Amanda Kalaydjian

Headache in a National Sample of American Children: Prevalence and Comorbidity

The purpose of this study was to determine the prevalence, sociodemographic correlates, and comorbidity of recurrent headache in children in the United States. Participants were individuals aged 4 to 18 years (n = 10 198) who participated in the National Health and Nutrition Examination Surveys. Data on recurrent and other health conditions were analyzed. Frequent or severe headaches including migraine in the past 12 months were reported in 17.1% of children. Asthma, hay fever, and frequent ear infections were more common in children with headache, with at least 1 of these occurring in 41.6% of children with headache versus 25.0% of children free of headache. Other medical problems associated with childhood headaches include anemia, overweight, abdominal illnesses, and early menarche. Recurrent headache in childhood is common and has significant medical comorbidity. Further research is needed to understand biologic mechanisms and identify more homogeneous subgroups in clinical and genetic studies.

Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits.

BACKGROUND Although mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. Although experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigated this question in this study using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders. METHOD Data came from the National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey that retrospectively assessed lifetime history and age of onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios. RESULTS Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders). CONCLUSIONS Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.

Magnitude and impact of comorbidity of mental disorders from epidemiologic surveys

Purpose of review To consider comorbidity across multiple classes of disorders in data derived from recent large-scale community surveys. Recent findings There has been substantial recent progress in our understanding of patterns and implications of comorbidity of mental disorders. There is now converging evidence on the magnitude and specific patterns of comorbidity in international studies worldwide. There is increasing recognition of comorbidity of mental and physical disorders. Comorbidity of mental disorders and substance abuse has now been recognized universally, and the results of treatment and prevention studies incorporating comorbidity are now beginning to emerge. Summary Comorbidity has been shown to be an index of more severe course and outcome of mental disorders. Systematic inclusion of comorbidity into clinical evaluation and treatment will enhance the effectiveness of intervention with these conditions. Prevention of the development of secondary conditions as a consequence of primary disorders should reduce the impact of these conditions on both the individual and society.

Sociodemographic predictors of transitions across stages of alcohol use, disorders, and remission in the National Comorbidity Survey Replication

BACKGROUND Although much is known about risk factors for the initiation of alcohol use, abuse, and dependence, few population-based studies have examined the predictors of transitions across these stages. AIM The aim of this study is to examine the sociodemographic predictors of transitions across 6 stages of alcohol use in the National Comorbidity Survey Replication, a nationally representative household survey of the US population. METHODS A lifetime history of alcohol use, regular use (at least 12 drinks in a year), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol abuse and dependence with abuse was collected in 5692 National Comorbidity Survey Replication respondents using the World Health Organization Composite International Diagnostic Interview, Version 3.0. RESULTS Lifetime prevalence estimates were 91.7% for lifetime alcohol use, 72.9% for regular use, 13.2% for abuse, and 5.4% for dependence with abuse. Male sex, young age, non-Hispanic white race/ethnicity, low education, student status, and never being married predicted the onset of alcohol use, the transition from use to regular use, and from regular use to abuse. An early age of onset of alcohol use also predicted the latter transition. The transition from abuse to dependence was associated with an early age of onset of regular alcohol use, being previously married, and student status. Remission was predicted by young age and a later age of onset of alcohol abuse. CONCLUSION The reduced number and magnitude of factors associated with transitions to dependence and remission suggest qualitatively different risk factors at these stages relative to other stages of progression. Further knowledge is needed concerning the mechanisms underlying these differences to guide selective and indicated prevention programs.

Physical and mental comorbidity of headache in a nationally representative sample of US adults.

Objective: To investigate the contribution of comorbidity to health utilization and negative health perception in a large-scale population-based study. Comorbidity of headache with physical and mental disorders has been reported frequently in clinical samples. Methods: This concern was addressed using combined 6-year data from the 1999 to 2004 National Health Examination and Nutrition Survey (n = 31,126 adults), nationally representative datasets of the US population. Measures of physical disorders were based on standardized interviews of chronic conditions, and mental disorders were assessed by the Composite International Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Results: The 3-month prevalence of severe headaches or migraine in the US general population was 22.73%, with females and young adults having greater rates than males and older adults. Adults with headache had increased odds for a variety of physical disorders (including asthma, rheumatoid arthritis, and stroke) and mental disorders (including depression, generalized anxiety disorder, and panic disorder). Adults with headache were more likely to rate their health as “fair or poor” (17.9% versus 6.1%), to seek health care four or more times in a year (43.3% versus 22.7%), and to endorse physical and mental limitations. Health utilization and negative health perception were more strongly influenced by comorbid mental disorders than physical disorders. Conclusions: The results from this nationally representative sample provide new information on the interrelationships of headache with mental and physical disorders. The greater impact of comorbid mental compared with physical disorders on healthcare utilization and health perception has important implications for the clinical evaluation and treatment of headache in the population. NHANES = National Health Examination and Nutrition Survey; WHO-CIDI = World Health Organization Composite International Diagnostic Interview; GAD = generalized anxiety disorder; HRQOL = health-related quality of life.

The Importance of Timing of Transitions for Risk of Regular Smoking and Nicotine Dependence

BackgroundEstimating the timing and speed among smoking milestones is an important challenge for epidemiology given that further reductions in smoking prevalence may be best achieved by programs that target potentially malleable smoking behavior before the development of nicotine dependence.PurposeThe purpose of the study was to investigate the association between the timing and speed of transition among major smoking milestones (onset, weekly, and daily smoking) and onset and recovery from nicotine dependence.MethodsAnalyses are based on data from The National Comorbidity Survey—Replication, a nationally representative face-to-face household survey conducted between February 2001 and April 2003.ResultsOf those who had ever smoked (n = 5,692), 71.3% had reached weekly smoking levels and 67.5% had reached daily smoking. Four in ten who had ever smoked met criteria for nicotine dependence. A shorter time since the onset of weekly and daily smoking was associated with a transition to both daily smoking and nicotine dependence, respectively. The risk for each smoking transition was highest within the year following the onset of the preceding milestone. Recovery was associated with a longer period of time between smoking initiation and the development of dependence and a later age of smoking onset.ConclusionsThese findings shed light on the clinical course of smoking and nicotine dependence. Given the importance of timing of smoking transitions, prevalence may be further reduced through intervention targeted at adolescents and young adults in the months most proximal to smoking initiation.

Improving targets for the prevention of drug use disorders: Sociodemographic predictors of transitions across drug use stages in the national comorbidity survey replication

OBJECTIVES Models of drug use etiology and prevention require precise information concerning the expression of population-based risk factors across the continuum of drug use. However, the majority of previous epidemiologic research on this topic has not addressed transitions between specific drug stages. The present investigation examined the sociodemographic predictors of progression across six stages of drug use in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of the U.S. population conducted between February, 2001 and April, 2003. METHODS Lifetime history of opportunity to use illicit substances, initial drug use, and DSM-IV drug use disorders were collected using in-person structured diagnostic interviews. RESULTS The median age of first opportunity to use drugs as well as drug use, abuse and dependence each occurred prior to age 20, while the median remission from abuse and dependence occurred at 26 and 30 years, respectively. Most sociodemographic variables, in particular sex and ethnicity, demonstrated highly differential associations with transitions depending on the stage examined. CONCLUSIONS The findings may partially explain the effectiveness of strategies designed to reduce drug use, abuse and dependence, and indicate that increased correspondence is needed between available epidemiologic data and existing models of etiology or prevention.