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Original Research

The Association Between Social Isolation and DSM-IV Mood, Anxiety, and Substance Use Disorders: Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

Kee-Lee Chou, PhD; Kun Liang, MPhil; and Jitender Sareen, MD

Published: January 11, 2011

Article Abstract

Objective: The objective of this study is to document the prevalence of social isolation from close friends and religious group members and to test the association of having infrequently contacted close friends and members of religious groups with the current DSM-IV mood, anxiety, and substance use disorders.

Method: We conducted a secondary data analysis based on a cross-sectional, population-based study conducted in 2004-2005 that consists of a nationally representative sample of 34,653 American community-dwelling adults aged 18 years and older. Mood, anxiety, and substance use disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. Due to missing values for social network characteristics, we focused on 33,368 subjects in this study.

Results: We found that many Americans lacked frequently contacted close friends (10.1%; 95% CI, 9.6%-10.6%) or religious group members (58.7%; 95% CI, 57.5%-59.9%) in their social network. After adjusting for sociodemographic variables, lifetime diagnosis of the disorder in question, and social isolation in terms of 10 other social ties, we found that the absence of close friends was associated (P < .01) with an increased risk of major depressive disorder, dysthymic disorder, social phobia, and generalized anxiety disorder; the absence of frequently contacted religious group members in a network was positively related (P < .01) to alcohol abuse and dependence, drug abuse, and nicotine dependence.

Conclusions: These results suggest that social isolation is common in the United States and is associated with a higher risk of mental health problems. Results provide valuable information for prevention and treatment.

J Clin Psychiatry

Submitted: February 1, 2010; accepted April 14, 2010.

Online ahead of print: January 11, 2011 (doi:10.4088/JCP.10m06019gry).

Corresponding author: Kee-Lee Chou, PhD, Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Rd, Hong Kong, China (

Volume: 72

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