Alcohol use disorder and divorce: evidence for a genetic correlation in a population-based Swedish sample

Divorce and risk of suicide attempt: a Swedish national study

BACKGROUND

Prior research has reported an association between divorce and suicide attempt. We aimed to clarify this complex relationship, considering sex differences, temporal factors, and underlying etiologic pathways.

METHODS

We used Swedish longitudinal national registry data for a cohort born 1960-1990 that was registered as married between 1978 and 2018 (N = 1 601 075). We used Cox proportional hazards models to estimate the association between divorce and suicide attempt. To assess whether observed associations were attributable to familial confounders or potentially causal in nature, we conducted co-relative analyses.

RESULTS

In the overall sample and in sex-stratified analyses, divorce was associated with increased risk of suicide attempt (adjusted hazard ratios [HRs] 1.66-1.77). Risk was highest in the year immediately following divorce (HRs 2.20-2.91) and declined thereafter, but remained elevated 5 or more years later (HRs 1.41-1.51). Divorcees from shorter marriages were at higher risk for suicide attempt than those from longer marriages (HRs 3.33-3.40 and 1.20-1.36, respectively). In general, HRs were higher for divorced females than for divorced males. Co-relative analyses suggested that familial confounders and a causal pathway contribute to the observed associations.

CONCLUSIONS

The association between divorce and risk of suicide attempt is complex, varying as a function of sex and time-related variables. Given evidence that the observed association is due in part to a causal pathway from divorce to suicide attempt, intervention or prevention efforts, such as behavioral therapy, could be most effective early in the divorce process, and in particular among females and those whose marriages were of short duration.

Divorce, genetic risk, and suicidal thoughts and behaviors in a sample with recurrent major depressive disorder

BACKGROUND

Theories of risk for suicidal thoughts and behaviors (STB) implicate both interpersonal and biological factors. Divorce/separation and aggregate genetic liability are robustly associated with STB, but have seldom been evaluated in conjunction with one another. Furthermore, whether these factors are effective predictors in high-risk populations is not clear.

METHODS

Analyses were conducted in a sample of Han Chinese women with severe recurrent major depressive disorder (maximum N = 4380). Logistic regressions were used to evaluate the associations between divorce/separation and polygenic scores (PGS) for suicidal ideation or behavior with STB. Where appropriate, additive interactions between divorce and PGS were tested.

RESULTS

Divorce/separation was significantly associated with increased risk of suicidal ideation, plans, and attempts (odds ratios = 1.28-1.61). PGS for suicidal ideation were not associated with STB, while PGS for suicidal behavior were associated with ideation and plans (odds ratios = 1.08-1.09). There were no significant interactions between divorce/separation and PGS.

CONCLUSIONS

Consistent with theories of suicidality, the disruption or end of an important interpersonal relationship is an indicator of risk for STB. Aggregate genetic liability for suicidal behavior more modestly contributes to risk, but does not exacerbate the negative impact of divorce. Thus, even within a high-risk sample, interpersonal and biological exposures distinguish between those who do and do not experience STB, and could motivate targeted screening. Further research is necessary to evaluate whether and how the context of divorce contributes to variation in its effect on STB risk.

Personality correlates of past-year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in alcoholics anonymous

BACKGROUND

Alcohol use disorder (AUD) is a highly impairing condition with important public health impacts. Despite the availability of treatment options for AUD, research shows that few people receive treatment, and even fewer can maintain abstinence/low-drinking levels. This study investigated the role of personality traits in past-year alcohol use among individuals with severe AUD who ever attended Alcoholics Anonymous (AA), a widespread and easily accessible self-help group for alcohol problems.

METHODS

Univariable and multivariable regressions were performed separately in females and males with alcohol consumption as an outcome. Socioeconomic factors, genetic liability, and psychopathology were included as covariates in the analyses.

RESULTS

Results from the multivariable model indicated that in females who attended AA, greater alcohol use was related to both positive and negative urgency and low sensation seeking, while in males, greater alcohol use was related to positive urgency. Results also showed that, in both sexes, younger age and lower educational levels were associated with greater alcohol use. Moreover, single males and individuals with lower AUD severity were at higher risk of using alcohol in the past year.

CONCLUSIONS

These findings highlight sex-specific correlates of drinking in individuals with AUD who engaged in self-help groups. These findings may help to improve treatment options, as personality encompasses modifiable traits that can be targeted in psychological interventions.

Indications of alcohol or drug use disorders in five different national registers in Sweden: a cross-sectional population-based study

OBJECTIVE

The purpose of this study is to examine the prevalence of indications of alcohol or drug use disorders in five different national Swedish registers and to investigate the correlation between these registers. Furthermore, the intent is to investigate whether combining data from different registers increases the prevalence of these indications in the population due to the identification of different demographic groups in different registers.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Individuals living in Sweden aged 20-64 years in 2006, n=5 453 616.

PRIMARY OUTCOME

National registers included the Registers of Inpatient Care, Outpatient Care, Medications, Social Insurance and Convictions. Demographic variables were sex, age, migrant status, education and civil status. Indications of alcohol or drug use disorders were presented as prevalence in percentage (%), correlation was examined using phi correlation coefficients and differences across demographic factors were studied using logistic regression.

RESULTS

The prevalence of an indication of alcohol or drug use disorder varied between registers, meaning that prevalence increased when all registers were considered together. The prevalence of alcohol use disorder increased by 60% and 66% among men and women, respectively, while the prevalence of drug use disorder increased by 45% and 80% among men and women, respectively, when all registers were combined, compared with only using the register with the highest prevalence. Registers contributed different indications of drug and alcohol use disorders.

CONCLUSIONS

Accurate estimates of alcohol or drug use disorders are critical for healthcare and rehabilitation. This study shows that using a single register alone underestimates the burden of disease unevenly, while combining a range of registers can provide a more accurate picture.

Genetic nurture effects for alcohol use disorder

We tested whether aspects of the childhood/adolescent home environment mediate genetic risk for alcohol problems within families across generations. Parental relationship discord and parental divorce were the focal environments examined. The sample included participants of European ancestry (N = 4806, 51% female) and African ancestry (N = 1960, 52% female) from the high-risk Collaborative Study on the Genetics of Alcoholism. Alcohol outcomes in the child generation included lifetime criterion counts for DSM-5 Alcohol Use Disorder (AUD), lifetime maximum drinks in 24 h, age at initiation of regular drinking, and age at first alcohol intoxication. Predictors in the parent generation included relationship discord, divorce, alcohol measures parallel to those in the child generation, and polygenic scores for alcohol problems. Parental polygenic scores were partitioned into alleles that were transmitted and non-transmitted to the child. The results from structural equation models were consistent with genetic nurture effects in European ancestry families. Exposure to parental relationship discord and parental divorce mediated, in part, the transmission of genetic risk for alcohol problems from parents to children to predict earlier ages regular drinking (βindirect = -0.018 [-0.026, -0.011]) and intoxication (βindirect = -0.015 [-0.023, -0.008]), greater lifetime maximum drinks (βindirect = 0.006 [0.002, 0.01]) and more lifetime AUD criteria (βindirect = 0.011 [0.006, 0.016]). In contrast, there was no evidence that parental alleles had indirect effects on offspring alcohol outcomes via parental relationship discord or divorce in the smaller number of families of African ancestry. In conclusion, parents transmit genetic risk for alcohol problems to their children not only directly, but also indirectly via genetically influenced aspects of the home environment. Further investigation of genetic nurture in non-European samples is needed.

Alcohol use disorder, psychiatric comorbidities, marriage and divorce in a high-risk sample

OBJECTIVE

To examine associations between alcohol use disorder (AUD), its psychiatric comorbidities, and their interactions, with marital outcomes in a diverse high-risk, genetically informative sample.

METHOD

Participants included European ancestry (EA; n = 4,045) and African ancestry (AA; n = 1,550) individuals from the multigenerational Collaborative Study on the Genetics of Alcoholism (COGA) sample (56% female, Mage ∼ 41 years). Outcomes were lifetime marriage and divorce. Predictors included lifetime AUD, an alcohol problems polygenic score (PRS), and AUD comorbidities, including conduct or antisocial personality disorder (ASP), cannabis dependence/abuse (CAN), frequent tobacco use (TOB), and major depressive disorder (MDD). Mixed effect Cox models and generalized linear mixed effects models were fit.

RESULTS

Among EA participants, those with AUD and CAN were less likely to marry (hazard ratios [HRs] 0.70-0.83, ps < 0.01). Among AA participants, those with AUD and TOB were less likely to marry (HRs 0.66-0.82, ps < 0.05) and those with MDD were more likely to marry (HR = 1.34, ps < 0.01). Among EA participants, AUD, CAN, TOB, and MDD were associated with higher odds of divorce (odds ratios [ORs] 1.59-2.21, ps < 0.01). Among AA participants, no predictors were significantly associated with divorce. Significant random effects indicated genetic and environmental influences on marriage, but only environmental factors on divorce.

CONCLUSIONS

In a high-risk sample, AUD was associated with reduced likelihood of marriage in EA and AA individuals and increased risk of divorce in EA individuals. These associations were largely independent of comorbidities. Genetic and environmental background factors contributed to marriage, while only environmental background factors contributed to divorce. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Role of parental divorce and discord in the intergenerational transmission of alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) has a strong familial component, and is associated with divorce and relationship discord. The purpose of this study was to test whether exposure to parental divorce and parental relationship discord contributes to the intergenerational transmission of AUD.

METHODS

The sample included N = 9005 adult twins (43% female) from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Participant AUD diagnoses were derived from structured clinical interviews based on DSM-IV alcohol dependence. Participants also reported on parental divorce and parental AUD. In addition, direct psychiatric interview data and measures of relationship discord were available for a subsample of parents of female-female twin pairs (855 mothers, 617 fathers). Indirect effects models were fit and tested using a robust maximum likelihood estimator with Monte Carlo integration.

RESULTS

Path and structural equation modeling results provided strong support for the intergenerational transmission of AUD, and indicated that parental AUD had indirect effects on offspring AUD through exposure to parental divorce and parental relationship discord. Effects were consistent across males and females.

CONCLUSIONS

In a population-based adult twin sample, exposure to parental divorce and relationship discord appears to be important for understanding the intergenerational transmission of AUD. These effects are broadly consistent with the idea of genetic nurturance, whereby parents transmit genetic risk for alcohol use disorder to their children indirectly via heritable aspects of the home environment. Ultimately, this etiological information could bolster engagement with skills-based therapeutic efforts used in substance-related preventive interventions for divorced or distressed families.

Meaningful associations in the adolescent brain cognitive development study

The Adolescent Brain Cognitive Development (ABCD) Study is the largest single-cohort prospective longitudinal study of neurodevelopment and children's health in the United States. A cohort of n = 11,880 children aged 9-10 years (and their parents/guardians) were recruited across 22 sites and are being followed with in-person visits on an annual basis for at least 10 years. The study approximates the US population on several key sociodemographic variables, including sex, race, ethnicity, household income, and parental education. Data collected include assessments of health, mental health, substance use, culture and environment and neurocognition, as well as geocoded exposures, structural and functional magnetic resonance imaging (MRI), and whole-genome genotyping. Here, we describe the ABCD Study aims and design, as well as issues surrounding estimation of meaningful associations using its data, including population inferences, hypothesis testing, power and precision, control of covariates, interpretation of associations, and recommended best practices for reproducible research, analytical procedures and reporting of results.

Commentary on Holst et al. (2020): Genetically informative research can clarify mechanisms linking non-intact family structure and alcohol use disorder

Genetically informative designs can illuminate the possible ‘outside-the-skin’ environmental exposures through which genetic risk for alcohol use disorder is transmitted in families.

Marital Strain, Support, and Alcohol Use: Results from a Twin Design Statistically Controlling for Genetic Confounding

Background: Marriage is one of the most frequently examined sources of social support and has been shown to protect against alcohol use and abuse. This study examines the relationship between perceived marital strain and support, and alcohol use controlling for additive genetic influence. Methods: Data from monozygotic (MZ) (n = 320) and dizygotic (DZ) (n = 464) twin pairs from the second wave of the National Survey of Midlife Development in the United States (MIDUS II) were used to test whether past year marital strain and support were associated with recent alcohol use. Generalized linear mixed models (GLMM) were estimated, allowing us to control for additive genetic and shared environmental influences as variance components. Results: Marital strain and support had positive, statistically significant associations with alcohol use. However, only the relationship between marital strain and alcohol use remained after controlling for variance in alcohol use attributed to genetics. Conclusions: After accounting for genetics, midlife adults still appear to cope with marital strain via alcohol use. However, this coping is unlikely to result in heavy episodic drinking or alcohol use disorder without other compounding factors.

The Role of Emergence in Genetically Informed Relationships Research: A Methodological Analysis

This paper provides a critical analysis of genetically informed research on relationships, with an emphasis on relationships among unrelated individuals (e.g., spouses). To date, research in this area has used traditional behavioral genetic frameworks to either partition the variance in relationship-related outcomes into genetic and environmental components, or to examine gene-environment interplay between relationship factors and other outcomes. However, this conventional approach is at odds with the long-standing understanding from the field of relationship science that both partners' characteristics matter when predicting shared outcomes-that is, outcomes that are emergent. We examine briefly the philosophical concept of emergence, and discuss ways to model dyadic outcomes in genetically informed relationships research. We also review the related topic of social genetic effects, which refer to the influence of a social partner's genotype on a proband's phenotype. A genetically informed dyadic perspective has potentially important consequences for our understanding of the pathways from genotype→shared or individual-level phenotypes, and more fully recognizes the complexity of how genetic and social/environmental factors come together to influence human behavior.

Alcoholic family marital heterogeneity aggregates different child behavior problems both pre- and postseparation

Children of alcoholics (COAs) are at risk for elevated internalizing and externalizing symptoms. Yet, little is known about the familial and behavioral adjustments of COAs following parental separation. Using an ecological-transactional framework, we examined how multiple risk factors contributed to the formation of different alcoholic family structures and how living in heterogeneous family structures affected COAs' behavioral problems. The Michigan Longitudinal Study, a multiwave study on initially intact alcoholic and control families with preschool-age children (n = 503), was used to evaluate outcomes of offspring, when families either remained intact or were separated when the child was aged 12-14. Alcoholic families who later transitioned into stepfamilies were characterized with higher paternal antisociality, marital aggression, and serious family crises than alcoholic families that remained intact. COAs in stepfamilies (but not in single-parent families) exhibited higher levels of internalizing and externalizing symptoms in preadolescence compared with those in alcoholic intact families, in part because of elevated behavioral risk at age 3. Structural equation modeling indicated that the aggregated risk of stepfamily residence directly related to COAs' internalizing and indirectly related to COAs' externalizing problems, partially mediated by family stressors. Findings suggest targeting COAs in separated families for early intervention.

The gene-editing of super-ego

New emerging biotechnologies, such as gene editing, vastly extend our ability to alter the human being. This comes together with strong aspirations to improve humans not only physically, but also mentally, morally, and socially. These conjoined ambitions aggregate to what can be labelled "the gene editing of super-ego." This article investigates a general way used to argue for new biotechnologies, such as gene-editing: if it is safe and efficacious to implement technology X for the purpose of a common good Y, why should we not do so? This is a rhetorical question with a conditional, and may be dismissed as such. Moreover, investigating the question transformed into a formal argument reveals that the argument does not hold either. Nonetheless, the compelling force of the question calls for closer scrutiny, revealing that this way of arguing for biotechnology is based on five assumptions. Analysis of these assumptions shows their significant axiological, empirical, and philosophical challenges. This makes it reasonable to claim that these kinds of question based promotions of specific biotechnologies fail. Hence, the aspirations to make a super-man with a super-ego appear fundamentally flawed. As these types of moral bioenhancement arguments become more prevalent, a revealing hype test is suggested: What is special with this technology (e.g., gene editing), compared to existing methods, that makes it successful in improving human social characteristics in order to make the world a better place for all? Valid answers to this question will provide good reasons to pursue such technologies. Hence, the aim is not to bar the development of modern biotechnology, but rather to ensure good developments and applications of highly potent technologies. So far, we still have a long way to go to make persons with goodness gene(s).

Associations Between Divorce and Onset of Drug Abuse in a Swedish National Sample

Rates of drug abuse are higher among divorced individuals than among those who are married, but it is not clear whether divorce itself is a risk factor for drug abuse or whether the observed association is confounded by other factors. We examined the association between divorce and onset of drug abuse in a population-based Swedish cohort born during 1965-1975 (n = 651,092) using Cox proportional hazards methods, with marital status as a time-varying covariate. Potential confounders (e.g., demographics, adolescent deviance, and family history of drug abuse) were included as covariates. Parallel analyses were conducted for widowhood and drug-abuse onset. In models with adjustments, divorce was associated with a substantial increase in risk of drug-abuse onset in both sexes (hazard ratios > 5). Co-relative analyses (among biological relatives) were consistent with a partially causal role of divorce on drug-abuse onset. Widowhood also increased risk of drug-abuse onset, although to a lesser extent. Divorce is a potent risk factor for onset of drug abuse, even after adjusting for deviant behavior in adolescence and family history of drug abuse. The somewhat less-pronounced association with widowhood, particularly among men, suggests that the magnitude of association between divorce and drug abuse may not be generalizable to the end of a relationship.

Alcohol Misuse Across the Lifespan: Insights from Developmental Studies in Behavior Genetics

Alcohol misuse, one of today's greatest public health challenges, is a developmentally dynamic, complex behavior at the intersection of genetic and environmental influences. This review examines such influences from a behavior genetics perspective and discusses implications for public policy. Alcohol misuse is moderately heritable with genetic influences accounting for around 50% of its variance, but to date few specific genes have been identified. However, numerous environmental and social factors moderate genetic risk, including parents, peers, romantic partners, family dynamics, employment, laws, and cultural influences. These moderating factors change in salience across development, and, accordingly, no one-size-fits-all approach is suitable for reducing alcohol misuse at a large scale. We provide examples of some effective prevention and intervention programs and discuss a framework for using the behavior genetics evidence to inform future public policy efforts.

Genetics, the Rearing Environment, and the Intergenerational Transmission of Divorce: A Swedish National Adoption Study

We used classical and extended adoption designs in Swedish registries to disentangle genetic and rearing-environment influences on the intergenerational transmission of divorce. In classical adoption analyses, adoptees ( n = 19,715) resembled their biological parents, rather than their adoptive parents, in their history of divorce. In extended adoption analyses, offspring ( n = 82,698) resembled their not-lived-with fathers and their lived-with mothers. There was stronger resemblance to lived-with mothers, providing indirect evidence of rearing-environment influences on the intergenerational transmission of divorce. The heritability of divorce assessed across generations was 0.13. We attempted to replicate our findings using within-generation data from adoptive and biological siblings ( ns = 8,523-53,097). Adoptees resembled their biological, not adoptive, siblings in their history of divorce. Thus, there was consistent evidence that genetic factors contributed to the intergenerational transmission of divorce but weaker evidence for a rearing-environment effect of divorce. Within-generation data from siblings supported these conclusions.