To examine prevalence of tobacco use and identify psychiatric symptoms and substance use correlates of tobacco use comparing adults 50-64 years of age with those 65+ years of age (N=10,891).
Data were from the 2008–2009 U.S. National Surveys on Drug Use and Health.
Past-year tobacco use was one-half as frequent among adults aged 65+ years (14.1%) compared to adults aged 50–64 years (30.2%); the latter group surpassed the former in rates of cigarette smoking (24.8 % vs. 10.6%), daily cigarette smoking (16.5% vs. 7.1%), cigar smoking (7.4% vs. 2.3%), and smokeless tobacco use (2.5% vs. 1.7%). Increased odds of cigarette smoking were noted among men, whites, African Americans, and those who had less education, had lower income, were not currently married, or were binge drinkers or illicit/non-medical drug users. In controlled analyses, odds ratio in those 65+ years of age who had smoked during the past year was 2.2 for binge drinking and 3.5 for illicit or non-medical drug use. Odds ratio of binge drinking among those 65+ years of age for cigar smokers during the past year was 3.1. Past year cigarette smoking was not associated with reports of symptoms of depression or anxiety in the 65+ age group.
Tobacco use is less prevalent among adults 65+ years of age yet continues to be strongly associated with binge drinking and illicit or non-medical drug use. Preventive efforts to decrease these substance use problems should include programs to decrease tobacco use.
Cigarette smoking; cigar smoking; older adults; smokeless tobacco use; epidemiology; binge drinking, substance use, depression, anxiety
To identify a potential core set of brief screeners for the detection of individuals with a substance use disorder (SUD) in medical settings.
Data were from two multisite studies that evaluated stimulant use outcomes of an abstinence-based contingency management intervention as an addition to usual care (National Drug Abuse Treatment Clinical Trials Network [CTN] trials 006-007). The sample comprised 847 substance-using adults who were recruited from 12 outpatient substance abuse treatment settings across the United States. Alcohol and drug use disorders were assessed by the DSM-IV Checklist. Data were analyzed by factor analysis, item response theory (IRT), sensitivity, and specificity procedures.
Comparatively prevalent symptoms of dependence, especially inability to cut down for all substances, showed high sensitivity for detecting a SUD (low rate of false negative). IRT-defined severe (infrequent) and low discriminative items, especially withdrawal for alcohol, cannabis, and cocaine, had low sensitivity in identifying cases of a SUD. IRT-defined less severe (frequent) and high discriminative items, including inability to cut down or taking larger amounts than intended for all substances and withdrawal for amphetamines and opioids, showed good-to-high values of area under the receiver operating characteristic curve in classifying cases and non-cases of a SUD.
Findings suggest the feasibility of identifying psychometrically reliable substance dependence symptoms to develop a two-item screen for alcohol and drug disorders.
Clinical trials network; Item response theory; Receiver operating characteristic curve; Brief screening; Substance use disorders
To estimate one-year prevalence and correlates of alcohol abuse, dependence, and subthreshold dependence (diagnostic orphans) among middle-aged and elderly persons in the United States.
2005–2007 National Surveys on Drug Use and Health.
Sample included 10,015 respondents 50–64 years of age and 6,289 respondents 65+ years of age. Data were analyzed by bivariate and multinomial regression analyses.
Sociodemographic variables, alcohol use and DSM-IV abuse and dependence, major depression, nicotine dependence, illicit drug use, and nonmedical use of prescription drugs.
Fifty-one percent of the sample used alcohol during the past year (56% in the 50-64 age group and 43% in the 65+ age group). Overall, 11% (dependence 1.9%, abuse 2.3%, and subthreshold dependence 7.0%) of adults aged 50–64 and about 6.7% (dependence 0.6%, abuse 0.9%, and subthreshold dependence 5.2%) of those aged 65+ reported alcohol abuse, dependence or dependence symptoms. Among past-year alcohol users, 20% (dependence 3.4%, abuse 4.0%, and subthreshold dependence 12.5%) of adults aged 50–64 and 15.4% (dependence 1.3%, abuse 2.1%, and subthreshold dependence 12.0%) of those aged 65+ endorsed alcohol abuse or dependence symptoms. “Tolerance” (48%) and “time spent using” (37%) were the two symptoms most frequently endorsed by the subthreshold group. Compared with alcohol users without alcohol abuse or dependence symptoms, Blacks or Hispanics, and those who had nicotine dependence or used nonmedical prescription drugs had increased odds of subthreshold dependence. Diagnostic orphans also were more likely to engage in binge drinking than the asymptomatic group.
Diagnostic orphans among middle-aged and elderly community adults show an elevated rate for binge drinking and nonmedical use of prescription drugs that require attention from health care providers.
Substance abuse among older adults is a looming public health concern. The number of Americans aged 50+ years with a substance use disorder is projected to double from 2.8 million in 2002–2006 to 5.7 million in 2020. The authors provide a review of epidemiological findings for this understudied area of research by focusing on illicit drug use disorders and nonmedical use of prescription drugs among adults aged 50+ years.
MEDLINE and PsychInfo were searched using keywords drug use, drug abuse, drug misuse, substance use disorder, and prescription drug abuse. Using the relatedarticles link, additional articles were screened for inclusion. This review included articles published between 1990 and 2010.
Results from multiple sources indicated a much higher rate of illicit drug use and nonmedical use of prescription drugs and drug-related treatment admissions for persons 50 to 64 years of age compared with adults 65+ years of age. Rates of treatment admissions involving primary use of illicit and misuse of prescription drugs have increased, while rates involving primary use of alcohol only have decreased. Alcohol, opioids/heroin, and cocaine were more likely than other substances to be associated with treatment use. Limited research data suggested the effectiveness of treatments, especially for women. Furthermore, older adults appeared to be less likely than younger adults to perceive substance use as problematic or to use treatment services.
There is robust evidence showing that an increased number of older adults will need substance abuse care in the coming decades. Increasing demands on the substance abuse treatment system will require expansion of treatment facilities and development of effective service programs to address emerging needs of the aging drug-using population.
alcohol; epidemiology; health behaviors; drug abuse; illicit drug use; prescription drug abuse
Despite the high occurrence of depressive symptoms in older adults, especially women, little is known about the long-term course of late-life depressive symptoms.
To characterize the natural course of depressive symptoms among elderly women followed for nearly 20 years, going from young old to oldest old.
Using a latent class growth-curve analysis, we analyzed women enrolled in an ongoing prospective cohort study (1988–2009).
Clinic sites in Baltimore, MD, Minneapolis, MN, the Monongahela Valley near Pittsburgh, PA, and Portland, OR.
We studied 7240 community-dwelling women age 65 years or older.
Main Outcome Measure
The Geriatric Depression Scale (GDS) short form (range: 0–15) was used to assess depressive symptoms repeatedly over follow-up.
We identified four latent classes over 20 years, comprising an expected 28% of women with minimal depressive symptoms, 54% with persistently low symptoms, 15% with increasing symptoms, and 3% with persistently high symptoms. In an adjusted model for latent class membership, odds ratios (ORs) for belonging in the increasing and persistently high depressive symptom classes, respectively, compared with minimal symptom group were substantially and significantly (P < .05) elevated for baseline smoking (ORs, 4.69 and 7.97), physical inactivity (ORs, 2.11 and 2.78), small social network (ORs, 3.24 and 6.75), physical impairment (ORs, 8.11 and 16.43), myocardial infarction (ORs, 2.09 and 2.41), diabetes (ORs, 2.98 and 3.03), and obesity (ORs, 1.86 and 2.90).
Over 20 years, approximately 20% of older women experienced persistently high or increasing depressive symptoms. In addition, these women had more comorbidities, physical impairment, and negative lifestyle factors at baseline. These associations support the need for intervention and prevention strategies to reduce depressive symptoms into oldest-old years.
Treatment of peritoneal metastases from appendiceal and colon cancer with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) shows great promise. Although long term disease free survival is achieved for some cases with this procedure, many patients recur. Oncologists have treated such recurrences of appendiceal cancer similarly to colorectal carcinoma, which has been largely ineffective. This study utilizes gene expression analysis of peritoneal metastases to better understand these neoplasms.
From a prospectively maintained database and tissue bank, 41 snap frozen samples of peritoneal metastases (26 appendiceal, 15 colorectal) from patients undergoing HIPEC with complete cytoreduction and >3 years of follow up underwent global gene expression analysis. Distinct phenotypes were identified using unsupervised hierarchical clustering based upon differential gene expression. Survival curves restratified by genotype were generated.
Three distinct phenotypes were found, two consisting of predominantly low grade appendiceal samples (10/13 in Cluster 1 and 15/20 in Cluster 2) and one consisting of predominantly colorectal samples (7/8 in Cluster 3). Cluster 1 consisted of patients with good prognosis and Clusters 2 and 3 consisted of patients with poor prognosis (p=0.006). Signatures predicted survival of low (Cluster 1) vs. high risk (Cluster 2) appendiceal (p=.04) and low risk appendiceal (Cluster 1) vs. colon primary (Cluster 3) (p=.0002).
This study represents the first use of gene expression profiling for appendiceal cancer, and demonstrates genomic signatures quite distinct from colorectal cancer, confirming their unique biology. Consequently, therapy for appendiceal lesions extrapolated from colonic cancer regimens may be unfounded. These phenotypes may predict outcomes guiding patient management. HIPEC, hyperthermic intraperitoneal chemotherapy PC, peritonel carcinomatosis OTC, optimal cutting temperature GSEA, gene set enrichment analysis
Improving identification and treatment for substance use disorders (SUDs) is a national priority, but data about various drug use disorders encountered in emergency departments (EDs) are lacking. We examined past-year substance use and SUDs (alcohol, 9 drug classes) among adult ED users. Prevalences of substance use and SUDs among ED non-users were calculated for reference purposes.
Using data from the 2007–2009 National Surveys on Drug Use and Health, we assessed SUDs among noninstitutionalized adults aged ≥18 years who responded to standardized survey questions administered by audio computer-assisted self-interviewing methods.
Of all adults (N=113,672), 27.8% used the ED in the past year. ED users had higher prevalences than ED non-users of coexisting alcohol–drug use (15.2% vs. 12.1%), drug use (any drug, 16.9% vs. 13.0%; marijuana, 12.1% vs. 9.7%; opioids, 6.6% vs. 4.1%), and alcohol or drug disorders (11.0% vs. 8.5%). Among substance users, the ED group on average spent more days using drugs than the non-ED group; ED users manifested higher conditional rates of SUDs than ED non-users (alcohol or drugs, 15.9% vs. 11.7%; marijuana, 16.6% vs. 13.2%; cocaine, 33.2% vs. 22.3%; opioids, 20.6% vs. 10.0%; stimulants, 18.6% vs. 9.2%; sedatives, 35.0% vs. 4.4%; tranquilizers, 12.4% vs. 5.2%). Regardless of ED use status, substance-using young adults, men, and less-educated adults showed elevated odds of having a SUD.
Drug use is prevalent and combined with high rates of drug use disorders among drug users seen in the ED.
alcohol use disorders; drug abuse; drug use disorders; prescription drug abuse; substance use disorder
To estimate the frequency, distribution, and correlates of non-prescription use of pain relievers among middle aged and elderly persons in the United States.
Cross-sectional data analysis of a national community survey.
The 2005 and 2006 National Surveys on Drug Use and Health (NSDUH).
10,953 respondents 50 years of age and older (6,717 respondents 50-64 years of age and 4,236 respondents 65+ years of age).
Social and demographic variables, detailed assessment of non-prescription use (and abuse) of prescription pain relievers (e.g., acetaminophen with codeine, morphine), substance use, major depression, self-reported medical illnesses, and self-rated health.
Non-prescription use of prescription pain relievers was reported by 1.4% of the sample during the past year. Combinations of acetaminophen with hydrocodone or propoxyphene were the most commonly used drugs. Use was associated with younger age (Odds Ratio, OR = 2.39, 95% CI = 1.31–4.36), American Indian/Alaska native (OR = 8.78, 95% CI = 2.50–30.85) and use of marijuana (OR = 7.07, 95% CI = 3.99–12.53). Less than 10% of non-prescription users were abusing these medications or dependent upon them.
In a representative sample of middle aged and older adults, non-prescription use of prescription pain relievers is relatively uncommon. Nevertheless, the much higher use among middle aged adults suggests that as this cohort ages, the problem may increase among the elderly.
elderly; pain relievers; non-prescription use; epidemiology; opioids; prescription drug misuse
To compare symptom expression in primarily middle-aged (<60) and older (60+) depressed patients and determine if symptom profiles differed by age.
Patients diagnosed with major depression (n=664) were screened using the Center for Epidemiologic Studies – Depression Scale and sections of the Diagnostic Interview Schedule. Patients were separated into homogeneous clusters based on symptom endorsement using latent class analysis.
Older patients were less likely to endorse crying spells, sadness, feeling fearful, being bothered, or feeling life a failure, but were more likely to endorse poor appetite and loss of interest in sex. Older patients were also less likely to report enjoying life, feeling as good as others, feeling worthless, wanting to die and thinking about suicide. In two latent class models with depressive symptoms as indicators, three-class models best fit the data. Profiles supported heterogeneity in symptom expression. Clusters differed by age when other demographic, clinical, health and social variables were controlled, but did not support age-specific symptom profiles. Overall, older patients had later age of onset, had fewer lifetime spells, were more likely to have ever received ECT and were less likely to have comorbid anxiety. Older patients also had more cognitive impairment, health conditions, and mobility limitations, but had higher levels of subjective social support and had experienced fewer stressful life events.
There are age differences in symptom endorsement between younger/middle-aged and older patients with major depression. The data, however, did not identify a symptom profile unique to late-life depression.
depression; symptoms; age differences; latent class analysis
While item response theory (IRT) research shows a latent severity trait underlying response patterns of substance abuse and dependence symptoms, little is known about IRT-based severity estimates in relation to clinically relevant measures. In response to increased prevalences of marijuana-related treatment admissions, an elevated level of marijuana potency, and the debate on medical marijuana use, we applied dimensional approaches to understand IRT-based severity estimates for marijuana use disorders (MUDs) and their correlates while simultaneously considering gender- and race/ethnicity-related differential item functioning (DIF). Using adult data from the 2008 National Survey on Drug Use and Health (N=37,897), DSM-IV criteria for MUDs among past-year marijuana users were examined by IRT, logistic regression, and multiple indicators–multiple causes (MIMIC) approaches. Among 6,917 marijuana users, 15% met criteria for a MUD; another 24% exhibited subthreshold dependence. Abuse criteria were highly correlated with dependence criteria (correlation=0.90), indicating unidimensionality; item information curves revealed redundancy in multiple criteria. MIMIC analyses showed that MUD criteria were positively associated with weekly marijuana use, early marijuana use, other substance use disorders, substance abuse treatment, and serious psychological distress. African Americans and Hispanics showed higher levels of MUDs than whites, even after adjusting for race/ethnicity-related DIF. The redundancy in multiple criteria suggests an opportunity to improve efficiency in measuring symptom-level manifestations by removing low-informative criteria. Elevated rates of MUDs among African Americans and Hispanics require research to elucidate risk factors and improve assessments of MUDs for different racial/ethnic groups.
Differential item functioning; item response theory; multiple indicators–multiple causes model; marijuana use disorders
To identify trajectories of depressive symptoms in older community residents.
Depressive symptomatology, based on a modified Center for Epidemiological Studies–Depression scale, was obtained at years 0, 3, 6, and 10, in the Duke Established Populations for Epidemiologic Studies of the Elderly (N=4,162). Generalized growth mixture models identified the latent class trajectories present. Baseline demographic, health and social characteristics distinguishing the classes were identified using multinomial logistic regression.
Four latent class trajectories were identified. Class 1-- stable low depressive symptomatology (76.6% of the sample); class 2 – initially low depressive symptomatology, increasing to the subsyndromal level (10.0%); class3 -- stable high depressive symptomatology (5.4%); class 4 –high depressive symptomatology improving over 6 years before reverting somewhat (8.0%). Class 1 was younger, male, with better education, health, and social resources, in contrast to class 3. Class 2 had poorer cognitive functioning and higher death rate. Class 4 had better health and social resources.
Reduction in high depressive symptomatology is associated with more education, better health, fewer stressful events, and a larger social network. Increasing depressive symptomatology is accompanied by poorer physical and cognitive health, more stressful life events, and greater risk of death.
depressive symptomatology; trajectories; community sample; longitudinal; elderly
To address an urgent need for screening of substance use problems in medical settings, we examined substance-specific dependence criteria as potential brief screeners for the detection of patients with a substance use disorder (SUD).
The sample included 920 opioid-dependent adults who were recruited from outpatient treatment settings at 11 programs in 10 U.S. cities and who completed intake assessments of SUDs for a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN003). Data were analyzed by factor analysis, item response theory (IRT), sensitivity, and specificity procedures.
Across all substances (alcohol, amphetamines, cannabis, cocaine, sedatives), withdrawal was among the least prevalent symptoms, while taking large amounts and inability to cut down were among the most prevalent symptoms. Items closely related to the latent trait of a SUD showed good-to-high values of area under the receiver operating characteristic curve in identifying cases of a SUD; IRT-defined severe and less discriminative items exhibited low sensitivity in identifying cases of a SUD (withdrawal for all substances; time using for alcohol and sedatives; giving up activities for sedatives).
Study results suggest that withdrawal and time using are much less reliable indicators for a SUD than taking larger amounts than intended and inability to cut down and should be studied further for consideration in developing a simplified tool for screening patients for SUDs in medical settings. These findings have implications for the use of common health indicators in electronic health records systems to improve patient care.
clinical trials network; item response theory; receiver operating characteristic curve; brief screening; sensitivity; specificity; substance use disorders
This study examined national trends, patterns, correlates, and barriers to substance abuse treatment use by adolescents aged 12–17 years who met at least one of the past-year criteria for prescription opioid abuse or dependence (N=1788).
Data were from the 2005–2008 National Surveys of Drug Use and Health (NSDUH). Past-year substance use disorders, major depression, and treatment use were assessed by audio computer-assisted self-interviewing.
About 17% of adolescents with opioid dependence (n=434) and 16% of those with opioid abuse (n=355) used any substance abuse treatment in the past year compared with 9% of subthreshold users, i.e., adolescents who reported 1–2 prescription opioid dependence criteria but no abuse criteria (n=999). Only 4.2% of adolescents with opioid dependence, 0.5% of those with abuse, and 0.6% of subthreshold users reported a perceived need for treatment of nonmedical opioid use. Self-help groups and outpatient rehabilitation were the most commonly used sources of treatment. Few black adolescents used treatment (medical settings, 3.3%; self-help groups, 1.7%) or reported a need for treatment (1.8%). Talking to parents/guardians about dangers of substance use increased the odds of treatment use. Barriers to treatment use included —wasn’t ready to stop substance use,” —didn't want others to find out,” and —could handle the problem without treatment.”
Adolescents with prescription opioid use disorders markedly underutilize treatment. Non-financial barriers are pervasive, including stigma and a lack of perceived treatment need.
Opioid use disorders; Misuse of prescription opioids; Self-help groups; Substance abuse treatment
This study applied item response theory (IRT) and latent class analysis (LCA) procedures to examine the dimensionality and heterogeneity of comorbid substance use disorders (SUDs) and explored their utility for standard clinical assessments, including the Addiction Severity Index (ASI), HIV Risk Behavior Scale (HRBS), and SF-36 quality-of-life measures.
The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the U.S. National Drug Abuse Treatment Clinical Trials Network (CTN001–002). Patients were recruited from inpatient and outpatient addiction treatment settings at 12 programs. Data were analyzed by factor analysis, IRT, LCA, and latent regression procedures.
A two-class LCA model fit dichotomous SUD data empirically better than one-parameter and two-parameter IRT models. LCA distinguished 10% of severe comorbid opioid-dependent individuals who had high rates of all SUDs examined—especially amphetamine and sedative abuse/dependence—from the remaining 90% who had SUDs other than amphetamine and sedative abuse/dependence (entropy=0.99). Item-level results from both one-parameter and two-parameter IRT models also found that amphetamine and sedative abuse/dependence tapped the more severe end of the latent poly-SUD trait. Regardless of whether SUDs were defined as a continuous trait or categorically, individuals characterized by a high level of poly-SUD demonstrated more psychiatric problems and HIV risk behaviors.
A combined application of categorical and dimensional latent approaches may improve the understanding of comorbid SUDs and their associations with other clinical indicators. Abuse of sedatives and methamphetamine may serve as a useful marker for identifying subsets of opioid-dependent individuals with needs for more intensive interventions.
clinical trials network; comorbidity; item response theory; latent class analysis; multiple indicators–multiple causes model; opioid dependence; polysubstance use; substance use disorders
This study examined the prevalence of substance use disorders (SUDs) among psychiatric patients aged 2–17 years in an electronic health records database (N=11,457) and determined patterns of comorbid diagnoses among patients with a SUD to inform emerging comparative effectiveness research (CER) efforts. DSM-IV diagnoses of all inpatients and outpatients at a large university-based hospital and its associated psychiatric clinics were systematically captured between 2000 and 2010: SUD, anxiety (AD), mood (MD), conduct (CD), attention deficit/hyperactivity (ADHD), personality (PD), adjustment, eating, impulse-control, psychotic, learning, mental retardation, and relational disorders. The prevalence of SUD in the 2–12-year age group (n=6,210) was 1.6% and increased to 25% in the 13–17-year age group (n=5,247). Cannabis diagnosis was the most prevalent SUD, accounting for more than 80% of all SUD cases. Among patients with a SUD (n=1,423), children aged 2–12 years (95%) and females (75–100%) showed high rates of comorbidities; blacks were more likely than whites to be diagnosed with CD, impulse-control, and psychotic diagnoses, while whites had elevated odds of having AD, ADHD, MD, PD, relational, and eating diagnoses. Patients with a SUD used more inpatient treatment than patients without a SUD (43% vs. 21%); children, females, and blacks had elevated odds of inpatient psychiatric treatment. Collectively, results add clinical evidence on treatment needs and diagnostic patterns for understudied diagnoses.
Attention deficit/hyperactivity disorder; comorbidity; comparative effectiveness research; electronic health records; mood disorder; personality disorder; relational disorder; substance use disorder
While young racial/ethnic groups are the fastest growing population in the United States, data on alcohol and drug use disorders among adolescents of various racial/ethnic backgrounds are lacking.
To examine the magnitude of past-year Diagnostic and Statistical Manual of Mental Disorders-IV substance use disorders (alcohol, marijuana, cocaine, inhalants, hallucinogens, heroin, analgesic opioids, stimulants, sedatives, tranquilizers) among whites, Hispanics, African Americans, Native Americans, Asians/Pacific Islanders, and multiple-race adolescents.
2005–2008 National Surveys of Drug Use and Health.
Non institutionalized, household adolescents aged 12–17 years.
Substance use disorders were assessed by standardized survey questions administered by the audio computer-assisted self-interviewing method.
Of all adolescents aged 12–17 (N=72,561), 37% used alcohol or drugs in the past year; 8% met criteria for an alcohol or drug use disorder, with Native Americans having the highest prevalence of use (48%) and disorder (15%). Analgesic opioids were the second most commonly used illegal drugs in all racial/ethnic groups, following marijuana; opioid use was comparatively prevalent among Native Americans (10%) and multiple-race adolescents (9%). Among past-year alcohol or drug users (n=27,705), Native Americans (32%), multiple-race adolescents (25%), whites (23%), and Hispanics (21%) had the highest rates of alcohol or drug use disorders. Marijuana was used by adolescents more frequently than alcohol or other drugs, and 26% of marijuana users met criteria for marijuana abuse/dependence. Controlling for adolescents’ age, socioeconomic variables, population density of residence, self-rated health, and survey year, adjusted analyses of adolescent substance users indicated elevated odds of having alcohol and drug use disorders among Native Americans, multiple-race adolescents, whites, and Hispanics compared with African Americans; the latter group did not differ from Asians/Pacific Islanders.
Substance use is widespread among Native-American, multiple-race, white, and Hispanic adolescents. These groups also are disproportionately affected by alcohol and drug use disorders.
drug abuse; drug use disorders; multiple race; multiethnic race; prescription drug abuse; racial and ethnic differences; substance use disorder
Late-life depression may be undiagnosed due to symptom expression. These analyses explore the structure of depressive symptoms in older patients diagnosed with major depression by identifying clusters of patients based on their symptom profiles.
The sample was 366 patients enrolled in a naturalistic treatment study. Symptom profiles were defined using responses to the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D) and the depression section of the Diagnostic Interview Schedule (DIS) administered at enrollment. Latent class analysis (LCA) was used to place patients into homogeneous clusters. As a final step, we identified a risk profile from representative items across instruments selected through variable reduction techniques.
A model with four discrete clusters provided the best fit to the data for the CES-D and the DIS depression module, while three clusters best fit the HAM-D. Using LCA to identify clusters of patients based on their endorsement of seventeen representative symptoms, we found three clusters of patients differing in ways other than severity. Age, sex, education, marital status, age of onset, functional limitations, level of perceived stress and subjective social support were differentially distributed across clusters.
We found considerable heterogeneity in symptom profiles among older adults with an index episode of major depression. Clinical indicators such as depression history may play less of a role differentiating clusters of patients than variables such as stress, social support, and functional limitations. These findings can help conceptualize depression and potentially reduce misdiagnosis for this age group.
depression; ageing; epidemiology
To study substance use and psychiatric disorders among prescription opioid users, heroin users, and non-opioid drug users in a national sample of adults.
Analyses of data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093).
Four groups were identified among 9140 illicit or non-prescribed drug users: heroin-other opioid users (1.0%; used heroin and other opioids), other opioid-only users (19.8%; used other opioids but never heroin), heroin-only users (0.5%; used heroin but never other opioids), and non-opioid drug users (78.7%; used drugs but never heroin or other opioids). After adjusting for variations in socioeconomic characteristics, history of substance abuse treatment, and familial substance abuse, heroin-other opioid users had greater odds of several substance use disorders (cocaine, hallucinogen, sedative, amphetamine, and tranquilizer) as compared with the other groups; heroin-only users had reduced odds of sedative and tranquilizer use disorders as compared with other opioid-only users. Non-opioid drug users had reduced odds of all substance use disorders and other mental disorders (mood, anxiety, pathological gambling, and personality) as compared with other opioid-only users. Past-year other opioid-only users also reported slightly lower scores on quality of life than past-year non-opioid drug users.
All opioid use groups had higher rates of substance use disorders than non-opioid drug users, and these rates were particularly elevated among heroin-other opioid users. Findings suggest the need to distinguish between these four groups in research and treatment as they may have different natural histories and treatment needs.
Comorbidity; Heroin use disorders; Opioid use disorders; Prescription opioid abuse
To identify subtypes of nonmedical opioid users, gender variations in psychiatric disorders, and quality of life in a representative sample of adults.
Analyses of data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093). Latent class analysis (LCA) and multinomial logistic regression procedures examined subtypes of nonmedical opioid users.
Approximately 5% (n=1,815) of adults used nonmedical opioids. LCA identified four subtypes: opioid–marijuana users (33%), opioid–other prescription drug users (9%), opioid–marijuana–hallucinogen users (28%), and opioid–polydrug users (30%). Subtypes were distinguished by race/ethnicity, gender, familial substance abuse, personal history of substance abuse treatment, and patterns of psychiatric disorders. Whites and men had increased odds of being in the opioid–polydrug and opioid–marijuana–hallucinogen subtypes. The opioid–other prescription drug use subtype had disproportionately affected women who were characterized by high rates of mood/anxiety disorders and low quality of life. Across all subtypes, women and men had similarly problematic substance use disorders; however, women had more major depression and disability in the mental health domain.
The generally high prevalence of psychiatric disorders among nonmedical opioid users, particularly women, underscores the need for comprehensive assessment and coordinated delivery of services to match needs with treatment, as well as continued monitoring of trends in opioid use and related problems.
Comorbidity; Latent class analysis; Marijuana; Opioid use disorder; Prescription drug abuse
To ascertain accuracy of self-reported height, weight (and hence body mass index) in African American and white women and men older than 70 years of age.
The sample consisted of cognitively intact participants at the third in-person wave (1992–1993) of the Duke Established Populations for Epidemiologic Studies of the Elderly (age 71 and older, N = 1761; residents of five adjacent counties, one urban, four rural). During in-person, in-home interviews using trained interviewers, height and weight were self-reported (and measured later in the same visit using a standardized protocol), and information were obtained on race, sex, and age.
Accuracy of self-reported height and weight was high (intraclass correlation coefficient 0.85 and 0.97, respectively) but differed as a function of race and age. On average, all groups overestimated their height; whereas (non-Hispanic) white men and women underestimated their weight, African Americans overestimated their weight. Overestimation of height and weight was more marked in persons 85 years and older. Specificity for overweight (body mass index [kg/m2] ≥ 25) and obesity (body mass index ≥ 30) ranged from 0.90 to 0.99 for African Americans and whites, but sensitivity was better for African Americans (overweight: 0.81, obesity: 0.89), than for whites (0.66 and 0.57, respectively).
Height and weight self-reported by African Americans and whites over the age of 70 can be used in epidemiological studies, with greater caution needed for self-reports of whites, and of persons 85 years of age or older.
Height; Weight; Body mass index; Elderly; African American
Physical symptoms are known to be associated with late life depression both cross-sectionally and over time. We attempted to determine if self-reported shortness of breath (SoB) is associated with depressive symptoms at long-term (3-year) follow-up in a community sample of older (65+) adults.
A sample of 2926 elderly subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) were evaluated at baseline and at 3-year follow-up. Depressive symptoms were assessed by a modified version of the Center for Epidemiologic Studies—Depression Scale (CES-D) and SoB was assessed by a three-item scale administered at baseline. The analyses were controlled for factors known to be associated with depressive symptoms and SoB. Both bivariate and multivariate analyses were performed.
Eighty-three percent of subjects who experienced SoB survived for three years. Within the analysis sample of those participating at follow-up, 36 percent experienced SoB at baseline. In biavriate analyses, SoB, older age, female sex, history of a heart attack, higher body mass index (BMI), depressive symptoms at baseline, cognitive impairment, and functional impairment were associated with follow-up depressive symptoms. When controlled variables were included in a linear regression model, SoB was a significant predictor of depressive symptoms at follow-up (p <0.0001) as well as baseline depressive symptoms, sex, BMI, and functional status. No two-way interaction terms with SoB were significant.
SoB is a significant predictor of depressive symptoms at 3-year follow-up. Given that SoB is a symptom that is responsive to therapeutic intervention, active intervention to relieve the symptom when identified could reduce the incidence of depressive symptoms.
old age; epidemiology; depression; shortness of breath; longitudinal study
► Patients diagnosed with granulosa cell tumor require long-term surveillance. ► Recurrent granulosa cell tumor may present as spontaneous retroperitoneal hemorrhage. ► We present an unusual case of recurrent granulosa cell tumor resulting in retroperitoneal hemorrhage.
Granulosa cell tumor; Spontaneous retroperitoneal hemorrhage
In response to the rising rate of treatment admissions related to illicit use of amphetamines (eg, methamphetamine), we examined the prevalence of amphetamine use among treatment-seeking, opioid-dependent adults, explored whether amphetamine users were as likely as nonamphetamine users to enroll in opioid-dependence treatment trials, and determined whether amphetamine users manifested greater levels of medical and psychiatric comorbidity than nonusers.
The sample included 1257 opioid-dependent adults screened for participation in three-multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-003), which studied the effectiveness of buprenorphine for opioid detoxification under varying treatment conditions. Patients were recruited from 23 addiction treatment programs across the US. Medical and psychiatric comorbidity were examined by past-month amphetamine use (current vs former) and route of administration. Five mutually exclusive groups were examined, ie, nonusers, current amphetamine injectors, current amphetamine noninjectors, former amphetamine injectors, and former amphetamine noninjectors.
Of the sample (n = 1257), 22.3% had a history of regular amphetamine use. Of the 280 amphetamine users, 30.3% reported injection as their primary route. Amphetamine users were more likely than nonusers to be white and use more substances. Amphetamine users were as likely as non-users to enroll in treatment trials. Bivariate analyses indicated elevated rates of psychiatric problems (depression, anxiety, hallucinations, cognitive impairment, violence, suicidal thoughts/attempts) and medical illnesses (dermatological, hepatic, cardiovascular, respiratory, neurological, seizure, allergy conditions) among amphetamine users. After adjusting for demographic variables and lifetime use of other substances: current amphetamine users and former injectors showed an increased likelihood of having medical illnesses and hospitalizations; current injectors had elevated odds of suicidal thoughts or attempts; current noninjectors exhibited elevated odds of anxiety, cognitive impairment, and violent behaviors; and former noninjectors had increased odds of depression.
Treatment-seeking, amphetamine-using, opioid-dependent adults manifest greater levels of medical and psychiatric morbidity than treatment-seeking, opioid-dependent adults who have not used amphetamines, indicating a greater need for intensive clinical management.
amphetamine use; buprenorphine; clinical trials network; injection drug use; methamphetamine use; opioid dependence; rehabilitation