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

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 (HR_males 3.96; HR_females 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 (HR_males 0.59; HR_females 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 disorder; anxiety disorders; bipolar disorder; major depression; nonaffective psychosis; social stress; spousal influences.

Fig. 1.

HR for AUD registration during marriage in males and females as a function of a spouse with (v. without) a premarital major depression or anxiety disorder (DAD) registration; DAD during marriage; or a bipolar disorder or nonaffective psychosis (BPN) registration. Note. Time is represented as year from marriage for spousal premarital DAD and BPN, and from year of registration for spousal DAD during marriage.