katherinepabilo

[katherinepabilo]

Creating graphs for your data

As a reminder:

Research Question: I chose to study the association between general anxiety disorder and substance use (alcohol, drugs, or medicines).

Refined Research Question: I chose to study the association between general anxiety disorder and substance use (alcohol, drugs, or medicines) among people who have used any type of substance in the last 12 months.

PROGRAM 

UNIVARIATE GRAPHS 

6+ MONTH PERIOD FELT TENSE/NERVOUS/WORRIED MOST OF TIME

This graph is unimodal, with its highest peak at the category of 2 which means NO 6+ month period felt tense most of time with 95%. I cannot say a shape because only the variable has 2 categories. And only 5% say that had 6+ month period felt tense most of time.

BADAFTEREFFECTS

All the people of the sample said that no had episodes from sides effects (alcohol or medicine/drug use).

EPISODE IN LAST 12 MONTHS AFTER DRINKING/DRUG USE

For this graph I will not count the category 11 because represents people not meet symptom criteria for generalized anxiety; had no episode in last 12 months. We can see that about 8% said that no has episode in last 12 months after drinking/drug use and only 2% said that have episode after drink or use drugs or medicines.

CONTINUED TENSE/NERVOUS WHEN STOPPED DRINKING/DRUG USE

For this graph I will not count the category 11 because represents people not meet symptom criteria for generalized anxiety; had no episode in last 12 months. We can see that about 6% said that no continued tense when stopped drinking/drug use and no one continued tense after episode when stopped drinking/drug use.

GENERALIZED ANXIETY IN LAST 12 MONTHS (NON-HIERARCHICAL)

This graph is unimodal, with its highest peak at the category of 0 which means NO general anxiety with 95% and 5% said that have general anxiety. I cannot say a shape because only the variable has 2 categories.

BIVARIATE GRAPHS 

Generalized anxiety vs. Episodes after drinking/drug use

The graph above plots the generalized anxiety in last 12 months to the episodes in last 12 months after drinking/drug use. So, you can see from this graph that the 100% of the people who have episodes after drinking or drug use has generalized anxiety and about the 75% of the of the people who not have episodes after drinking or drug use has generalized anxiety. So in a graphical way, we're already seeing that there seems to be a relationship between the use of substance and general anxiety as we hypothesized.

[katherinepabilo]

Making Data Management Decisions

As a reminder:

Research Question: I chose to study the association between general anxiety disorder and substance use (alcohol, drugs, or medicines).

Refined Research Question: I chose to study the association between general anxiety disorder and substance use (alcohol, drugs, or medicines) among people who have used any type of substance in the last 12 months.

Data Management

To manage my data, I included coding out missing data, coding in valid data, and recoding variable. I think that I don’t need for my research question to grouping the variables and I intended to create secondary variables but It was a little difficult to me because I think that the operation that I wanted to perform has not been done even in the videos so I will continuing learning and if I consider to include something else I will add in the next week.

1) PROGRAM 

2) Output that displays three of your data managed variables as frequency tables:

3) A few sentences describing frequency distributions in terms of the values the variables take, how often they take them, the presence of missing data, etc.

Here are three of the variables now managed chosen to study the relationship between general anxiety disorder and substance use:

1. EPISODE IN LAST 12 MONTHS AFTER DRINKING/DRUG USE

 The variable can take the following values:

1. Means Yes

2. Means No

11. Means The worst time not meet symptom criteria for generalized anxiety; had no episode in last 12 months

For this variable, 4 people were found who had no episodes in the last 12 months after ingesting alcohol or using drugs, which represents a percentage of 5.33%, and one person who did, which represents a percentage of 1.33% and 70 people said that their symptoms did not meet criteria for generalized anxiety which represents the percentage of 93.33%. There is no missing data.

2. CONTINUED TENSE/NERVOUS AFTER ONLY/ANY EPISODE WHEN STOPPED DRINKING/DRUG USE

The variable can take the following values:

1. Means Yes

2. Means No

11. Means The worst time not meet symptom criteria for generalized anxiety; had no episode in last 12 months

 For this variable, 5 people were found did not continued tense/nervous when stopped drinking/drug use which represents a percentage of 6.67%, and no one continued tense/nervous when stopped drinking/drug use which represents a percentage of 0% and 70 people said that their symptoms did not meet criteria for generalized anxiety which represents the percentage of 93.33%. There is no missing data.

3. MEDICINE/DRUG FOR GENERALIZED ANXIETY PRESCRIBED BY DOCTOR

 The variable can take the following values:

1. Means Yes

2. Means No

11. Means The worst time not meet symptom criteria for generalized anxiety.

For this variable, 5 people were found who had no use medicine/drug for generalized anxiety prescribed by doctor, which represents a percentage of 6.67%, and one person who did, which represents a percentage of 1.33% and 69 people said that their symptoms did not meet criteria for generalized anxiety which represents the percentage of 92.00%. There is no missing data.

[katherinepabilo]

Running Your First Program

Sorry I don´t know how to upload the tables like images. 

I decided to refine my research question as follows:

Research Question: I chose to study the association between general anxiety disorder and substance use (alcohol, drugs, or medicines).

Refined Research Question: I chose to study the association between general anxiety disorder and substance use (alcohol, drugs, or medicines) among people who have used any type of substance in the last 12 months.

1) Program: I ALSO INCLUDED A SCREENSHOT SO IT IS VISUALIZED IN A CLEARER WAY

/*The LIBNAME statement simply tells SAS where to find the data*/

LIBNAME mydata "/courses/d1406ae5ba27fe300" access=readonly;

/*In the DATA STEP a temporary dataset is created*/ /*The set statement is used to tell SAS, which data file is set for analysis*/

DATA new; set mydata.nesarc_pds;  

LABEL S9Q1A="6+ MONTH PERIOD FELT TENSE/NERVOUS/WORRIED MOST OF    

      TIME"       S9Q11= "EPISODE WHEN EXPERIENCING BAD AFTEREFFECTS OF  

      DRINKING"             S9Q13= "EPISODE WHEN EXPERIENCING BAD AFTEREFFECTS OF

      MEDICINE OR DRUG"       S9Q14CR= "EPISODE IN LAST 12 MONTHS AFTER DRINKING/DRUG

      USE"       S9Q14GR= "CONTINUED TENSE/NERVOUS WHEN STOPPED

      DRINKING/DRUG USE"       S9Q17= "MEDICINE/DRUG FOR GENERALIZED ANXIETY PRESCRIBED

      BY DOCTOR"       S9Q19B= "DRANK ALCOHOL TO AVOID GENERALIZED ANXIETY IN

      LAST 12 MONTHS"       S9Q20B= "USED MEDICINE/DRUG ON OWN TO AVOID GENERALIZED

      ANXIETY IN LAST 12 MONTHS"       S2AQ4A= "DRANK ANY COOLERS IN LAST 12 MONTHS"       CKSTATUS= "TIME FRAME FOR ANY DRUG USE"       GENAXDXSNS12= "GENERALIZED ANXIETY IN LAST 12 MONTHS

      (SUBSTANCE-INDUCED RULED OUT)";

/*Subsetting the data to include only people who have used any type of substance in the last 12 months*/ IF S2AQ4A = 1; IF CKSTATUS = 1;

PROC SORT; by IDNUM; /*sort data by unique identifer*/

/*Variables of interest*/ PROC FREQ; TABLES S9Q1A S9Q11 S9Q13 S9Q14CR S9Q14GR S9Q17 S9Q19B S9Q20B S2AQ4A CKSTATUS GENAXDXSNS12;

RUN;    

 2) Output that displays three of your variables as frequency tables:

SEE THE INCLUDED PHOTOS

3) A few sentences describing your frequency distributions in terms of the values the variables take, how often they take them, the presence of missing data, etc.

It is important to clarify that I reduced the sample to only those people who have used substances (alcohol, drugs or medicines) in the last 12 months. Based on this, 75 people turned out.

Here are three of the variables chosen to study the relationship between general anxiety disorder and substance use:

1.   EPISODE IN LAST 12 MONTHS AFTER DRINKING/DRUG USE

The variable can take the following values:

1. Means Yes

2. Means No

For this variable, 4 people were found who had no episodes in the last 12 months after ingesting alcohol or using drugs, which represents a percentage of 80%, and one person who did, which represents a percentage of 20%. Regarding the missing data, 70 people were found to be those who did not meet the criteria for symptoms of generalized anxiety to establish that their episode was due to this disorder.

2.  TIME FRAME FOR ANY DRUG USE

The variable can take the following values:

1. Last 12 months only                              

2.  Prior to last 12 months only

I only decided to work with those people who had used drugs in the last 12 months. Only 75 people said that they had used drugs during this period, which represents 100% of my sample. The rest of the observations were discarded. There is no missing data.

3. GENERALIZED ANXIETY IN LAST 12 MONTHS (SUBSTANCE-INDUCED RULED OUT)

The variable can take the following values:

0. Means No

1. Means Yes

For this variable there were 71 people who had not been diagnosed in which it was ruled out that their generalized anxiety was induced by substances, which represents 94.67%. And 4 people indicated that if they had been diagnosed with general anxiety disorder that is not induced by substances, this represents 5.33%. There is no missing data.

[katherinepabilo]

Getting Your Research Project Started – General Anxiety Disorder and Substances Use

The data set I chose to study was that of NESARC (U.S. National Epidemiological Survey on Alcohol and Related Conditions).

Research Question: I chose to study the association between general anxiety disorder and substance use (alcohol, drugs, or medicines). I am not currently sure which of the substances available within the NESARC surveys I will analyze.

Hypothesis: General anxiety disorder and substance use are strongly related. Since, the general anxiety disorder condition can lead to the use of substances, either as a treatment method or to alleviate adverse effects or symptoms. Another possible hypothesis would be that there are substances that alter brain functions, which can lead to a state of stress that triggers general anxiety disorders.

There is an extensive literature that explains the relationship between anxiety disorders and the use of multiple substances. Based on this literature, I developed the hypothesis for this investigation. I will present below some of my findings:

Prevalence and Co-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders - Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most common psychiatric disorders in the United States. The associations between most substance use disorders, and independent mood and anxiety disorders were overwhelmingly positive and significant, suggesting that treatment for comorbid mood or anxiety disorder should not be discontinued to the people with substance use disorders.

Furthermore, national epidemiological surveys and numerous clinical studies consistently indicate that substance use disorders and mood and anxiety disorders have strong associations when considered for life.

Co-occurrence of substance use disorders and mood and anxiety disorders.

All independent mood and anxiety disorders were strongly and consistently associated with alcohol and drug use disorders. Any drug abuse was also significantly related to all independent anxiety and mood disorders. All independent anxiety and mood disorders were consistently more related to drug and alcohol dependence than drug abuse.

Prevalence of substance use disorders among respondents with mood or anxiety disorders

Among respondents with any 12-month anxiety disorder, 14.96% had at least 1 substance use disorder.

Respondents with panic disorder with agoraphobia and generalized anxiety disorder were more likely than those with other mood and anxiety disorders to have a substance use disorder.

More importantly, this study also showed that some individuals in the general population experienced anxiety disorders (50,980 American adults) that were only substance-induced. Approximately 15% of individuals with at least one 12-month independent anxiety disorder had a substance use disorder.

However, the nature of the current or recent simultaneous occurrence of substance and mood disorders or anxiety remains largely unexamined and poorly understood.

One factor that has persistently impeded a better understanding of the relationship between substance use disorders and mood and anxiety disorders is diagnosis. Diagnosis of current mood or anxiety disorders among active substance users is complicated by the fact that many symptoms of alcohol and other substance intoxication and withdrawal resemble symptoms of mood and anxiety disorders. The challenge among people with current substance use disorders has been to design diagnostic criteria and measurement techniques that differentiate between symptoms of intoxication and withdrawal and symptoms of psychiatric disorders.

The distinction between independent and substance-induced disorders in the studies is problematic in several ways. First, retrospective reports of chronological sequences that occur many years before may be inaccurate. Second, basing the distinction on substance use disorders rather than periods of substance use leaves open the possibility of independent psychiatric disorders occurring during periods of undiagnosable substance use. Third, the clinical assessment methods in these studies did not determine independent mood and anxiety disorder episodes that begin during periods of alcohol or drug use and persist more than 1 month after discontinuation of use.

 Associations of Social Phobia and General Anxiety with Alcohol and Drug Use in A Community Sample of Adolescents.

Anxiety disorders have been found to be repeatedly associated with alcohol abuse and substance use disorders. Longitudinal studies suggest that anxiety disorders generally precede substance use problems.

Self-medication theory suggests that alcohol and other substances can be used to alleviate anxiety symptoms. An alternative order of progression can be explained using substances that alter brain functions, making them more vulnerable to stress, thereby creating a state of anxiety. The order of progression, therefore, is not yet fully understood.

According to the Diagnostic and Statistical Manual on Mental Disorders, 4th Edition (DSM-IV), seven types of anxiety disorders can be distinguished in children and adolescents. Of these, among the most clinically important are social phobia and generalized anxiety disorder. Generalized anxiety disorder is characterized by disproportionate, uncontrollable, and often irrational concern about everyday affairs. Due to differences in symptomatology, specific types of anxiety disorders may have different types of associations with substance use. General anxiety can, for example, lead to self-medication with alcohol.

  The present study is part of an ongoing prospective follow-up study entitled 'Adolescent Mental Health Cohort Study'. Ninth-grade students (ages 15-16) from all Finnish-speaking high schools in two Finnish cities, Tampere (200,000 inhabitants) and Vantaa (180,000 inhabitants), completed a person-identifiable questionnaire during a school lesson supervised by a teacher.

 General anxiety

General anxiety was measured by a single question that focused on the cognitive aspect of being anxious.

Respondents were asked to rate the alternative that best describes them today: "I don't easily lose my nerve or get anxious" (= 0) / "I don't feel anxious or nervous" (= 0); 'I get anxious and nervous quite easily' (= 1); "I get anxious, or nervous very easily" (= 2); "I am constantly anxious and nervous, my nerves are always on the edge" (= 3). The measure has been used in previous studies of large community samples of adolescents. As in previous studies, scores of 2 to 3 were taken as symptoms of significant anxiety.

General anxiety was associated with a higher incidence of frequent use of alcohol and cannabis when controlling for sex, family structure, and parents' educational levels, and even when controlling for depression further. Frequent use of alcohol, frequent drunkenness, and cannabis use were not associated with the incidence of either type of anxiety.

 Conclusions

Studying the progression order of anxiety and substance use among Finnish middle-aged adolescents revealed that anxiety preceded substance use while no reciprocal associations were observed. Overall, symptoms of general anxiety raised the incidence of substance use. Both anxiety and substance use showed significant continuity at a 2-year follow-up. Comorbid general anxiety increased persistence of frequent alcohol consumption. Continued frequent drunkenness and cannabis use were not affected by comorbid anxiety.

While, therefore, it may be theoretically possible to conclude that primary anxiety caused secondary alcohol consumption.

In the present study, general anxiety and social phobia symptoms were not affected by previous cannabis use.

Consistent with previous findings, all types of substance use and anxiety showed substantial persistence or recurrence at the 2-year follow-up.

General anxiety in middle adolescence puts adolescents at risk for simultaneous and subsequent substance use. However, the risk may be associated with comorbid depression.

   Cannabis and anxiety: a critical review of the evidence

Frequent cannabis users have a high prevalence of anxiety disorders, and patients with anxiety disorders have relatively high rates of cannabis use. However, it is not clear whether cannabis use increases the risk of developing lasting anxiety disorders. Many hypotheses have been proposed to explain these relationships, including neurobiological, environmental, and social influences.

 Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literatura.

The prevalence of other psychiatric diagnoses among those with substance-related disorders is remarkable. Community anxiety disorders in the United States can be diagnosed in about 25% of alcohol dependent people and 43% of drug dependent people.

All patients in the sample had substance use disorders. Only adults included in the study. The patients in the sample had been selected for depressive or anxiety symptoms or a diagnosis of depression or anxiety. The study compared an integrated non-somatic treatment for both substance use disorders and depression or anxiety with a treatment program focused solely on substance use disorder.

 Bibliographic Information.

Bridget F. Grant, PhD, PhD; Frederick S. Stinson, PhD; Deborah A. Dawson, PhD; et al. (August 2004). Prevalence and Co-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders - Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Sari Fröjd, Klaus Ranta, Riittakerttu Kaltiala-Heino, Mauri Marttunen. (January 2011). Associations of Social Phobia and General Anxiety with Alcohol and Drug Use in A Community Sample of Adolescents.

José Alexandre Crippa Antonio Waldo Zuardi Rocio Martín ‐ Santos Sagnik Bhattacharyya Zerrin Atakan Philip McGuire Paolo Fusar-Poli. (Agosto de 2009). Cannabis and anxiety: a critical review of the evidence.

Morten Hesse. (Febrero 2009). Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literatura.