Gender Differences in Prevalence, Risk, and Clinical Correlates of Alcoholism Comorbidity in Bipolar Disorder

University of Freiburg, Freiburg, Baden-Württemberg, Germany
American Journal of Psychiatry (Impact Factor: 13.56). 06/2003; 160(5):883-9. DOI: 10.1176/appi.ajp.160.5.883
Source: PubMed

ABSTRACT The prevalence of lifetime alcohol abuse and/or dependence (alcoholism) in patients with bipolar disorder has been reported to be higher than in all other axis I psychiatric diagnoses. This study examined gender-specific relationships between alcoholism and bipolar illness, which have previously received little systematic study.
The prevalence of lifetime alcoholism in 267 outpatients enrolled in the Stanley Foundation Bipolar Network was evaluated by using the Structured Clinical Interview for DSM-IV. Alcoholism and its relationship to retrospectively assessed measures of the course of bipolar illness were evaluated by patient-rated and clinician-administered questionnaires.
As in the general population, more men (49%, 57 of 116) than women with bipolar disorder (29%, 44 of 151) met the criteria for lifetime alcoholism. However, the risk of having alcoholism was greater for women with bipolar disorder (odds ratio=7.35) than for men with bipolar disorder (odds ratio=2.77), compared with the general population. Alcoholism was associated with a history of polysubstance use in women with bipolar disorder and with a family history of alcoholism in men with bipolar disorder.
This study suggests that there are gender differences in the prevalence, risk, and clinical correlates of alcoholism in bipolar illness. Although this study is limited by the retrospective assessment of illness variables, the magnitude of these gender-specific differences is substantial and warrants further prospective study.

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    • "Epidemiological studies indicate that lifetime alcohol use disorders (AUDs) are significantly more prevalent among individuals with BDs (46–61% in BD I; 36–39% in BD II), exceeding the rates reported in schizophrenia and major depression (Regier et al, 1990; Kessler et al, 1997; Merikangas et al, 2007). Clinically, individuals with both AUDs and BD have higher rates of experienced physical or verbal abuse (Frye et al, 2003) and suicide attempts (Frye et al, 2003), poorer treatment compliance (Strakowski et al, 1998), and higher relapse rates (Tohen et al, 1990) compared with BD patients alone. However, the etiology of AUDs in BD has not been previously explored experimentally (Le Strat and Gorwood, 2008). "
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    ABSTRACT: Elevated lifetime prevalence rates of alcohol use disorders (AUDs) are a feature of bipolar disorder (BD). Individuals at-risk for AUDs exhibit blunted subjective responses to alcohol (low levels of response), which may represent a biomarker for AUDs. Thus, individuals at-risk for BD may exhibit low responses to alcohol. Participants were 20 unmedicated adult males who reported high rates of hypomanic experiences (bipolar phenotype participants; BPPs), aged 18 to 21 years, and 20 healthy controls matched on age, gender, IQ, BMI, and weekly alcohol intake. Subjective and pharmacokinetic responses to acute alcohol (0.8 g/kg) vs placebo administration were collected in a randomized, double-blind, cross-over, placebo-controlled, within-subjects design. BPP participants reported significantly lower subjective intoxication effects ('feel high': F=14.2, p=0.001; 'feel effects': F=8.1, p=0.008) across time, but did not differ in their pharmacokinetic, stimulant, or sedative responses. Paradoxically, however, the BPP participants reported significantly higher expectations of the positive effects of alcohol than controls. Our results suggest that unmedicated young males with previous hypomanic experiences exhibit diminished subjective responses to alcohol. These blunted alcohol responses are not attributable to differences in weekly alcohol intake, pharmacokinetic effects (eg, absorption rates), or familial risk of AUDs. These observations suggest that the dampened intoxication may contribute to the increased rates of alcohol misuse in young people at-risk for BD, and suggest possible shared etiological factors in the development of AUDs and BD.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 04/2012; 37(8):1808-15. DOI:10.1038/npp.2012.45 · 7.83 Impact Factor
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    • "The finding of an association of diagnostic subtype (bipolar I vs bipolar II) with marital status in men but not in women may be related to gender differences in manic symptomatology. Men with bipolar I disorder are more likely than women to have substance abuse comorbidity [20] "
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    ABSTRACT: Despite the importance of marriage as a source of social support, it has been largely neglected in studies of bipolar disorder; and differential effects on men and women have not been explored. Data on episodes of depression, mania, and mixed states were collected for the previous 2 years from a sample of 282 bipolar individuals using the National Institute of Mental Health Life Chart Methodology. Effects unique to women included the following: Bipolar women were significantly more likely to be married. Married women had fewer episodes of depression during the past 2 years than never-married women, and the cumulative severity of depression was lower. There were no differences in diagnostic subtype or age of onset between married and never-married women. Among men, never-married men were more likely to have bipolar I disorder and had an earlier age of onset compared with married men. There were no differences between married and never-married men in frequency, duration, or severity of mood episodes. Partner selection processes as they relate to bipolar disorder may be different for men and women. The bipolar I diagnostic subtype and early age of onset were associated with a lower likelihood of being married for men, but not for women. Marriage was associated with less depression in women during a 2-year period; but marital status was not associated with disease course differences in men, suggesting that women may be more sensitive to the positive effects of social support available within a stable marital relationship.
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    • "Likewise, our results suggest that men are more likely to be in the co-morbidity group than in the noneco-morbidity group, whereas for women the opposite occurs. It is important to mention that, although women with BD had a lower prevalence of lifetime alcoholism compared to men, there is evidence that they are particularly vulnerable to alcohol dependence, compared to the general female population (odds ratio 5 7.35) (Frye et al., 2003). The findings of a statistically significant difference in education (P 5 .045), in line with recent data (Weiss et al., 2005), show that patients with past history or current SUD are less likely to have college education compared to patients with no SUD. "
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    ABSTRACT: Alcohol use is highly prevalent in patients with bipolar disorder (BD) and is associated with significant mortality and morbidity. The detrimental effects of each condition are compounded by the presence of the other. The objective of this study was to examine the impact of alcohol abuse and of alcohol dependence in BD in a Brazilian sample, as indicated by clinical severity, functional impairment, and quality of life (QOL). A cross-sectional survey of 186 bipolar outpatients were interviewed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-4th Edition. The primary outcome measures were functioning, as indicated by the Global Assessment of Functioning Scale scores and QOL, as indicated by the World Health Organization Quality of Life Instrument. Secondary outcomes were clinical severity features. Alcohol abuse and dependence were associated with male gender, lower education, earlier age of onset, psychosis within first episode, depressive symptoms, and worse functioning. In addition, the presence of alcohol abuse or dependence was associated with remarkably high rates of suicide attempt. Our findings suggest that the co-occurrence of alcohol abuse/dependence with BD increases the risk for suicide attempt, which may reflect in part the greater severity of symptoms and impaired functioning. This subgroup of bipolar patients requires a treatment tailored to address both conditions.
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