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Original Research

Depressive and Anxiety Disorders Predicting First Incidence of Alcohol Use Disorders: Results of the Netherlands Study of Depression and Anxiety (NESDA)

Lynn Boschloo, PhD; Nicole Vogelzangs, PhD; Wim van den Brink, MD, PhD; Johannes H. Smit, PhD; Dick J. Veltman, MD, PhD; Aartjan T. F. Beekman, MD, PhD; and Brenda W. J. H. Penninx, PhD

Published: December 15, 2013

Article Abstract

Introduction: Depressive and anxiety disorders may predict first incidence of alcohol abuse and alcohol dependence. This study aims to identify those persons who are at an increased risk of developing alcohol abuse or alcohol dependence by considering the heterogeneity of depressive and anxiety disorders and exploring the role of other risk factors.

Method: In a large sample of persons with and without baseline DSM-IV depressive or anxiety disorders (n = 2,676; 18-65 years; assessed in 2004-2007), the first incidences of DSM-IV alcohol abuse and alcohol dependence during a 4-year follow-up were considered as primary outcomes. Status (remitted or current disorder), severity, and type (specific disorders) of depressive and anxiety disorders were assessed, as well as other risk factors, such as sociodemographic, vulnerability, and addiction-related factors.

Results: Cumulative first-incidence rates of alcohol abuse and alcohol dependence were 2.0% and 3.0%, respectively. Persons with current, but not remitted, depressive or anxiety disorders were at an increased risk of a first incidence of alcohol dependence (hazard ratio [HR] = 2.69; 95% CI, 1.37-5.29), but not first incidence of alcohol abuse (HR = 0.55; 95% CI, 0.28-1.09). Although this association was not conditional on the type of disorder, first-incidence rates of alcohol dependence gradually increased with the number of depressive and anxiety disorders (HR per SD increase = 1.65; 95% CI, 1.37-2.00). Subthreshold alcohol problems especially (P < .001), but also recent negative life events (P = .06), were additional independent predictors of first incidence of alcohol dependence.

Conclusion: Current depressive disorder, anxiety disorder, or both significantly predicted first incidence of alcohol dependence, which stresses the importance of addiction prevention strategies for depressed and anxious patients in mental health settings. Subthreshold alcohol problems and recent negative life events may help to identify persons at an increased risk for developing alcohol dependence.

J Clin Psychiatry 2013;74(12):1233-1240

Submitted: September 11, 2012; accepted February 11, 2013(doi:10.4088/JCP.12m08159).

Corresponding author: Lynn Boschloo, PhD, Department of Psychiatry; University of Groningen, University Medical Center Groningen, Hanzeplein 1 Groningen, The Netherlands (

Volume: 74

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