Questões metodológicas na avaliação da comorbidade de distúrbios psiquiátricos e abuso de drogas em estudos epidemiológicos

Lopes, Claudia de Souza

doi:10.1590/S0103-73311999000100010

Resumos

Estudos conduzidos em diferentes partes do mundo têm mostrado que a comorbidade entre os distúrbios psiquiátricos e o abuso de drogas é altamente prevalente. Entretanto, a identificação de tal comorbidade tem apresentado uma série de problemas metodológicos que afetam os resultados, tomando difíceis as comparações entre diferentes localidades e estudos. O presente artigo, através da avaliação da literatura sobre as pesquisas empíricas disponíveis, mostra que as principais causas para as diferenças nas taxas de comorbidade obtidas em estudos prévios podem ser devidas a diferenças em: l) critérios diagnósticos e técnicas de entrevistas utilizadas; 2) tipos de amostras estudadas; 3) o momento da avaliação; e 4) estabelecimento da seqüência temporal dos eventos. Apesar da existência de obstáculos importantes, a avaliação destas questões em estudos epidemiológicos tem contribuído com soluções criativas e fornecido um cenário bastante otimista para a direção futura de pesquisas na área.

Estudos epidemiológicos; comorbidade psiquiátrica; distúrbios psiquiátricos; abuso de drogas

Studies conducted in different parts of the world have shown that comorbidity is híghly prevalent among psychíatric dísorders and drug abuse. However, identifying coexisting psychopathology in drug users presents several specifíc methodologícal problems that affect the results, making comparisons across dífferent settíngs and places difficult. This artícle, through the evaluation of the literature based on empírical research, found that differences in the rates of such comorbidity obtained from previous studies may be due to dífferences in: 1) the diagnostic criteria and interview techníques used; 2) the samples studíed; 3) the tíming of the assessment; or 4) the establishment of a temporal sequence for the events. Despite these important obstacles, the evaluation of these questions in epidemiologíc studies has contributed with creative solutions that allowed an optimístíc scenario for the future directions of research in this area.

Epidemiologíc studies; psychíatric comorbídíty; psychiatric disorders; drug abuse

Études conduits dans dífférents régíons du monde nous ont montré que la comorbidité parmí les troubles psychíatriques et l'abus des drogues est fortement prévalent. Cependant I'identificatíon de la coexistence des troubles psychiatriques parmí ceux qui font usage de drogues ont presenté une variété de problemes méthodologíques, qui modifient les resultats des recherches et rendrent plus dífficile les comparaisons entre différents lieus et études. Cet artícle, en appréciant la littérature sur les recherches plus connues, a découvert que les plus importants motifs qui determínent les différences dans les taxes des comorbidité obtenues dans de préalables études peuvent être dus par des différences dans: 1) les cri teres diagnostiques et techniques des entrevues utilisées; 2) les déchantillons étudiées; 3) le moment de l'évaluation; et 4) la suite temporelle des evénements. Malgré l' éxistence des obstacles importants, l'évaluation de ces questions dans des études epidémiologiques ont été chaque fois de plus l' objet d' études spécifiques qui ont contribué avec des solutions origineles qui nous présentent un décor trés optimiste pour la direction future de recherches dans ce domaine.

Études epidemiologiques; comorbidité psychiatrique; psychiatriques troubles; l' abus de drogues

Questões metodológicas na avaliação da comorbidade de distúrbios psiquiátricos e abuso de drogas em estudos epidemiológicos

Methodological questions in the evaluation of psychiatric disorders and drug abuse comorbidity in epidemiologic studies

Questions méthodologiques de I'évaluation de la comorbidité parmi les troubles psychiatriques et l'abus des drogues aux études epidémiologiques

Claudia de Souza Lopes

Professora Adjunta do Departamento de Epidemiologia do Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro

RESUMO

Estudos conduzidos em diferentes partes do mundo têm mostrado que a comorbidade entre os distúrbios psiquiátricos e o abuso de drogas é altamente prevalente. Entretanto, a identificação de tal comorbidade tem apresentado uma série de problemas metodológicos que afetam os resultados, tomando difíceis as comparações entre diferentes localidades e estudos. O presente artigo, através da avaliação da literatura sobre as pesquisas empíricas disponíveis, mostra que as principais causas para as diferenças nas taxas de comorbidade obtidas em estudos prévios podem ser devidas a diferenças em: l) critérios diagnósticos e técnicas de entrevistas utilizadas; 2) tipos de amostras estudadas; 3) o momento da avaliação; e 4) estabelecimento da seqüência temporal dos eventos. Apesar da existência de obstáculos importantes, a avaliação destas questões em estudos epidemiológicos tem contribuído com soluções criativas e fornecido um cenário bastante otimista para a direção futura de pesquisas na área.

Palavras-chave: Estudos epidemiológicos; comorbidade psiquiátrica; distúrbios psiquiátricos; abuso de drogas.

ABSTRACT

Studies conducted in different parts of the world have shown that comorbidity is híghly prevalent among psychíatric dísorders and drug abuse. However, identifying coexisting psychopathology in drug users presents several specifíc methodologícal problems that affect the results, making comparisons across dífferent settíngs and places difficult. This artícle, through the evaluation of the literature based on empírical research, found that differences in the rates of such comorbidity obtained from previous studies may be due to dífferences in: 1) the diagnostic criteria and interview techníques used; 2) the samples studíed; 3) the tíming of the assessment; or 4) the establishment of a temporal sequence for the events. Despite these important obstacles, the evaluation of these questions in epidemiologíc studies has contributed with creative solutions that allowed an optimístíc scenario for the future directions of research in this area.

Keywords: Epidemiologíc studies; psychíatric comorbídíty; psychiatric disorders; drug abuse.

RÉSUMÉ

Études conduits dans dífférents régíons du monde nous ont montré que la comorbidité parmí les troubles psychíatriques et l'abus des drogues est fortement prévalent. Cependant I'identificatíon de la coexistence des troubles psychiatriques parmí ceux qui font usage de drogues ont presenté une variété de problemes méthodologíques, qui modifient les resultats des recherches et rendrent plus dífficile les comparaisons entre différents lieus et études. Cet artícle, en appréciant la littérature sur les recherches plus connues, a découvert que les plus importants motifs qui determínent les différences dans les taxes des comorbidité obtenues dans de préalables études peuvent être dus par des différences dans: 1) les cri teres diagnostiques et techniques des entrevues utilisées; 2) les déchantillons étudiées; 3) le moment de l'évaluation; et 4) la suite temporelle des evénements. Malgré l' éxistence des obstacles importants, l'évaluation de ces questions dans des études epidémiologiques ont été chaque fois de plus l' objet d' études spécifiques qui ont contribué avec des solutions origineles qui nous présentent un décor trés optimiste pour la direction future de recherches dans ce domaine.

Mots-clé: Études epidemiologiques; comorbidité psychiatrique; psychiatriques troubles; l' abus de drogues.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 19/12/99.

Aprovado em 17/3/99.

AVICO, U.; KAPLAN, C. et al Cocaine epidemiology in three European community cities: A pilot study using a snowball sampling methodology. Anonymous Research Report of the Cocaine Steering Group Belgium: Health Directorate Commission of the European Communities Brussels, fev. 1988.
BERKSON, J. Limitations on the application of the four-fold table analysis to hospital data. Biometrics, v. 2, p. 47-53, 1946.
BIBB, J. L.; CHAMBLESS, D. L. Alcohol use and abuse among diagnosed agoraphobics. Behaviour Research Therapy, v. 24, p. 49-58, 1986.
BIERNACKI, P.; W ALDFORD, D. Snowball sampling: Problems and techniques of chain referral sampling. Sociological Methods Research, v. 2, p. 141-163, 1981.
BOYLE, M. H.; OFFORD, D. R. Psychiatric disorder and substance use in adolescence. Canadian Journal of Psychiatry, v. 36, p. 699-705, 1991.
BOYLE, M. H.; OFFORD, D. R.; RACINE, Y. A. et al Predicting substance use in early adolescence based on parent and teacher assessments of childhood psychiatric disorder: results from the Ontario Child Health Study follow-up. J. Child Psychol. Psychiatry, v. 34, p. 535-44, 1993.
____ . Predicting substance use in late adolescence: results from the Ontario Child Health Study follow-uP. American Journal of Psychiatry, v. 149, p. 761 7, 1992.
BRAUCHT, G. N.; BRAKARSCH, D. et ai. Deviant drug use in adolescence: A review of psychological correlates. Psychological Bulletin, v. 79, p. 92-106, 1973.
BUKSTEIN, O. G.; BRENT, D. A.; KAMINER, Y. Comorbidity of substance abuse and other psychiatric disorders in adolescents [see comments]. American Journal of Psychiatry, v. 146, p. 1.131-41, 1989.
BUKSTEIN, O. G.; GLANCY, L. J.; KAMINER, Y. Pattems of affective comorbidity in a clinical population of dually diagnosed adolescent substance abusers. Journal of American Academy of Child and Adolescent Psychiatry, v. 31, p. 1.041-5, 1992.
CARROL, K. M.; ROUNSA VILLE, B. J. Contrast of treatment-seeking and untreated cocaine abusers. Archives of General Psychiatry, v. 49, p. 464-71, 1992.
CHRISTIE, K. A.; BURKE, J. D. J.; REGIER, D. A. et al Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. American Journal of Psychiatry, v. 145, p. 971-5, 1988.
GA WIN, F. H.; KLEBER, H. D. Abstinence symptomatology and psychiatric diagnosis in cocaine abusers. Archives of General Psychiatry, v. 43, p. 107-13, 1986.
GOODMAN, L. Snowball sampling. Annals of Mathematical Statistics, v. 32, p. 245-68, 1961.
GRIFFITHS, P.; GOSSOP, M. et al Reaching hidden populations of drug users by privileged access interviewers: Methodological and practical issues. Addiction, v. 88, p. 1.617-26, 1993.
HELZER, J. E.; PRYZBECK, T. R. The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies on Alcohol, v. 49, p. 219-24, 1988.
HENDRIKS, V. M. Psychiatric disorders in a Dutch addict population: Rates and correlates of DSM-III diagnosis. Journal of Consulting and Clinical Psychology, v. 58, p. 158-65, 1990.
HESSELBROCK, M. N.; MEYER, R. E.; KEENER, J. J. Psychopathology in hospitalized alcoholics. Archives of General Psychiatry, v. 42, p. 1.050-5, 1985.
KAPLAN, C. D.; KORF, D.; STERK, C. Temporal and social contexts of heroin using populations: An illustration of the snowball sampling technique. The Journal of Nervous and Mental Disease, v. 175, p. 566-74, 1987.
KEELER, M. H.; TAYLOR, C. 1.; MILLER, W. C. Are all recently detoxified alcoholics depressed? American Journal of Psychiatry, v. 136, p. 586-8, 1979.
KESSLER, R. C.; PRICE, R. H. Primary prevention of secondary disorders: A proposal and agenda. American Journal of Community Psychology, v. 21, p. 607-33, 1993.
KHANTZIAN, E. J. Self selection and progression in drug dependence. Psychiatry Digest, v. 10, p. 19-22, 1975.
KLEIN, D. Anxiety reconceptualized. Comprehensive Psychiatry, v. 21, p. 411-27, 1980.
KLEINMAN, P. H.; MILLER, A. B.; MILLMAN, R. B. et al Psychopathology among cocaine abusers entering treatment. The Journal of Nervous and Mental Disease, v. 178, p. 442-7, 1990.
LOPES, C. S. Psychiatric risk factors for drug abuse among adults in Rio de Janeiro. Tese de Doutorado. Institute of Psychiatry, University of London, 1994.
LOPES, C. S.; LEWIS, G.; MANN, A. Psychiatric and alcohol disorders as risk factors for drug abuse. A case-control study among adults in Rio de Janeiro, Brazil. Social Psychiatry and Psychiatric Epidemiology, v. 31, p. 355-63, 1996a.
LOPES, C. S.; RODRIGUES, L. C.; SICHIERI, R. The lack of selection bias in a snowball sampled case-contral study on drug abuse. International Journal of Epidemiology, v. 25, p. 1.267-70, 1996b.
MCAREE, C. P.; STEFFENHAGEN, R. A.; ZHENTLEN, L. S. Personality factors and patterns of drug usage in college students. American Journal of Psychiatry, v. 128, p. 890-3, 1972.
METER, K. M. Methodological and design issues: Techniques for assessing the representatives of snowball samples. ln: LAMBERT, E. (ed.). The collection and interpretation of data from hidden populations Rockville: NIDA Research Monograph, v. 98, p. 31-43, 1990.
MILLER, N. S.; RIES, R. K. Drug and alcohol dependence and psychiatric populations: The need for diagnosis, intervention, and training. Comprehensive Psychiatry, v. 32, p. 268-76, 1991.
NEWCOMB, M. D.; MADDAHIAN, E.; BENTLER, P. M. Risk factors for drug use among adolescents: Concurrent and longitudinal analyses. American Journal of Public Health, v. 76, p. 525-31, 1986.
PATON, S.; KESSLER, R.; KANDEL, D. Depressive mood and adolescent illicit drug use: A longitudinal analysis. Journal of Genetic Psychology, v .131, p. 267-89, 1977.
POST, R. M.; KOTIN, J.; GOODWIN, F. K. The effects of cocaine on depressed patients. American Journal of Psychiatry, v. 131, p. 511-7, 1974.
REGIER, D. A.; BOYD, J. H.; BURKE JR., J. D. et ai. One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Archives of General Psychiatry, v. 45, p. 977-86, 1988.
REGIER, D. A.; FARMER, M. E.; ERA, D. S. et ai. Comorbidity of mental disorders with alcohol and other drug abuse. Results fram the Epidemiologic Catchment Area (ECA) Study [see comments]. JAMA, v. 264, p. 2.511-8, 1990.
REGIER, D. A.; MYERS, J. K.; KRAMER, M. et ai. The NIMH Epidemiologic Catchment Area programo Historical context, major objectives, and study population characteristics. Archives of General Psychiatry, v. 41, p. 934-41, 1984.
ROBINS, L. N.; PRZYBECK, T. R. Age of onset of drug use as a factor in drug and other disorders. ln: JONES, C. L. R.; BATTJES, R. J. (eds.). Etiology of drug abuse: implications for prevention. Rockville: National lnstitute on Drug Abuse, Research Monograph, n. 56, p. 178-192, 1985.
ROBINS, L. N.; WING, J.; WITTCHEN, H. U. et ai. The Composite lnternational Diagnostic lnterview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, v. 45, p. 1.069-77, 1988.
ROSS, H. E.; GLAZER, F. B.; GERMANSüN, T. The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Archives of General Psychiatry, v. 45, p. 1.023-31, 1988.
ROUNSAVILLE, B. J.; KLEBER, H. Untreated opiate addicts. How do they differ from those seeking treatment? Archives of General Psychiatry, v. 42, p. 1.072 7, 1985.
ROUNSAVILLE, B. J.; WEISSMAN, M. M.; KLEBER, H. Heterogeneity of psychiatric diagnosis in treated opiate addicts. Archives of General Psychiatry, v. 39, p. 161-6, 1982.
ROUNSAVILLE, B.; CARROLL, K. Psychiatric disorders in treatment-entering cocaine abusers. NIDA Res. Monogr., v. 110, p. 227-51, 1991.
VENER, A. M.; STEWART, C. S.; HAGER, D. L. Depression and the adolescent in middle America. In: ANNUAL MEETING OF THE AMERICAN SOCIOLOGICAL ASSOCIATION, 67, 1972, New Orleans. Paper .. New Orleans, L. A. (não publicado), 1972.
WEISS, R. D.; MIRIN, S. M.; GRIFFIN, M. L. Methodological considerations in the diagnosis of coexisting psychiatric disorders in substance abusers. British Journal of Addiction, v. 87, p. 179-87, 1992.
WEISS, R. D.; MIRIN, S. M.; GRIFFIN, M. L.; MICHAEL, J. L. Psychopathology in cocaine abusers: changing trends. The Journal of Nervous and Mental Disease, v. 176, p. 719-25, 1988.
YAMAGUCHI, K.; KANDEL, D. B. Patterns of drug use from adolescence to young adulthood: II. Sequences of progression. American Journal of Public Health, 74, p. 668-72" 1984a.
____ . Patterns of drug use from adolescence to young adulthood: III. Predictors of progression. American Journal of Public Health, v. 74, p. 673-81, 1984b.

Datas de Publicação

Publicação nesta coleção
25 Nov 2008
Data do Fascículo
Jun 1999

Histórico

Recebido
19 Dez 1999
Aceito
17 Mar 1999

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] AVICO, U.; KAPLAN, C. et al Cocaine epidemiology in three European community cities: A pilot study using a snowball sampling methodology. Anonymous Research Report of the Cocaine Steering Group Belgium: Health Directorate Commission of the European Communities Brussels, fev. 1988.

[2] BERKSON, J. Limitations on the application of the four-fold table analysis to hospital data. Biometrics, v. 2, p. 47-53, 1946.

[3] BIBB, J. L.; CHAMBLESS, D. L. Alcohol use and abuse among diagnosed agoraphobics. Behaviour Research Therapy, v. 24, p. 49-58, 1986.

[4] BIERNACKI, P.; W ALDFORD, D. Snowball sampling: Problems and techniques of chain referral sampling. Sociological Methods Research, v. 2, p. 141-163, 1981.

[5] BOYLE, M. H.; OFFORD, D. R. Psychiatric disorder and substance use in adolescence. Canadian Journal of Psychiatry, v. 36, p. 699-705, 1991.

[6] BOYLE, M. H.; OFFORD, D. R.; RACINE, Y. A. et al Predicting substance use in early adolescence based on parent and teacher assessments of childhood psychiatric disorder: results from the Ontario Child Health Study follow-up. J. Child Psychol. Psychiatry, v. 34, p. 535-44, 1993.

[7] ____ . Predicting substance use in late adolescence: results from the Ontario Child Health Study follow-uP. American Journal of Psychiatry, v. 149, p. 761 7, 1992.

[8] BRAUCHT, G. N.; BRAKARSCH, D. et ai. Deviant drug use in adolescence: A review of psychological correlates. Psychological Bulletin, v. 79, p. 92-106, 1973.

[9] BUKSTEIN, O. G.; BRENT, D. A.; KAMINER, Y. Comorbidity of substance abuse and other psychiatric disorders in adolescents [see comments]. American Journal of Psychiatry, v. 146, p. 1.131-41, 1989.

[10] BUKSTEIN, O. G.; GLANCY, L. J.; KAMINER, Y. Pattems of affective comorbidity in a clinical population of dually diagnosed adolescent substance abusers. Journal of American Academy of Child and Adolescent Psychiatry, v. 31, p. 1.041-5, 1992.

[11] CARROL, K. M.; ROUNSA VILLE, B. J. Contrast of treatment-seeking and untreated cocaine abusers. Archives of General Psychiatry, v. 49, p. 464-71, 1992.

[12] CHRISTIE, K. A.; BURKE, J. D. J.; REGIER, D. A. et al Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. American Journal of Psychiatry, v. 145, p. 971-5, 1988.

[13] GA WIN, F. H.; KLEBER, H. D. Abstinence symptomatology and psychiatric diagnosis in cocaine abusers. Archives of General Psychiatry, v. 43, p. 107-13, 1986.

[14] GOODMAN, L. Snowball sampling. Annals of Mathematical Statistics, v. 32, p. 245-68, 1961.

[15] GRIFFITHS, P.; GOSSOP, M. et al Reaching hidden populations of drug users by privileged access interviewers: Methodological and practical issues. Addiction, v. 88, p. 1.617-26, 1993.

[16] HELZER, J. E.; PRYZBECK, T. R. The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies on Alcohol, v. 49, p. 219-24, 1988.

[17] HENDRIKS, V. M. Psychiatric disorders in a Dutch addict population: Rates and correlates of DSM-III diagnosis. Journal of Consulting and Clinical Psychology, v. 58, p. 158-65, 1990.

[18] HESSELBROCK, M. N.; MEYER, R. E.; KEENER, J. J. Psychopathology in hospitalized alcoholics. Archives of General Psychiatry, v. 42, p. 1.050-5, 1985.

[19] KAPLAN, C. D.; KORF, D.; STERK, C. Temporal and social contexts of heroin using populations: An illustration of the snowball sampling technique. The Journal of Nervous and Mental Disease, v. 175, p. 566-74, 1987.

[20] KEELER, M. H.; TAYLOR, C. 1.; MILLER, W. C. Are all recently detoxified alcoholics depressed? American Journal of Psychiatry, v. 136, p. 586-8, 1979.

[21] KESSLER, R. C.; PRICE, R. H. Primary prevention of secondary disorders: A proposal and agenda. American Journal of Community Psychology, v. 21, p. 607-33, 1993.

[22] KHANTZIAN, E. J. Self selection and progression in drug dependence. Psychiatry Digest, v. 10, p. 19-22, 1975.

[23] KLEIN, D. Anxiety reconceptualized. Comprehensive Psychiatry, v. 21, p. 411-27, 1980.

[24] KLEINMAN, P. H.; MILLER, A. B.; MILLMAN, R. B. et al Psychopathology among cocaine abusers entering treatment. The Journal of Nervous and Mental Disease, v. 178, p. 442-7, 1990.

[25] LOPES, C. S. Psychiatric risk factors for drug abuse among adults in Rio de Janeiro. Tese de Doutorado. Institute of Psychiatry, University of London, 1994.

[26] LOPES, C. S.; LEWIS, G.; MANN, A. Psychiatric and alcohol disorders as risk factors for drug abuse. A case-control study among adults in Rio de Janeiro, Brazil. Social Psychiatry and Psychiatric Epidemiology, v. 31, p. 355-63, 1996a.

[27] LOPES, C. S.; RODRIGUES, L. C.; SICHIERI, R. The lack of selection bias in a snowball sampled case-contral study on drug abuse. International Journal of Epidemiology, v. 25, p. 1.267-70, 1996b.

[28] MCAREE, C. P.; STEFFENHAGEN, R. A.; ZHENTLEN, L. S. Personality factors and patterns of drug usage in college students. American Journal of Psychiatry, v. 128, p. 890-3, 1972.

[29] METER, K. M. Methodological and design issues: Techniques for assessing the representatives of snowball samples. ln: LAMBERT, E. (ed.). The collection and interpretation of data from hidden populations Rockville: NIDA Research Monograph, v. 98, p. 31-43, 1990.

[30] MILLER, N. S.; RIES, R. K. Drug and alcohol dependence and psychiatric populations: The need for diagnosis, intervention, and training. Comprehensive Psychiatry, v. 32, p. 268-76, 1991.

[31] NEWCOMB, M. D.; MADDAHIAN, E.; BENTLER, P. M. Risk factors for drug use among adolescents: Concurrent and longitudinal analyses. American Journal of Public Health, v. 76, p. 525-31, 1986.

[32] PATON, S.; KESSLER, R.; KANDEL, D. Depressive mood and adolescent illicit drug use: A longitudinal analysis. Journal of Genetic Psychology, v .131, p. 267-89, 1977.

[33] POST, R. M.; KOTIN, J.; GOODWIN, F. K. The effects of cocaine on depressed patients. American Journal of Psychiatry, v. 131, p. 511-7, 1974.

[34] REGIER, D. A.; BOYD, J. H.; BURKE JR., J. D. et ai. One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Archives of General Psychiatry, v. 45, p. 977-86, 1988.

[35] REGIER, D. A.; FARMER, M. E.; ERA, D. S. et ai. Comorbidity of mental disorders with alcohol and other drug abuse. Results fram the Epidemiologic Catchment Area (ECA) Study [see comments]. JAMA, v. 264, p. 2.511-8, 1990.

[36] REGIER, D. A.; MYERS, J. K.; KRAMER, M. et ai. The NIMH Epidemiologic Catchment Area programo Historical context, major objectives, and study population characteristics. Archives of General Psychiatry, v. 41, p. 934-41, 1984.

[37] ROBINS, L. N.; PRZYBECK, T. R. Age of onset of drug use as a factor in drug and other disorders. ln: JONES, C. L. R.; BATTJES, R. J. (eds.). Etiology of drug abuse: implications for prevention. Rockville: National lnstitute on Drug Abuse, Research Monograph, n. 56, p. 178-192, 1985.

[38] ROBINS, L. N.; WING, J.; WITTCHEN, H. U. et ai. The Composite lnternational Diagnostic lnterview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, v. 45, p. 1.069-77, 1988.

[39] ROSS, H. E.; GLAZER, F. B.; GERMANSüN, T. The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Archives of General Psychiatry, v. 45, p. 1.023-31, 1988.

[40] ROUNSAVILLE, B. J.; KLEBER, H. Untreated opiate addicts. How do they differ from those seeking treatment? Archives of General Psychiatry, v. 42, p. 1.072 7, 1985.

[41] ROUNSAVILLE, B. J.; WEISSMAN, M. M.; KLEBER, H. Heterogeneity of psychiatric diagnosis in treated opiate addicts. Archives of General Psychiatry, v. 39, p. 161-6, 1982.

[42] ROUNSAVILLE, B.; CARROLL, K. Psychiatric disorders in treatment-entering cocaine abusers. NIDA Res. Monogr., v. 110, p. 227-51, 1991.

[43] VENER, A. M.; STEWART, C. S.; HAGER, D. L. Depression and the adolescent in middle America. In: ANNUAL MEETING OF THE AMERICAN SOCIOLOGICAL ASSOCIATION, 67, 1972, New Orleans. Paper .. New Orleans, L. A. (não publicado), 1972.

[44] WEISS, R. D.; MIRIN, S. M.; GRIFFIN, M. L. Methodological considerations in the diagnosis of coexisting psychiatric disorders in substance abusers. British Journal of Addiction, v. 87, p. 179-87, 1992.

[45] WEISS, R. D.; MIRIN, S. M.; GRIFFIN, M. L.; MICHAEL, J. L. Psychopathology in cocaine abusers: changing trends. The Journal of Nervous and Mental Disease, v. 176, p. 719-25, 1988.

[46] YAMAGUCHI, K.; KANDEL, D. B. Patterns of drug use from adolescence to young adulthood: II. Sequences of progression. American Journal of Public Health, 74, p. 668-72" 1984a.

[47] ____ . Patterns of drug use from adolescence to young adulthood: III. Predictors of progression. American Journal of Public Health, v. 74, p. 673-81, 1984b.

Brasil

Brasil

Questões metodológicas na avaliação da comorbidade de distúrbios psiquiátricos e abuso de drogas em estudos epidemiológicos

Methodological questions in the evaluation of psychiatric disorders and drug abuse comorbidity in epidemiologic studies

Questions méthodologiques de I'évaluation de la comorbidité parmi les troubles psychiatriques et l'abus des drogues aux études epidémiologiques

Resumos

Datas de Publicação

Histórico