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Origins of spousal cross-concordance for psychiatric disorders: a test of the social stress theory for alcohol use disorder

Published online by Cambridge University Press:  22 June 2022

Jessica E. Salvatore Open the ORCID record for Jessica E. Salvatore [Opens in a new window] ,
Sara Larsson Lönn ,
Jan Sundquist ,
Kristina Sundquist  and
Kenneth S. Kendler
Jessica E. Salvatore*
Affiliation:
Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
Sara Larsson Lönn
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden
Jan Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden
Kristina Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden
Kenneth S. Kendler*
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
*
Authors for correspondence: Jessica E. Salvatore, E-mail: jessica.salvatore@rutgers.edu; Kenneth S. Kendler, E-mail: kenneth.kendler@vcuhealth.org
Authors for correspondence: Jessica E. Salvatore, E-mail: jessica.salvatore@rutgers.edu; Kenneth S. Kendler, E-mail: kenneth.kendler@vcuhealth.org
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Abstract

Background

The authors sought to clarify the impact of spousal psychiatric disorders of differing severity [major depression or anxiety disorders (DAD) v. bipolar disorder or nonaffective psychosis (BPN)] on proband risk for alcohol use disorder (AUD) during marriage.

Methods

In a Swedish cohort (N = 744 628), associations between spousal DAD and BPN and proband AUD were estimated with Cox proportional hazards; associations between parental AUD, proband premarital AUD, and spousal lifetime DAD and BPN were estimated with logistic regression; and whether spousal DAD or BPN causally increased risk for AUD was evaluated with frailty models.

Results

Spousal premarital DAD, spousal marital-onset DAD, and spousal BPN (premarital or marital-onset) were associated with proband AUD during marriage [hazard ratios (HR) range 1.44–3.72]. Those with a parental or premarital history of AUD (v. without) were more likely to marry a spouse with DAD or BPN (odds ratios 1.22–2.77). Moving from an unaffected first spouse to a DAD-affected second spouse increased AUD risk in males (HR 2.90). Moving from an unaffected first spouse to a BPN-affected second spouse increased AUD risk (HRmales 3.96; HRfemales 5.64). Moving to an unaffected second spouse from a DAD-affected first spouse decreased AUD risk, with stronger evidence in females compared to males (HRmales 0.59; HRfemales 0.28).

Conclusions

Associations between spousal DAD or BPN and proband AUD reflect both selection and causal effects. Marriage to a BPN-affected spouse has a particularly strong effect on AUD risk, with more modest effects for spousal DAD.

Keywords

Alcohol use disorderanxiety disordersbipolar disordermajor depressionnonaffective psychosissocial stressspousal influences
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 10 , July 2023 , pp. 4772 - 4779
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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Footnotes

*

Now in the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers Behavioral and Health Sciences, New Brunswick, NJ, USA.

†

Shared last authorship.

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