative to the alcohol use only group, while the severity of AUD was greater among AUD-DUD comorbidity groups relative to the AUD only group.Conclusions: Research on consequences and treatment outcome of concurrent use of alcohol and drugs and AUD-DUD comorbidity is warranted to inform the development of more effective prevention/intervention programs. [ABSTRACT FROM AUTHOR]

Objectives: To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD).Methods: Face-to-face interviews with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5.Results: Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with Conclusions: DSM-5 PTSD is prevalent, highly comorbid, disabling, and associated with delayed help seeking. Additional research is needed to elucidate relationships identified herein, estimate PTSD-related costs, investigate hypotheses regarding etiology, course, and treatment, and support decisions about resource allocation to service delivery and research. Initiatives are needed to destigmatize PTSD, educate the public about its treatment, and encourage affected individuals to seek help. [ABSTRACT FROM AUTHOR]

Objective: The authors examined 3-year transitions among nonuse, asymptomatic use, and problem use of illicit drugs for U.S. adults in the general household population. Method: Data were from the nationally representative National Epidemiologic Survey on Alcohol and Related Conditions, a study of 34,653 adults interviewed twice, 3 years apart. Respondents were categorized on three mutually exclusive categories of baseline drug status: past-year nonusers (N=32,675), past-year asymptomatic drug users (N=861), and past-year symptomatic drug users (N=1,117). Symptomatic drug use, or problem use, was defined as presence of one or more symptoms that operationalize DSM-IV drug abuse and dependence criteria. The authors assessed sociodemographic, health, substance use, and psychiatric covariates for association with 3-year transitions to different status categories. Results: Among baseline nonusers, 95.4% continued to be nonusers at follow-up, 2.1% became asymptomatic users, and 2.5% developed problem use. Among baseline asymptomatic users, 66.6% had stopped using drugs at follow-up, 14.3% continued to be asymptomatic users, and 19.1% had developed problem use. Nearly half (49.0%) of those with problem use at baseline had stopped using drugs at follow-up, 10.9% had transitioned to asymptomatic use, and 40.1% continued to have problem use. Younger age, male sex, white race,and not being married were associated with progression from nonuse to use or problem use, as were alcohol and tobacco use and disorders, major depression, and schizotypal, borderline, and narcissistic personality disorders. Panic disorder and avoidant personality disorder were associated with less progression. Conclusions: Transitions in drug use status are common. The finding that alcohol and tobacco variables and co-occurring psychopathology are important correlates of transitions suggests the value of addressing all co-occurring disorders and substance use in patient assessments and treatment planning, both to prevent adverse transitions and to promote positive transitions. [ABSTRACT FROM AUTHOR]

The article presents a study which compared the gender differences in the prevalence of 12-month psychiatric disorders among the U.S. National Epidemiologic Survey participants who were positive and negative to HIV. HIV-positive men are at risk to any mood disorder than HIV-negative men. HIV-positive men are also at risk to any anxiety disorder and personality disorder. The effect of HIV status on the risk to mood, anxiety and personality disorders is higher for men than women.

Background: Existing studies of the association between age at first drink (AFD) and the risk of alcohol use disorders (AUD) suffer from inconsistent levels of control and designs that may inflate associations by failure to control for duration of exposure to risk. Methods: This study examined associations between AFD (ages <15 and 15–17 vs. 18+ years) and first incidence of DSM-IV alcohol dependence, abuse, and specific AUD criteria over a 3-year follow-up in a longitudinal study of U.S. drinkers 18 years of age and older at baseline ( n = 22,316), controlling for duration of exposure, family history, and a wide range of baseline and childhood risk factors. Results: After adjusting for all risk factors, the incidence of dependence was increased for AFD < 15 years (OR = 1.38) and for women only with AFD at ages 15 to 17 (OR = 1.54). The incidence of abuse was increased at AFD <15 and 15 to 17 years (OR = 1.52 and 1.30, respectively). Most dependence criteria showed significant associations with AFD, but hazardous drinking and continued drinking despite interpersonal problems were the only abuse criteria to do so. All associations were nonsignificant after controlling for volume of consumption, except that AFD at all ages <18 combined was associated with a reduced likelihood of impaired control, and AFD at ages 15 to 17 was associated with lower odds of drinking more/longer than intended among heavy-volume drinkers. In a population of low-risk drinkers that excluded those with positive family histories, personality disorders, and childhood risk factors, there were strong associations between early AFD (<18) and the incidence of dependence (OR = 3.79) and continued drinking despite physical/psychological problems (OR = 2.71), but no association with incidence of abuse. Conclusions: There is a robust association between AFD and the risk of AUD that appears to reflect willful rather than uncontrolled heavy drinking, consistent with misuse governed by poor decision-making and/or reward-processing skills associated with impaired executive cognitive function (ECF). Additional research is needed to determine causality in the role of impaired ECF, including longitudinal studies with samples of low-risk adolescents. [ABSTRACT FROM AUTHOR]

The present study examined one dimensional approach to personality disorders (PDs) in a large (n = 43,093), nationally representative sample of the U.S. population. Respondents were classified in four personality severity categories (no PD, subthreshold PD, simple PD, complex PD). Linear regression analyses were conducted to examine mental disability by PD severity for major DSM-IV substance use, mood and anxiety disorders. Significant increases in disability were observed between no PD and simple PD and between simple PD and complex PD for each Axis I disorder except drug dependence, but few differences in disability were found between no PD and subthreshold PD. This study found support for the clinical utility of the dimensional classification of PD severity with regard to the distinction between simple and complex PD and for a combined no PD-subthreshold PD level of severity. Future planned analyses will address the clinical utility of the classification prospectively, with a full battery of all Axis II PDs. [ABSTRACT FROM AUTHOR]

The article explores the prevalence of psychiatric disorders and substance use among past-year pregnant and postpartum women in the United States. The subject of the study include more than 40,000 women, aged 18 to 50 years old, more than 14,000 of whom have past year pregnancy status. Results show that there is significant lower rates of alcohol use disorders and substance use as well as lower risk of having any mood disorder in past year pregnant and postpartum women, compared to nonpregnant women. However, there is higher prevalence of major depressive disorders in postpartum than in nonpregnant women.

Background: Antisocial personality disorder (ASPD), syndromal adult antisocial behavior (AABS) without conduct disorder (CD) before age 15, and CD without progression to ASPD (“CD only”) are highly prevalent among adults with alcohol use disorders (AUDs). Among patients in AUD treatment, antisocial behavioral syndromes are associated with more severe AUDs and poorer treatment outcomes. Comparative data concerning associations of antisocial syndromes with clinical characteristics of AUDs and the sociodemographic and clinical correlates of these syndromes among general population adults with AUDs have not previously been available. This study examines prevalences and correlates of antisocial syndromes among adults with lifetime Diagnostic and Statistical Manual—Version IV (DSM-IV) AUDs, and describes associations of these syndromes with clinical characteristics of AUDs, in the general U.S. population. Methods: This report is based on the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions ( n=43,093, response rate=81%). Respondents ( n=11,843) with lifetime AUDs were classified according to whether they met criteria for ASPD, AABS, “CD only,” or no antisocial syndrome. Correlates of antisocial syndromes were examined using contingency table approaches and normal theory analyses of variance. Associations of antisocial syndromes with clinical characteristics of AUDs, including number of lifetime episodes, duration of longest or only episode, and alcohol consumption during period of heaviest drinking were examined using normal theory and logistic regression. Results: Sociodemographic and clinical correlates of antisocial syndromes among respondents with AUDs were consistent with results from prior studies. Antisocial syndromes were significantly associated with phenomenology of AUDs, particularly ASPD with the most severe clinical presentations. Associations with AABS were similar to but more modest than those with ASPD; those with “CD only” were weaker and less consistent. Patterns of associations between antisocial syndromes and clinical characteristics of AUDs were generally similar between men and women. Conclusions: Antisocial syndromes, particularly ASPD, appear to identify a more pernicious clinical profile of AUDs among adults in the general U.S. population. [ABSTRACT FROM AUTHOR]

Background: Very little information is available on the co-occurrence of different personality disorders (PDs) and alcohol and drug use disorders in the U.S. population. Objective: To present national data on sex differences in the co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol and drug use disorders and 7 of the 10 DSM-IV PDs. Design: Face-to-face interviews conducted in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Setting: The United States and the District of Columbia, including Alaska and Hawaii. Participants: Household and group-quarters residents, age 18 and older. Results: Among individuals with a current alcohol use disorder, 28.6 percent (95 percent confidence interval [CI], 26.7–30.6) had at least one PD, whereas 47.7 percent (95 percent CI, 43.9–51.6) of those with a current drug use disorder had at least one PD. Further, 16.4 percent (95 percent CI, 15.1-17.6) of individuals with at least one PD had a current alcohol use disorder, and 6.5 percent (95 percent CI, 5.7–7.3) had a current drug use disorder. Associations between PDs and alcohol and drug use disorders were overwhelmingly positive and significant (P < .05). Overall, alcohol use disorders were most strongly related to antisocial (odds ratio [OR], 4.8; 95 percent CI, 4.1–5.6), histrionic (OR, 4.7; 95 percent CI 3.8–5.8), and dependent (OR, 3.0; 95 percent CI, 1.9–4.8) PDs. Drug use disorders also were more highly associated with antisocial (OR, 11.8; 95 percent CI, 9.7–14.3), histrionic (OR, 8.0; 95 percent CI, 6.0–10.7), and dependent (OR, 11.6; 95 percent CI, 7.1–19.1) PDs. Associations between obsessive-compulsive, histrionic, schizoid, and antisocial PDs and specific alcohol and drug use disorders were significantly stronger (P < .04) among women than men, whereas the association between dependent PD and drug dependence was significantly greater (P < .04) among men than women. Conclusions: The co-occurrence of PDs with alcohol and drug use disorders is pervasive in the U.S. population. Results highlight the need for further research on the underlying structure of these disorders and the treatment implications of these disorders when comorbid. [ABSTRACT FROM AUTHOR]

Aims: To investigate the prevalence and correlates of recovery from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol dependence by examining the past-year status of individuals who met the criteria for prior-to-past-year (PPY) dependence. Design: Cross-sectional, retrospective survey of a nationally representative sample of U.S. adults age 18 and older (first wave of a planned longitudinal survey). Methods: This analysis is based on data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), in which data were collected in personal interviews conducted with one randomly selected adult in each sample household. A subset of the NESARC sample (total n = 43,093), consisting of 4,422 U.S. adults age 18 and older classified with PPY DSM-IV alcohol dependence, were evaluated with respect to their past-year recovery status: past-year dependence, partial remission, full remission, asymptomatic risk drinking, abstinent recovery (AR), and nonabstinent recovery (NR). Correlates of past-year status were examined in bivariate analyses and using multivariate logistic regression models. Findings: Of people classified with PPY alcohol dependence, 25.0 percent were still classified as dependent in the past year; 27.3 percent were classified as being in partial remission; 11.8 percent were asymptomatic risk drinkers who demonstrated a pattern of drinking that put them at risk of relapse; 17.7 percent were low-risk drinkers; and 18.2 percent were abstainers. Only 25.5 percent of people with PPY dependence ever received treatment. Being married was associated positively with the odds of both AR and NR, and ethanol intake was negatively associated with both. Severity of dependence increased the odds of AR but decreased the odds of NR. The odds of AR (but not NR) increased with age and female gender but were decreased by the presence of a personality disorder. Treatment history modified the effects of college attendance/graduation, age at onset, and interval since onset on the odds of recovery. Conclusions: There is a substantial level of recovery from alcohol dependence. Information on factors associated with recovery may be useful in targeting appropriate treatment modalities. [ABSTRACT FROM AUTHOR]

Objective To present nationally representative data on 12-month and lifetime prevalence, correlates, and comorbidity of DSM-IV major depressive disorder (MDD) among adults in the United States. Design/Setting/Participants Face-to-face survey of more than 43 000 adults aged 18 years and older residing in households and group quarters in the United States. Main Outcome Measures Prevalence and associations of MDD with sociodemographic correlates and Axis I and II disorders. Results The prevalence of 12-month and lifetime DSM-IV MDD was 5.28% (95% confidence interval, 4.98-5.57) and 13.23% (95% confidence interval, 12.64-13.81), respectively. Being female; Native American; middle-aged; widowed, separated, or divorced; and low income increased risk, and being Asian, Hispanic, or black decreased risk (P<.05). Women were significantly more likely to receive treatment than men. Both current and lifetime MDD were significantly associated with other specific psychiatric disorders, notably substance dependence, panic and generalized anxiety disorder, and several personality disorders. Conclusions This large survey suggests a higher prevalence of MDD in the US population than large-sample estimates from the 1980s and 1990s. The shift in highest lifetime risk from young to middle-aged adults is an important transformation in the distribution of MDD in the United States and specificity in risk for an age-period cohort. Associations between MDD and Axis I and II disorders were strong and significant, with variation within broad categories by specific diagnoses signaling the need for attention to the genetic and environmental reasons for such variation, as well as the implications for treatment response. [ABSTRACT FROM AUTHOR]

To investigate the prevalence and correlates of recovery fromDiagnostic and Statistical Manualversion IV (DSM-IV) alcohol dependence by examining the past-year status of individuals who met the criteria for prior-to-past-year (PPY) dependence.Cross-sectional, retrospective survey of a nationally representative sample of US adults 18 years of age and over (first wave of a planned longitudinal survey).This analysis is based on data from the 2001–02 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), in which data were collected in personal interviews conducted with one randomly selected adult in each sample household. A subset of the NESARC sample (totaln = 43 093), consisting of 4422 US adults 18 years of age and over classified with PPY DSM-IV alcohol dependence, were evaluated with respect to their past-year recovery status: past-year dependence, partial remission, full remission, asymptomatic risk drinking, abstinent recovery (AR) and non-abstinent recovery (NR). Correlates of past-year status were examined in bivariate analyses and using multivariate logistic regression models.Of people classified with PPY alcohol dependence, 25.0% were still classified as dependent in the past year; 27.3% were classified as being in partial remission; 11.8% were asymptomatic risk drinkers who demonstrated a pattern of drinking that put them at risk of relapse; 17.7% were low-risk drinkers; and 18.2% were abstainers. Only 25.5% of people with PPY dependence ever received treatment. Being married was associated positively with the odds of both AR and NR, and ethanol intake was negatively associated with both. Severity of dependence increased the odds of AR but decreased the odds of NR. The odds of AR (but not NR) increased with age and female gender but were decreased by the presence of a personality disorder. Treatment history modified the effects of college attendance/graduation, age at onset and interval since onset on the odds of recovery.There is a substantial level of recovery from alcohol dependence. Information on factors associated with recovery may be useful in targeting appropriate treatment modalities. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines the associations between past-year drinking status and the prevalence of 15 different past-year anxiety, mood and personality disorders, using a large (n = 43,093) nationally representative sample of the U.S. population. The prevalence of these disorders and their associations with drinking are compared for college students 18–29 years of age, other youth 18–29 years of age, and adults 30 years of age and older. After adjusting for sociodemographic characteristics and past-year tobacco and illicit drug use, only drinkers with alcohol dependence experienced an excess risk of a mood or anxiety disorder among college students 18–29 years of age, OR = 2.4. In contrast, the excess risk of any mood or anxiety disorder associated with drinking status among non-college youth varied from an OR of 1.8 for non-binge drinkers to 4.7 for drinkers with alcohol dependence. Among persons 30 years of age and older, the degree of excess risk was slightly lower but still higher than those for college students, OR = 1.5–3.8. Similarly, the excess odds of any personality disorder associated with drinking varied from 1.6 to 5.0 for the younger, non-college group and from 1.5 to 3.8 for the older adults, with no significant effect observed among college students. Factors that may help explain the weaker association of psychopathology and drinking in the college population include selectivity and greater availability of social and treatment resources that serve as alternatives to self-medicating the symptoms of psychological distress with alcohol. [Copyright &y& Elsevier]

Background No information is available on the co-occurrence of DSM-IV nicotine dependence and Axis I and II psychiatric disorders in the US population. Objectives To present national data on the co-occurrence of current DSM-IV nicotine dependence and other psychiatric disorders by sex and to estimate the burden of all US tobacco consumption carried by nicotine-dependent and psychiatrically ill individuals. Design Face-to-face interviews. Setting The United States. Participants Household and group-quarters adults (N = 43 093). Main Outcome Measures Prevalence and comorbidity of current nicotine dependence and Axis I and II disorders and the percentage of cigarettes consumed in the United States among psychiatrically vulnerable subgroups. Results Among US adults, 12.8% (95% confidence interval, 12.0-13.6) were nicotine dependent. Associations between nicotine dependence and specific Axis I and II disorders were all strong and statistically significant (P<.05) in the total population and among men and women. Nicotine-dependent individuals made up only 12.8% (95% confidence interval, 12.0-13.6) of the population yet consumed 57.5% of all cigarettes smoked in the United States. Nicotine-dependent individuals with a comorbid psychiatric disorder made up 7.1% (95% confidence interval, 6.6-7.6) of the population yet consumed 34.2% of all cigarettes smoked in the United States. Conclusions Nicotine-dependent and psychiatrically ill individuals consume about 70% of all cigarettes smoked in the United States. The results of this study highlight the importance of focusing smoking cessation efforts on individuals who are nicotine dependent, individuals who have psychiatric disorders, and individuals who have comorbid nicotine dependence and other psychiatric disorders. Further, awareness of industry segmentation strategies can improve smoking cessation efforts of clinicians and other health professionals among all smokers and especially among the most vulnerable. [ABSTRACT FROM AUTHOR]

Abstract: To compare the 12-month prevalence of psychiatric disorders in Asian Americans/Pacific Islanders in contrast to non-Hispanic whites; and further compare persistence and treatment-seeking rates for psychiatric disorders among Asian American/Pacific Islanders and non-Hispanic whites, analyses from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, Wave 1 (n =43,093) were conducted for the subsample of 1332 Asian Americans/Pacific Islanders (596 men and 736 women) and 24,507 non-Hispanic whites (10,845 men and 13,662 women). The past 12-month prevalence for any psychiatric disorder was significantly lower in Asian American/Pacific Islander males and females than non-Hispanic white males and females. Asian American/Pacific Islander males were less likely than non-Hispanic white males to have any mood, anxiety, substance use, and personality disorders, whereas the prevalence of mood disorders among Asian American/Pacific Islander females did not differ from those of non-Hispanic white females. In some cases, such as drug use disorders, both male and female Asian Americans/Pacific Islanders were more likely to have more persistent disorders than non-Hispanic whites. Compared to non-Hispanic white females, Asian American/Pacific Islander females had lower rates of treatment-seeking for any mood/anxiety disorders. Although less prevalent than among non-Hispanic whites, psychiatric disorders are not uncommon among Asian Americans/Pacific Islanders. The lower treatment-seeking rates for mood/anxiety disorders in Asian American/Pacific Islander females underscore the unmet needs for psychiatric service among this population. [Copyright &y& Elsevier]