Zimmermann P, Wittchen H U, Höfler M, Pfister H, Kessler R C, Lieb R
Max-Planck Institute of Psychiatry, Clinical Psychology and Epidemiology Unit, Munich, Germany.
Psychol Med. 2003 Oct;33(7):1211-22. doi: 10.1017/s0033291703008158.
Cross-sectional findings in community surveys of adults suggest that adolescent anxiety disorders are strong predictors of the subsequent onset of alcohol use, abuse and dependence. However, prospective data that follow a sample of adolescents into adulthood are needed to confirm these associations.
Baseline and 4-year follow-up data from the EDSP-Study, a prospective community survey of 3021 (2548 at follow-up) adolescents and young adults aged 14 to 24 years at baseline carried out in Munich, were used. DSM-IV anxiety disorders, alcohol use and alcohol use disorders were assessed with the Munich-Composite-International-Diagnostic-Interview (M-CIDI). Multiple logistic regression analysis, controlling for age, gender, other mental disorders, substance use disorders and antisocial behaviour was used to study the associations of baseline anxiety disorders with the subsequent onset and course of alcohol use and alcohol disorders.
Baseline social phobia significantly predicts the onsets of regular use and hazardous use and the persistence of dependence. Panic attacks significantly predict the onsets of hazardous use and abuse as well as the persistence of combined abuse/dependence. Panic disorder significantly predicts the persistence of combined abuse/dependence. Other anxiety disorders do not significantly predict any of the outcomes.
Panic and social phobia are predictors of subsequent alcohol problems among adolescents and young adults. Further studies are needed to investigate the underlying mechanisms and the potential value of targeted early treatment of primary panic and social phobia to prevent secondary alcohol use disorders.
针对成年人的社区调查中的横断面研究结果表明，青少年焦虑症是随后发生酒精使用、滥用和依赖的有力预测因素。然而，需要有追踪青少年样本直至成年期的前瞻性数据来证实这些关联。
使用了EDSP研究的基线数据和4年随访数据，该研究是在慕尼黑对3021名（随访时为2548名）14至24岁的青少年和青年成年人进行的前瞻性社区调查。采用慕尼黑综合国际诊断访谈（M-CIDI）评估DSM-IV焦虑症、酒精使用及酒精使用障碍。运用多因素逻辑回归分析，控制年龄、性别、其他精神障碍、物质使用障碍和反社会行为，以研究基线焦虑症与随后酒精使用及酒精障碍的发生和病程之间的关联。
基线社交恐惧症显著预测了规律使用和危险使用的开始以及依赖的持续存在。惊恐发作显著预测了危险使用和滥用的开始以及滥用/依赖合并状态的持续存在。惊恐障碍显著预测了滥用/依赖合并状态的持续存在。其他焦虑症对任何结果均无显著预测作用。
惊恐症和社交恐惧症是青少年和青年成年人随后出现酒精问题的预测因素。需要进一步研究以探讨其潜在机制以及针对原发性惊恐症和社交恐惧症进行有针对性的早期治疗对预防继发性酒精使用障碍的潜在价值。
