Swendsen J D, Merikangas K R, Canino G J, Kessler R C, Rubio-Stipec M, Angst J
Yale University School of Medicine, New Haven, CT 06510, USA.
Compr Psychiatry. 1998 Jul-Aug;39(4):176-84. doi: 10.1016/s0010-440x(98)90058-x.
The comorbidity of alcoholism with anxiety and depressive disorders was examined in four epidemiologic investigations from diverse geographic sites. Despite variability in lifetime prevalence rates for these disorders, there was strong cross-site consistency in the magnitude and specific patterns of comorbidity. Individuals with alcohol abuse or dependence generally experienced a twofold to threefold increased risk of anxiety and depressive disorders. Phobic conditions typically preceded the onset of alcoholism, but no systematic pattern was observed for panic or depressive disorders. Considerable heterogeneity was also observed concerning the impact of comorbid conditions on symptoms of the index disorder. While the presence of comorbid anxiety or depressive disorders was consistently associated with moderate increases in the symptoms of alcohol abuse or dependence, alcoholism was associated with large increases in the number of depressive symptoms and little or no increase in phobic symptoms. The findings are discussed in terms of the self-medication hypothesis and the etiologic heterogeneity of these forms of comorbidity in the general population.
在来自不同地理位置的四项流行病学调查中，研究了酒精中毒与焦虑症和抑郁症的共病情况。尽管这些疾病的终生患病率存在差异，但共病的程度和具体模式在不同地点之间具有很强的一致性。患有酒精滥用或依赖的个体通常患焦虑症和抑郁症的风险会增加两到三倍。恐惧症通常先于酒精中毒出现，但惊恐障碍或抑郁症未观察到系统模式。关于共病情况对索引疾病症状的影响，也观察到了相当大的异质性。虽然共病焦虑症或抑郁症的存在始终与酒精滥用或依赖症状的适度增加相关，但酒精中毒与抑郁症状数量的大幅增加相关，而恐惧症状几乎没有增加或没有增加。根据自我用药假说以及这些共病形式在一般人群中的病因异质性对研究结果进行了讨论。
