{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:14:49Z","timestamp":1790896489883,"version":"4.1.0"},"reference-count":55,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2019,7,22]],"date-time":"2019-07-22T00:00:00Z","timestamp":1563753600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0033291719001788_sec_a1\" sec-type=\"other\"><jats:title>Background<\/jats:title><jats:p>Causes of the comorbidity of substance misuse with anxiety-related and depressive disorders (anxiety\/depression) remain poorly known. We estimated associations of substance misuse and anxiety\/depression in the general population and tested them while accounting for genetic and shared environmental factors.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291719001788_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>We studied individuals born in Sweden 1968\u20131997 (<jats:italic>n<\/jats:italic> = 2 996 398) with follow-up in nationwide register data for 1997\u20132013. To account for familial effects, stratified analyses were conducted within siblings and twin pairs. Substance misuse was defined as ICD-10 alcohol or drug use disorder or an alcohol\/drug-related criminal conviction. Three dimensions of ICD-10 anxiety and depressive disorders and a substance misuse dimension were identified through exploratory factor analysis.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291719001788_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Substance misuse was associated with a 4.5-fold (95% CI 4.50\u20134.58) elevated risk of lifetime generalized anxiety\/depression, 4.7-fold (95% CI 4.63\u20134.82) elevated risk of panic disorder and agora\/social phobia, and 2.9-fold elevated risk of phobias\/OCD (95% CI 2.82\u20133.02) as compared to those without substance misuse. The associations were attenuated in within-family analyses but we found elevated risks in monozygotic twin pairs discordant for substance misuse as well as significant non-shared environmental correlations. The association between anxiety\/depression and substance misuse was mainly driven by generalized anxiety\/depression, whereas other anxiety\/depression dimensions had minor or no independent associations with substance misuse.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291719001788_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Substance misuse and anxiety\/depression are associated at the population level, and these associations are partially explained by familial liabilities. Our findings indicate a common genetic etiology but are also compatible with a potential partially causal relationship between substance misuse and anxiety\/depression.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291719001788","type":"journal-article","created":{"date-parts":[[2019,7,22]],"date-time":"2019-07-22T09:44:24Z","timestamp":1563788664000},"page":"1706-1715","source":"Crossref","is-referenced-by-count":36,"title":["Comorbidity of substance misuse with anxiety-related and depressive disorders: a genetically informative population study of 3 million individuals in 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