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Addiction ; 114(6): 968-982, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30891835


BACKGROUND AND AIMS: Despite a wealth of literature, the relationship between anxiety and alcohol use remains unclear. We examined whether (a) child and adolescent anxiety is positively or negatively associated with later alcohol use and disorders and (b) study characteristics explain inconsistencies in findings. DESIGN AND SETTING: We conducted a systematic review of 51 prospective cohort studies from 11 countries. Three studies contributed to a meta-analysis. We searched PubMed, Scopus, Web of Science and PsycINFO databases, and studies were included if they met the following criteria: English language publication, human participants, anxiety exposure (predictor variable) in childhood or adolescence and alcohol outcome at least 6 months later. PARTICIPANTS: Study sample sizes ranged from 110 to 11 157 participants. Anxiety exposure ages ranged from 3 to 24 years, and alcohol outcome ages ranged from 11 to 42 years. MEASUREMENTS: Ninety-seven associations across 51 studies were categorized by anxiety exposure (generalized anxiety disorder, internalizing disorders, miscellaneous anxiety, obsessive compulsive disorder, panic disorder, separation anxiety disorder, social anxiety disorder and specific phobias) and alcohol use outcome (drinking frequency/quantity, binge drinking and alcohol use disorders). FINDINGS: The narrative synthesis revealed some evidence for a positive association between anxiety and later alcohol use disorders. Associations of anxiety with later drinking frequency/quantity and binge drinking were inconsistent. Type and developmental period of anxiety, follow-up duration, sample size and confounders considered did not appear to explain the discrepant findings. The meta-analysis also showed no clear evidence of a relationship between generalized anxiety disorder and later alcohol use disorder (odds ratio = 0.94, 95% confidence interval = 0.47-1.87). CONCLUSIONS: Evidence to date is suggestive, but far from conclusive of a positive association between anxiety during childhood and adolescence and subsequent alcohol use disorder.

Drug Alcohol Depend ; 197: 344-353, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30827758


BACKGROUND: High levels of alcohol use in pregnancy have been shown to be associated with negative physical health consequences in offspring. However, the literature is less clear on the association of alcohol use in pregnancy and offspring mental health, specifically for low levels of prenatal alcohol exposure. We conducted a systematic review to evaluate studies examining this association. METHODS: Studies were identified by searching PsycINFO, PubMed and Web of Science, and were included if they examined alcohol use during pregnancy as an exposure and offspring mental health at age 3 or older as an outcome. We excluded non-English language publications and studies of fetal alcohol syndrome. RESULTS: Thirty-three studies were included and were categorized by mental health outcomes: anxiety/depression, emotional problems, total internalizing problems, total problem score, and conduct disorder. Over half of the analyses reported a positive association of prenatal alcohol exposure and offspring mental health problems. CONCLUSIONS: Our review suggests that maternal alcohol use during pregnancy is associated with offspring mental health problems, even at low to moderate levels of alcohol use. Future investigation using methods that allow stronger causal inference is needed to further investigate if these associations shown are causal.

Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/psicologia , Transtornos do Neurodesenvolvimento/induzido quimicamente , Complicações na Gravidez/psicologia , Efeitos Tardios da Exposição Pré-Natal/psicologia , Pré-Escolar , Feminino , Humanos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente
Eur Child Adolesc Psychiatry ; 28(8): 1079-1086, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30604131


Previous cohort studies have observed higher birth order to be associated with increased risk of suicidal behaviour. However, the mechanisms underlying this association are unclear. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we used multivariable logistic regression models and mediation analysis to investigate the associations of birth order with adolescent suicide attempts and psychiatric disorder. We investigated whether the number of maternal depressive episodes and father absence mediated the associations found. In fully adjusted models (n = 2571), higher birth order was associated with an increased risk of both suicide attempts (OR = 1.42, CI = 1.10-1.84) and psychiatric disorder (OR = 1.29, CI = 0.99-1.69). Maternal depression and father absence only partially mediated (8%; 12%) these associations. Whilst maternal depression and paternal absence partially mediated the associations between birth order, and suicidal behaviour and psychiatric disorder, other pathways may account for much of these associations. Future studies should investigate alternative mediating pathways.

Ordem de Nascimento/psicologia , Saúde Mental/tendências , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Adulto Jovem
Health Technol Assess ; 22(41): 1-84, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30079863


BACKGROUND: Nicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data. OBJECTIVES: To assess (1) the effectiveness, safety and tolerability of nicotine preloading in a routine NHS setting relative to usual care, (2) the mechanisms of the action of preloading and (3) the cost-effectiveness of preloading. DESIGN: Open-label randomised controlled trial with examination of mediation and a cost-effectiveness analysis. SETTING: NHS smoking cessation clinics. PARTICIPANTS: People seeking help to stop smoking. INTERVENTIONS: Nicotine preloading comprised wearing a 21 mg/24 hour nicotine patch for 4 weeks prior to quit date. In addition, minimal behavioural support was provided to explain the intervention rationale and to support adherence. In the comparator group, participants received equivalent behavioural support. Randomisation was stratified by centre and concealed from investigators. MAIN OUTCOME MEASURES: The primary outcome was 6-month prolonged abstinence assessed using the Russell Standard. The secondary outcomes were 4-week and 12-month abstinence. Adverse events (AEs) were assessed from baseline to 1 week after quit day. In a planned analysis, we adjusted for the use of varenicline (Champix®; Pfizer Inc., New York, NY, USA) as post-cessation medication. Cost-effectiveness analysis took a health-service perspective. The within-trial analysis assessed health-service costs during the 13 months of trial enrolment relative to the previous 6 months comparing trial arms. The base case was based on multiple imputation for missing cost data. We modelled long-term health outcomes of smoking-related diseases using the European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) model. RESULTS: In total, 1792 people were eligible and were enrolled in the study, with 893 randomised to the control group and 899 randomised to the intervention group. In the intervention group, 49 (5.5%) people discontinued preloading prematurely and most others used it daily. The primary outcome, biochemically validated 6-month abstinence, was achieved by 157 (17.5%) people in the intervention group and 129 (14.4%) people in the control group, a difference of 3.02 percentage points [95% confidence interval (CI) -0.37 to 6.41 percentage points; odds ratio (OR) 1.25, 95% CI 0.97 to 1.62; p = 0.081]. Adjusted for use of post-quit day varenicline, the OR was 1.34 (95% CI 1.03 to 1.73; p = 0.028). Secondary abstinence outcomes were similar. The OR for the occurrence of serious AEs was 1.12 (95% CI 0.42 to 3.03). Moderate-severity nausea occurred in an additional 4% of the preloading group compared with the control group. There was evidence that reduced urges to smoke and reduced smoke inhalation mediated the effect of preloading on abstinence. The incremental cost-effectiveness ratio at the 6-month follow-up for preloading relative to control was £710 (95% CI -£13,674 to £23,205), but preloading was dominant at 12 months and in the long term, with an 80% probability that it is cost saving. LIMITATIONS: The open-label design could partially account for the mediation results. Outcome assessment could not be blinded but was biochemically verified. CONCLUSIONS: Use of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication. TRIAL REGISTRATION: Current Controlled Trials ISRCTN33031001. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 41. See the NIHR Journals Library website for further project information.

Psychon Bull Rev ; 25(2): 732-738, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29392633


We used the 7.5% carbon dioxide model of anxiety induction to investigate the effects of state anxiety on simple information processing. In both high- and low-anxious states, participants (n = 36) completed an auditory-visual matching task and a visual binary categorization task. The stimuli were either degraded or clear, so as to investigate whether the effects of anxiety are greater when signal clarity is compromised. Accuracy in the matching task was lower during CO2 inhalation and for degraded stimuli. In the categorization task, response times and indecision (measured using mouse trajectories) were greater during CO2 inhalation and for degraded stimuli. For most measures, we found no evidence of Gas × Clarity interactions. These data indicate that state anxiety negatively impacts simple information processing and do not support claims that anxiety may benefit performance in low-cognitively-demanding tasks. These findings have important implications for understanding the impact of state anxiety in real-world situations.

R Soc Open Sci ; 4(5): 160855, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28572987


High trait anxiety has been associated with detriments in emotional face processing. By contrast, relatively little is known about the effects of state anxiety on emotional face processing. We investigated the effects of state anxiety on recognition of emotional expressions (anger, sadness, surprise, disgust, fear and happiness) experimentally, using the 7.5% carbon dioxide (CO2) model to induce state anxiety, and in a large observational study. The experimental studies indicated reduced global (rather than emotion-specific) emotion recognition accuracy and increased interpretation bias (a tendency to perceive anger over happiness) when state anxiety was heightened. The observational study confirmed that higher state anxiety is associated with poorer emotion recognition, and indicated that negative effects of trait anxiety are negated when controlling for state anxiety, suggesting a mediating effect of state anxiety. These findings may have implications for anxiety disorders, which are characterized by increased frequency, intensity or duration of state anxious episodes.