Sage Journals: Discover world-class research

Abstract

Objectives:

Although alcohol dependence is highly prevalent in patients with bipolar disorder, the causal relationship is not yet well-established. This study estimated the incidence of alcohol dependence in a nationwide bipolar disorder cohort and examined risk factors for alcohol dependence.

Methods:

Patients aged 15–65 years with consistent bipolar disorder who had their first psychiatric admission between 1999 and 2012 (n = 21,791) were enrolled from the National Health Insurance Research Database in Taiwan. We calculated the adjusted incidence rate ratio of alcohol dependence in the bipolar cohort relative to the general population after stratification by age and sex. In the nested case–control study, we included patients with incident alcohol dependence as cases and four age- and sex-matched controls for each case to analyze health care utilization, comorbidities and concomitant medications between them.

Results:

We identified 1261 patients with bipolar disorder with incident alcohol dependence. Relative to the general population, the adjusted incidence rate ratio of alcohol dependence was 9.20 in the bipolar cohort. All adjusted incidence rate ratios were high across all age subgroups. Cases had higher psychiatric and nonpsychiatric health care utilization than did controls. Multivariate analysis revealed that cases tended to have cardiovascular disease, diabetes mellitus, chronic hepatic disease, pneumonia and delirium before alcohol dependence diagnosis. Cases had higher psychiatric comorbidities, namely drug-induced mental disorders, anxiety disorder, personality disorder, adjustment disorder and sleep disorder.

Conclusion:

The bipolar cohort had a higher incidence of alcohol dependence. We identified specific groups with a high risk of alcohol dependence. Additional strategies for early detection, treatment and intervention for alcohol dependence should be developed.

Keywords

Alcohol dependence alcohol use disorder bipolar disorder comorbidity incidence

Get full access to this article

View all access options for this article.

References

Azorin

J-M

Perret

Fakra

, et al. (2017) Alcohol use and bipolar disorders: Risk factors associated with their co-occurrence and sequence of onsets. Drug and Alcohol Dependence 179: 205–212.

Boylan

Bieling

Marriott

, et al. (2004) Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder. The Journal of Clinical Psychiatry 65: 1106–1113.

Cardoso

KauerSant’Anna

Dias

, et al. (2008) The impact of co-morbid alcohol use disorder in bipolar patients. Alcohol 42: 451–457.

Cassidy

Ahearn

Carroll

(2001) Substance abuse in bipolar disorder. Bipolar Disorders 3: 181–188.

Chen

Tsai

Pan

, et al. (2021) High risk and trajectories of physical illnesses before the diagnosis of bipolar disorder. Journal of Affective Disorders 281: 99–108.

Chien

Lin

Chou

, et al. (2013) Risk of hypertension in patients with bipolar disorder in Taiwan: A population-based study. Comprehensive Psychiatry 54: 687–693.

Conigrave

Rimm

(2003) Alcohol for the prevention of type 2 diabetes mellitus? Treatments in Endocrinology 2: 145–152.

Crump

Sundquist

Winkleby

, et al. (2013) Comorbidities and mortality in bipolar disorder: A Swedish national cohort study. JAMA Psychiatry 70: 931–939.

Di Florio

Craddock

vandenBree

(2014) Alcohol misuse in bipolar disorder. A systematic review and meta-analysis of comorbidity rates. European Psychiatry: The Journal of the Association of European Psychiatrists 29: 117–124.

10.

Gardner

Kleinman

Brook

, et al. (2006) The economic impact of bipolar disorder in an employed population from an employer perspective. The Journal of Clinical Psychiatry 67: 1209–1218.

11.

Godin

Etain

Henry

, et al. (2014) Metabolic syndrome in a French cohort of patients with bipolar disorder: Results from the FACE-BD cohort. The Journal of Clinical Psychiatry 75: 1078–1085; quiz 1085.

12.

Guha

Bhowmick

Mazumder

, et al. (2014) Assessment of insulin resistance and metabolic syndrome in drug naive patients of bipolar disorder. Indian Journal of Clinical Biochemistry: IJCB 29: 51–56.

13.

Horwitz

Storfer-Isser

Young

, et al. (2017) Development of alcohol and drug use in youth with manic symptoms. Journal of the American Academy of Child and Adolescent Psychiatry 56: 149–156.

14.

Hunt

Malhi

Cleary

, et al. (2016) Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis. Journal of Affective Disorders 206: 331–349.

15.

Kendler

Heath

Neale

, et al. (1992) A population-based twin study of alcoholism in women. JAMA 268: 1877–1882.

16.

Kushner

Abrams

Borchardt

(2000) The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings. Clinical Psychology Review 20: 149–171.

17.

Leopold

Reif

Haack

, et al. (2016) Type 2 diabetes and pre-diabetic abnormalities in patients with bipolar disorders. Journal of Affective Disorders 189: 240–245.

18.

Martin

Ul-Haq

Nicholl

, et al. (2016) Cardiometabolic disease and features of depression and bipolar disorder: Population-based, cross-sectional study. The British Journal of Psychiatry: The Journal of Mental Science 208: 343–351.

19.

Martinez-Aran

Vieta

Torrent

, et al. (2007) Functional outcome in bipolar disorder: The role of clinical and cognitive factors. Bipolar Disorders 9: 103–113.

20.

McIntyre

(2002) Psychotropic drugs and adverse events in the treatment of bipolar disorders revisited. The Journal of Clinical Psychiatry 63: 15–20.

21.

Merikangas

Jin

, et al. (2011) Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of General Psychiatry 68: 241–251.

22.

Mullins

Mazer-Amirshahi

Pines

(2017) Alcohol-related visits to US emergency departments, 2001–2011. Alcohol and Alcoholism 52: 119–125.

23.

Newcomer

Haupt

(2006) The metabolic effects of antipsychotic medications. The Canadian Journal of Psychiatry 51: 480–491.

24.

Ojesjö

Hagnell

Otterbeck

(1998) Mortality in alcoholism among men in the Lundby Community Cohort, Sweden: A forty-year follow-up. Journal of Studies on Alcohol 59: 140–145.

25.

Pan

C-H

M-S

Yang

T-W

, et al. (2018) Identification and medical utilization of incident cases of alcohol dependence: A population-based case-control study. Drug and Alcohol Dependence 188: 216–223.

26.

Pan

Jhong

Tsai

, et al. (2014) Excessive suicide mortality and risk factors for suicide among patients with heroin dependence. Drug Alcohol Depend 145: 224–230.

27.

Parmar

Kaloiya

(2018) Comorbidity of personality disorder among substance use disorder patients: A narrative review. Indian Journal of Psychological Medicine 40: 517–527.

28.

Piano

(2017) Alcohol’s effects on the cardiovascular system. Alcohol Research: Current Reviews 38: 219–241.

29.

Rehm

Room

Graham

, et al. (2003) The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: An overview. Addiction 98: 1209–1228.

30.

Rehm

Shield

Rehm

, et al. (2012) Alcohol consumption, alcohol dependence and attributable burden of disease in Europe. Centre for Addiction and Mental Health. DOI: 10.5167/uzh-64919.

31.

Rossow

Amundsen

(1997) Alcohol abuse and mortality: A 40-year prospective study of Norwegian conscripts. Social Science & Medicine 44: 261–267.

32.

SayuriYamagata

Brietzke

Rosenblat

, et al. (2017) Medical comorbidity in bipolar disorder: The link with metabolic-inflammatory systems. Journal of Affective Disorders 211: 99–106.

33.

Simhandl

Radua

Konig

, et al. (2016) Prevalence and impact of comorbid alcohol use disorder in bipolar disorder: A prospective follow-up study. The Australian and New Zealand Journal of Psychiatry 50: 345–351.

34.

WHO (1977) Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death (9th revision) (ICD–9). Geneva: World Health Organization.

35.

Smith

Martin

McLean

, et al. (2013) Multimorbidity in bipolar disorder and undertreatment of cardiovascular disease: A cross sectional study. BMC Medicine 11: 263.

36.

Strakowski

DelBello

Fleck

, et al. (2005) Effects of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania. Archives of General Psychiatry 62: 851–858.

37.

Strakowski

DelBello

Fleck

, et al. (2000) The impact of substance abuse on the course of bipolar disorder. Biological Psychiatry 48: 477–485.

38.

Szklo

Nieto

(2019) Epidemiology: Beyond the Basics, 4th Edition. Burlington, MA: Jones & Bartlett Learning.

39.

WHO Collaborating Centre for Drug Statistics Methodology (2020) ATC/DDD Index 2021. Available at: www.whocc.no/atc_ddd_index/ (accessed 1 March 2021).

40.

Yasseen

Kennedy

Zawertailo

, et al. (2010) Comorbidity between bipolar disorder and alcohol use disorder: Association of dopamine and serotonin gene polymorphisms. Psychiatry Research 176: 30–33.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.06 MB

Incidence of and risk factors for alcohol dependence in bipolar disorder: A population-based cohort and nested case–control study

Abstract

Objectives:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material