An evolutionary perspective on the co-occurrence of social anxiety disorder and alcohol use disorder

Nationally representative epidemiological study of social anxiety disorder from India

Background

Social anxiety disorder (SAD), also termed as social phobia, is a disabling psychiatric condition with limited epidemiological research on it in India. This study, using data from the National Mental Health Survey (NMHS), 2016, is the first to explore its current prevalence and associated factors in India.

Materials and Methods

The NMHS in India used a comprehensive population-based study with subjects selected through a multistage stratified random cluster sampling technique across 12 states. The study included 34,802 adults interviewed with the Mini-International Psychiatric Interview 6.0.0. Firth penalized logistic regression (FPLR) was used to estimate covariate odds ratios (ORs), and the treatment gap for SAD and disability measured using Sheehan's disability scale was calculated.

Results

The study found a 0.47% prevalence of SAD, with an average age of 35.68 years (standard deviation (SD) = 15.23) among those affected. Factors, such as male gender, unemployment, and living in urban areas, were associated with higher odds of SAD, while the elderly had lower odds. A significant proportion of individuals with SAD experienced disability in work (63%), social life (77%), and family life (68%). They spent a median of ₹ 2500 per month on treatment and had a high rate of comorbid psychiatric disorders (58%). The treatment gap was substantial at 82%.

Conclusions

A considerable portion of India's population (approximately >65 lakhs) is affected by SAD. Surprisingly, the NMHS 2016 report indicates a higher risk of SAD among males compared with females, a trend that warrants further investigation. SAD in India is linked to significant disability and a considerable treatment gap, emphasizing the need for innovative approaches to address this large, affected population, especially in light of the scarcity of mental health professionals.

Comparing self-affirmation manipulations to reduce alcohol consumption in university students

Objective: Self-affirmation theory proposes that defensive processing prevents people from accepting health-risk messages, which may explain university students' dismissal of risk-information about binge drinking. SA-interventions may encourage non-biased processing of such information through impacting on interpersonal feelings and self-esteem. This study compared two self-affirmation manipulations on interpersonal feelings, self-esteem, message processing, message acceptance and subsequent alcohol consumption.Participants: UK university students (N = 454).Methods: Participants were randomly allocated to one of three conditions (Self-affirmation Implementation Intention, Kindness Questionnaire, Control) before reading health-risk information about binge drinking. This was followed by measures of interpersonal feelings, self-esteem, message processing, acceptance and behavioral intentions. Alcohol consumption was assessed one week later.Results: The self-affirmation manipulations had non-significant effects on all outcome variables.Conclusion: Consistent with previous research, the results indicate that self-affirmation interventions are not effective for reducing alcohol consumption in university students.

The relationship between performance appraisal interval and employees' proactive working behavior - analysis based on time-gain effect and time-loss effect

Introduction

Performance appraisal is the most widely motivation means for employees' initiative and work improvement. As a large number of organizations are moving from traditional annual performance appraisal to more frequent appraisals, there is little research to compare the motivational effect of different performance appraisal intervals.

Methods

We explore the relationship between performance appraisal interval (PAI) and positive work behavior (PWB) as well as how to improve the relationship between them. Drawing from the psychological momentum (PM) theory, we constructed a model of the dual effect (the time-gain effect and time-loss effect) of PAI on PWB as well as their boundary conditions.

Results

A cross-level analysis of 622 employees in 57 teams indicated that: (1) PAI exerted a positive but marginal decreasing effect on delay of gratification (DG), and then increase PWB indirectly (i.e., the time-gain effect). (2) PAI exerted a positive and marginal increasing effect on perceived uncertainty (PU), and then decrease PWB indirectly (i.e., the time-loss effect). (3) According to the additive principle of the benefit and cost proposed by Hanns et al (2016), the addition of the time-gain effect and time-loss effect leads to an inverted U-shape effect of PAI on PWB. (4) Supervisor developmental feedback (SDF) moderated the inverted U-shape effect of PAI on PWB.

Discussion

This research enriches the application of PM theory in performance appraisal research, advances employee proactivity research from a perspective of organizations' time mechanisms, and also provides a theoretical basis for leaders to adopt developmental feedback as an optimization strategy.

Self-management with alcohol over lifespan: psychological mechanisms, neurobiological underpinnings, and risk assessment

Self-management includes all behavioural measures and cognitive activities aimed at coping with challenges arising throughout the lifespan. While virtually all of these challenges can be met without pharmacological means, alcohol consumption has long been instrumentalized as a supporting tool to help coping with problems arising selectively at adolescence, adulthood, and ageing. Here, we present, to our knowledge, the first systematic review of alcohol instrumentalization throughout lifespan. We searched MEDLINE, Google Scholar, PsycINFO and CINAHL (from Jan, 1990, to Dec, 2022) and analysed consumption patterns, goals and potential neurobiological mechanisms. Evidence shows a regular non-addictive use of alcohol to self-manage developmental issues during adolescence, adulthood, and ageing. Alcohol is selectively used to overcome problems arising from dysfunctional personality traits, which manifest in adolescence. A large range of psychiatric disorders gives rise to alcohol use for the self-management of distinct symptoms starting mainly in adulthood. We identify those neuropharmacological effects of alcohol that selectively serve self-management under specific conditions. Finally, we discuss the adverse effects and associated risks that arise from the use of alcohol for self-management. Even well-controlled alcohol use adversely impacts health. Based on these findings, we suggest the implementation of an entirely new view. Health policy action may actively embrace both sides of the phenomenon through a personalized informed use that allows for harm-controlled self-management with alcohol.

ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders

Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.

Non-pharmacological factors that determine drug use and addiction

Based on their pharmacological properties, psychoactive drugs are supposed to take control of the natural reward system to finally drive compulsory drug seeking and consumption. However, psychoactive drugs are not used in an arbitrary way as pure pharmacological reinforcement would suggest, but rather in a highly specific manner depending on non-pharmacological factors. While pharmacological effects of psychoactive drugs are well studied, neurobiological mechanisms of non-pharmacological factors are less well understood. Here we review the emerging neurobiological mechanisms beyond pharmacological reinforcement which determine drug effects and use frequency. Important progress was made on the understanding of how the character of an environment and social stress determine drug self-administration. This is expanded by new evidence on how behavioral alternatives and opportunities for drug instrumentalization generate different patterns of drug choice. Emerging evidence suggests that the neurobiology of non-pharmacological factors strongly determines pharmacological and behavioral drug action and may, thus, give rise for an expanded system's approach of psychoactive drug use and addiction.

Explaining the association between anxiety disorders and alcohol use disorder: A twin study

BACKGROUND

It is unknown whether social anxiety disorder (SAD) has a unique association with alcohol use disorder (AUD) over and beyond that of other anxiety disorders, how the associations develop over time, and whether the associations are likely to be causal.

METHODS

Diagnoses of AUD, SAD, generalized anxiety disorder, panic disorder, agoraphobia, and specific phobias were assessed twice using the Composite International Diagnostic Interview among 2,801 adult Norwegian twins. The data were analyzed using logistic regression analyses and multivariate biometric structural equation modeling.

RESULTS

SAD had the strongest association with AUD, and SAD predicted AUD over and above the effect of other anxiety disorders. In addition, SAD was prospectively associated with AUD, whereas other anxiety disorders were not. AUD was associated with a slightly elevated risk of later anxiety disorders other than SAD. Biometric modeling favored a model where SAD influenced AUD compared to models where the relationship was reversed or due to correlated risk factors. Positive associations between AUD and other anxiety disorders were fully explained by shared genetic risk factors.

CONCLUSIONS

Unlike other anxiety disorders, SAD plausibly has a direct effect on AUD. Interventions aimed at prevention or treatment of SAD may have an additional beneficial effect of preventing AUD, whereas interventions aimed at other anxiety disorders are unlikely to have a similar sequential effect on AUD.

Longitudinal association between social anxiety disorder and incident alcohol use disorder: results from two national samples of US adults

This study assessed the association between subclinical social fears and a 12-month diagnosis of Social Anxiety Disorder (SAD) at baseline and the risk of incident Alcohol Use Disorder (AUD) at follow-up, compared to those without subclinical social fears and a 12-month diagnosis of SAD. We performed an individual participant meta-analysis based on data from two national longitudinal surveys. Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was conducted in 2001-2002 in a sample of 43,093 adults and Wave 2 was conducted in 2004-2005 in 34,653 of the original respondents. Wave 1 of the National Comorbidity Survey was conducted in 1990-1992 in a sample of 8098 respondents and Wave 2 was conducted in 2001-2002 in 5001 of the original respondents. Binary logistic regression analyses were performed independently in each study and then the effect estimates were combined using random-effects meta-analysis. Neither subclinical social fears nor 12-month SAD at baseline were associated with incident AUD at follow-up. These findings conflict with reports of previous studies that a diagnosis of SAD is a risk factor for AUD in adults, and suggest that subclinical social fears are not associated with differential risk of incident AUD.

Comorbid social anxiety disorder in patients with alcohol use disorder: A systematic review

INTRODUCTION

Lifetime prevalence of social anxiety disorder (SAD) among patients with alcohol dependence is around 11%. However, no systematic review has assessed the effect of comorbid SAD on the clinical outcomes of patients with alcohol use disorder (AUD).

OBJECTIVES

We aimed to compare clinical outcomes, such as alcohol relapse, suicide attempts, treatment response, readmissions, psychiatric comorbidities, and treatment compliance between patients with AUD and comorbid SAD versus patients with AUD without SAD.

METHODS

We carried out a systematic review by searching PubMed for articles published between January 1, 1960 and May 6, 2018. Inclusion criteria were met if a study reported a dichotomous sample of adult patients with AUD and SAD compared to patients with AUD without SAD. Review articles and preclinical studies were excluded. From the eligible studies, we extracted outcomes of interest, such as alcohol relapse, suicidal thoughts, suicide plan and attempts, treatment response, readmissions, psychiatric comorbidities, and treatment compliance.

RESULTS

Patients with both AUD and SAD have a higher prevalence of psychiatric comorbidities, mainly major depressive disorder (MDD), and depressive symptoms. In addition, they have poor treatment compliance. Conversely, the impact of comorbid SAD on alcohol relapse is controversial and current studies have yielded mixed results. Only one study assessed the impact of comorbid SAD on treatment response and showed no association. Furthermore, one study assessed suicidality and found higher rates of suicidal thoughts, suicide plans and attempts in patients with AUD and SAD.

CONCLUSION

The present systematic review shows that it is important to screen for other psychiatric comorbidities (especially MDD), suicidality, and improve treatment adherence in patients with AUD and comorbid SAD. Future prospective studies should clarify the impact of comorbid SAD.

The association of Social Anxiety Disorder, Alcohol Use Disorder and reproduction: Results from four nationally representative samples of adults in the USA

Social Anxiety Disorder (SAD) and Alcohol Use Disorder (AUD) are highly prevalent and frequently co-occur. The results of population studies suggest that SAD tends to precede AUD, and the results of laboratory studies suggest that alcohol use facilitates social behaviors in socially anxious individuals. Therefore, we posited that, in a modern context, a tendency to consume alcohol may be positively selected for among socially anxious individuals by its effect on the likelihood of finding a partner and reproducing. We tested the hypothesis that a higher proportion of individuals with a lifetime diagnosis of SAD and AUD reproduce (i.e., have at least one child) relative to individuals with SAD absent AUD in an individual participant meta-analysis based on over 65,000 adults derived from four nationally representative cross-sectional samples. We then cross-validated these findings against the results of a 10-year follow up of one of these surveys. Lifetime history of SAD was not associated with reproduction whereas lifetime history of AUD was positively associated with reproduction. There was no statistically detectable difference in the proportion of individuals with a lifetime history of SAD with or without AUD who reproduced. There was considerable heterogeneity in all of the analyses involving SAD, suggesting that there are likely to be other pertinent variables relating to SAD and reproduction that should be delineated.