Journal of Affective Disorders
Volume 85, Issue 3 , Pages 301-315, April 2005

Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder

  • Mark S. Bauer

      Affiliations

    • VAMC and Brown University, 116R, 830 Chalkstone Avenue, Providence, RI 02908-4799, United States
    • Corresponding Author InformationCorresponding author. Tel.: +1 401 273 7100x3863; fax: +1 401 457 3311.
    • ,
  • Lori Altshuler

      Affiliations

    • West LA VAMC and UCLA, Los Angeles, CA, United States
    • ,
  • Denise R. Evans

      Affiliations

    • Augusta VAMC and Medical College of Georgia, Augusta, GA, United States
    • ,
  • Thomas Beresford

      Affiliations

    • Denver VAMC and University of Colorado, Denver, CO, United States
    • ,
  • William O. Williford

      Affiliations

    • Perry Point VAMC and University of Maryland, Perry Point, MD, United States
    • ,
  • Richard Hauger

      Affiliations

    • San Diego VAMC and UCSD, San Diego, CA, United States
    • ,
  • for the VA Cooperative Study #430 Team

Received 12 April 2004; accepted 30 November 2004.

Abstract 

Background

Recent data indicate high prevalence of both anxiety and substance comorbidity in bipolar disorder. However, few studies have utilized public sector samples, and only one has attempted to separate contributions of each type of comorbidity.

Methods

328 inpatient veterans with bipolar disorder across 11 sites were assessed using selected Structured Clinical Interview for DSM-IV modules and self-reports.

Results

Comorbidity was common (current: 57.3%; lifetime: 78.4%), with multiple current comorbidities in 29.8%. Substance comorbidity rate was comparable to rates typically reported in non-veteran inpatient samples (33.8% current, 72.3% lifetime). Selected anxiety comorbidity rates exceeded those in other inpatient samples and appeared more chronic than episodic/recurrent (38.3% current, 43.3% lifetime). 49% of PTSD was due to non-combat stressors. Major correlates of current substance comorbidity alone were younger age, worse marital status, and higher current employability. Correlates of current anxiety comorbidity alone were early age of onset, greater number of prior-year depressive episodes, higher rates of disability pension receipt, and lower self-reported mental and physical function. Combined comorbidity resembled anxiety comorbidity.

Limitations

This is a cross-sectional analysis of acutely hospitalized veterans.

Conclusions

Distinct patterns of substance and anxiety comorbidity are striking, and may be subserved by distinct neurobiologic mechanisms. The prevalence, chronicity and functional impact of anxiety disorders indicate the need for improved recognition and treatment of this other dual diagnosis group is warranted. Clinical and research interventions should recognize these divergent comorbidity patterns and provide individualized treatment built “from the patient out.”

Keywords: Bipolar disorder, Substance use disorders, Anxiety disorders, Assessment, Function, Adherence, Post-traumatic stress disorder, Panic disorder, Obsessive–compulsive disorder, Alcohol, Cocaine

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PII: S0165-0327(04)00437-9

doi:10.1016/j.jad.2004.11.009

Journal of Affective Disorders
Volume 85, Issue 3 , Pages 301-315, April 2005

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