Co-occurring mood, anxiety, and substance use disorders in Canada 2022: Prevalence, patterns, correlates, and changes over time

Co-occurring mood, anxiety, and substance use disorders in Canada 2022: Prevalence, patterns, correlates, and changes over time | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Co-occurring mood, anxiety, and substance use disorders in Canada 2022: Prevalence, patterns, correlates, and changes over time Jillian Halladay, Chris Ji, Katholiki Georgiades, Tim Slade, Cath Chapman, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7872114/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study examines: (1) the 2022 prevalence and co-occurrence of past 12 month mood, anxiety, and substance use disorders (SUD)among Canadian’s aged 15+; and (2) changes in the prevalence of co-occurring disorders from 2012 to 2022. Methods: Data from the 2022 Mental Health and Access to Care Survey (MHACS; n=9,861) and the 2012 Canadian Community Health Survey’s Mental Health Component (CCHS-MH; n=25,113) were analyzed. Diagnoses for past 12 month mood (major depressive episode, bipolar), anxiety (generalized anxiety, social phobia), and substance use (alcohol, cannabis, and drug) disorders were assessed using the World Health Organization Composite International Diagnostic Interview. Multivariable multinomial regression examined demographic and clinical correlates, as well as changes over time, of mood/anxiety disorder(s) alone, SUD(s) alone, and concurrent disorders (mood/anxiety+SUD). Age (youth aged 15-24 vs adults 26+) and sex (females vs males) differences were explored through stratified analyses and interactions. Results: In 2022, 16.4% of Canadians met criteria for a mood (8.4%), anxiety (9.9%), or SUD (3.5%). Of those with at least one disorder, co-occurrence was common: 39.5% had 2+ disorders with 10.6% experiencing concurrent SUD and mood/anxiety disorders. Among those with an SUD, 48.9% had a concurrent mood/anxiety disorder, while 15.2% and 9.6% of those with a mood and anxiety disorders respectively had a concurrent SUD. Youth, unemployed individuals, and those with high distress or suicidality had elevated odds of concurrent disorders. Males had higher overall concurrent disorder prevalences, but among those with SUDs, concurrent disorders were higher among females. While the odds of SUD-alone declined, mood/anxiety disorders and concurrent disorders doubled from 2012 to 2022. Conclusions: Findings highlight the urgent need for integrated mental health and substance use services in Canada, particularly for youth and females, who are disproportionately affected. Psychiatry Epidemiology Substance Use Disorders Depression Anxiety Trends Figures Figure 1 Figure 2 Introduction Substance use and other mental health disorders represent major global health concerns. These conditions are the primary contributors to morbidity world-wide. 1 , 2 In recent 2022 national surveys using structured diagnostic interviews in Canada, Australia, and the Netherlands, between 17–19% of people met criteria for a lifetime substance use disorder (SUD), 14–28% met criteria for lifetime mood disorders, and 15–29% met criteria for lifetime anxiety disorders. 3 – 5 Co-occurring disorders are also common, with roughly half of people with a disorder experiencing two or more diagnosable conditions. 5 , 6 At a population level, mood and anxiety disorders have increased over time while SUDs have remained stable or decreased. 3 – 5 Given mood and anxiety disorders represent the most common mental health comorbidity 6 , simultaneous increases in their population prevalences are expected. That said, co-occurring SUDs and mood and anxiety disorders are also common 7 , 8 , and their co-occurrence is typically associated with greater complexity and severity of symptoms, more difficult service access, and poorer prognosis. 9 In Canada, co-occurring SUD with another non-substance mental disorder is referred to as a concurrent disorder. Among Canadians aged 15–64 in 2012, 1.2% experienced a concurrent SUD and mood/anxiety disorders in the past year. 10 Those with concurrent disorders versus those without, reported worse mental health, more service use, and higher unmet needs. 10 While updated prevalences have not yet been explored in Canada, recent analyses of Australian population data found that despite declines in the population prevalence of SUDs, the severity of SUDs have increased 3 and the prevalence of co-occurring SUD and other disorders have remained stable. 6 Differences in the presence and patterns of disorders, as well as their changes over time, have been found based on developmental age and sex assigned at birth. For example, in the aforementioned 2022 national surveys, the prevalences of any past 12-month mental disorders was between 17–28% among females compared to 12–24% for males, and 26–40% for youth (ages ~ 15–24) compared to 17–35% in adult age groups. 3 – 5 Over time, mood/anxiety disorders have disproportionately increased among youth 4 , 11 , 12 and females. 4 Additionally, while males often report higher rates of SUDs, females report higher prevalences of concurrent disorders. 6 , 13 As such, identifying age and sex specific prevalences, correlates, and changes are critical to determine whether sub-group targeted policies, prevention efforts, and service planning and delivery are needed. Informed by recent analyses of Australian population data 6 , this study updates our understanding of common comorbidities among Canadians using 2022 population data. Specifically, this study first identifies the past-year (a) prevalence of SUDs (alcohol, cannabis, and other drugs use), mood (depression and bipolar), and anxiety (generalized anxiety and social phobia) disorders and (b) prevalence of co-occurring conditions. Second, demographic and clinical correlates of reporting various patterns of disorders are explored (e.g., SUD only, mood and/or anxiety only, concurrent disorders, none). Third, the prevalence SUD-alone, mood and/or anxiety-alone, or concurrent disorders between 2012 and 2022 are compared. Age and sex differences are explored across objectives. A contemporary understanding the prevalence of common comorbidities will assist with evidence-informed service planning, such as the need for integrated or concurrent treatment, and investments in new treatment or programs where needed. Our hypotheses and analysis plans were pre-registered: https://doi.org/10.17605/OSF.IO/DCVFA . Methods Design and Sampling Data come from the 2022 Mental Health and Access to Care Survey (MHACS), 14 a representative cross-sectional survey of Canadians 15 years of age or older and living in the provinces. Data are representative of the general ambulatory population. Individuals living on reserves or other Indigenous settlements, in the territories, and full-time members of the Canadian Forces are excluded. 14 , 15 Data were collected using computer-assisted telephone interviews due to the COVID-19 pandemic, with an overall response rate of 25% (n = 9,861). Total nonresponse is addressed through weighting procedures. The 2012 Canadian Community Health Survey’s Mental Health Component (CCHS-MH) 15 was used to compare changes in co-occurring conditions across survey years. It was a similarly structured survey but was collected using interviewer-delivered standardized computer-assisted interviewing, with 87% conducted in-person in participant’s homes and 13% conducted over the phone. The overall response rate was 68.9% (n = 25,113). Measures Mood, Anxiety, and Substance Use Disorders Diagnostic information for all disorders was obtained from the Statistics Canada adaptation of the World Health Organization Composite International Diagnostic Interview (WHO CIDI). Information from this interview was used to assess if individuals met criteria for having the disorders as per the Diagnostic Statistical Manual 4 (DSM-4) criteria in their lifetime. Participants were then asked about whether experiences occurred during the past 12-months. Variables were created for major depressive disorder (MDE), bipolar disorder, generalized anxiety disorder (GAD), social phobia, any alcohol disorder (AUD; abuse and/or dependence), any cannabis disorder (CUD; abuse and/or dependence), and any non-cannabis drug disorder (DUD; abuse and/or dependence; includes sedatives, tranquilizers, simulants, pain killers, cocaine, club drugs, hallucinogens, heroin, fentanyl, down, inhalants, solvents, or other illegal drugs). For descriptive statistics, three variables where created which combined diagnoses of (1) MDE and bipolar into any mood disorder, (2) GAD and social phobia into any anxiety disorder, and (3) AUD, CUD, and DUD into any SUD. As previously defined, “concurrent disorders” are SUDs occurring alongside any mood or anxiety disorder. The term “co-occurring disorder” will hereby be used when individuals meet criteria for more than one disorder within a broader domain; for example, meeting criteria for both GAD and social phobia (co-occurring anxiety disorders) or both AUD and DUD (co-occurring SUDs). An omnibus variable was then created for subsequent analyses indicating whether an individual had a mood and/or anxiety disorder only (MDE, bipolar, GAD, or social phobia), a SUD only (AUD, CUD, or DUD), or concurrent disorders (i.e., SUD + mood/anxiety). Sociodemographic and other correlates Mental health related covariates included psychological distress, measured using the K10 scale (high distress = > 20) 16 , suicidality (1 = anyone who experienced suicidal thoughts, plans, or attempts in the past year, 0 = otherwise), perceived need for care (1 = no perceived need, 2 = perceived needs met, 3 = perceived needs partially met, 4 = perceived needs not met; measured with the Perceived Need for Help Questionnaire and related algorithms 17 ), and mental health treatment in the past 12-months (0 = no, 1 = yes). Other sociodemographic covariates include year of data collection (2022 vs. 2012), biological sex (female vs. male), developmental age group 1 (youth 15–24 vs. adults age 25+), racialized (racialized vs. White), rurality (rural vs. population centre), immigrant background (immigrant vs. Canadian born), marital status (married/common-law vs single/divorced), past week work status (1 = worked, 2 = had a job but did not work, 3 = no job or permanently unable to work), education (1 = less than high school, 2 = high school, 3 = trades certificate/diploma, 4 = University certificate or above), and income (1–14, from no income to $ 100,000+, coded continuously). Statistical Analyses All descriptive analyses were performed in R software version 4.4.2 and multinomial regression performed in Stata version 18.5 using survey weights based on the Canadian population, and replicate bootstrap weights to adjust the estimation of variances to account for the complex survey design. Survey weights were normalized between the two surveys prior to analysis. For the first objective, prevalences of each diagnosis of interest, as well as proportion of people who have only that diagnosis, 2 + diagnoses within their domain (mood/anxiety or SUD), and concurrent disorders (SUD + mood/anxiety) were calculated. Patterns of co-occurrence between each individual diagnosis were quantified through pairwise bivariate tetrachoric correlations and pairwise conditional probabilities. These descriptives were stratified by sex and age. For each disorder, the comorbidity to diagnosis inflation ratio (CDIR) 18 was also calculated by dividing the total number of co-occurring disorder pairs by the total number of diagnoses for each disorder. For the second objective, multivariable multinomial logistic regression was used to examine demographic and clinical factors associated with having no disorder, mood and/or anxiety disorders-only, SUDs-only, or concurrent disorders. For the third objective, changes in disorder (co)occurrence over time were assessed using multinomial logistic regressions using the same dependent variables as objective two with year as key predictor and interactions tested for age and sex; social phobia was excluded from these analyses due to a lack of measurement in 2012. Significance was set at p-values < 0.01. Across both surveys, missing data for diagnostic variables and most demographic and clinical correlates was minimal (< 5%), with the exception of work status at 10%. Overall, 21.6% of participants (27.3% 2022, 19.3% 2012) had missing data on at least one variable. A series of univariable robust Poisson regressions predicting any missing (1) compared to no missing (0) adjusting for year found missingness to be related to lower income, lower education, higher distress, and being single, unemployed, Canadian born, White, female, and older age. Missingness was not significantly related to mood, anxiety, or SUD status. See Supplementary Materials for full results. While our pre-registration indicated we would use multiple imputation where missingness was > 5%, we opted to use random forest imputation based on recent guidance from Statistics Canada. 19 Results Prevalence and patterns of mood, anxiety, and substance use disorders Table 1 provides the past 12-month prevalence of each disorder among Canadians 15 years of age and older in 2022, including the prevalence of those with a single disorder, prevalence with co-occurring disorders within the same overarching domain (e.g., mood/anxiety or SUD), and the prevalence with concurrent mood/anxiety and SUDs. The past 12-month prevalence of any measured disorder was 16.4% (16.1–16.7), with mood disorders being 8.4% (8.2–8.7), anxiety disorders 9.9% (9.7–10.2), and SUDs 3.5% (3.4–3.7). Over two-thirds (39.5%) of Canadians with at least one disorder met criteria for two or more disorders, with 10.6% experiencing concurrent disorders. About half of those with a SUD had a concurrent mood and/or anxiety disorder (48.9%), while about 1 in 7 (15.2%) of those with a mood disorder and 1 in 10 (9.6%) of those with an anxiety disorder had a concurrent SUD. When stratified by sex, overall, females had a higher prevalence of co-occurring mood and/or anxiety disorders than males (30.8% vs 24.2%), while males had a higher prevalence of concurrent disorders than females (12.8% vs 9.0%). However, females with a SUD had a higher prevalence of concurrent disorders than males with a SUD (63.2% vs 39.5%). When stratified by age, youth consistent reported higher prevalences of concurrent disorders compared to adults (overall 14.0% vs 9.3%). When looking at disorders individually, over half of those who had any specific mood, anxiety, or SUD had at least one other disorder, with high levels of co-occurrence within specific mood and/or anxiety disorders (i.e., 2 + mood or anxiety disorders) and high prevalences of concurrent disorders among those with SUDs. When stratified, both having more than one disorder (average 68.0% females vs 63.4% males) and any concurrent disorder specifically (average 35.3% females vs 30.1% males) were higher among females. Similarly, any co-occurring disorder (average 70.1% youth vs 62.1% adults) and any concurrent disorder (average 40.0% youth vs 26.5% adults) were higher among youth. Those with bipolar disorder (80.5), DUD (74.2%), GAD (71.4%), had the highest prevalence of 2 + disorders, while CUD (56.0%), AUD (56.0%), Social Phobia (56.0%) had the lowest. These patterns were largely reflected in CDIRs (Fig. 1 ), correlations (See Supplementary Materials), and conditional probabilities (Table 2 ). For example, the strongest correlations were between bipolar disorder and mood disorder (0.71), reflecting the conditional probability of MDE among those with bipolar disorder being 63.5%, and the probability of bipolar disorder among those with MDE being 31.6%. Figure 2 provides descriptives related to patterns of disorders among all Canadians who met criteria for at least one past 12-month mental disorder. The most common pattern of disorder(s) was anxiety-disorder(s)-only, representing 34.8% (33.6–36.0), followed by mood disorder(s)-only representing 23.7% (22.7–24.7%), and mood and anxiety disorders without SUDs representing 19.9% (19.0-20.9) of those with at least one disorder. Eleven percent (11% [10.4–11.7]) of Canadians with at least one disorder experienced SUD(s)-only and 10.5% (CI 9.4% to 11.7%) experienced a concurrent SUD and mood and/or anxiety disorder(s). While the percentage of these disorder patterns differed across sex and age groups, the ranking of common patterns remained consistent–except for males, where SUD-only is more prevalent than co-occurring mood and/or anxiety disorders. See Supplementary Materials for additional figures and stratified results. Demographics and clinical correlates of disorder patterns Multivariable multinomial logistic regression results are in Table 3 . Youth, females, higher distress, suicidality, perceived need for care, or past 12-month mental health treatment had significantly greater odds of experiencing mood and/or anxiety disorder(s)-only, compared to no disorder. The odds SUD-only were higher among males, White Canadians, unemployed individuals, and individuals with perceived needs not fully met. The odds of concurrent disorders were higher among youth, unemployed individuals, and those endorsing higher distress, suicidality, and perceived need for care. Youth had 2 times the odds of meeting criteria for mood and/or anxiety disorders and 3 times the odds of meeting criteria for concurrent disorders compared to adults. While females had a higher odds of mood and/or anxiety disorders (OR = 1.5), and lower odds of SUDs (OR = 0.3), the odds of concurrent disorders were the same between males and females. Concerningly, suicidality (OR = 3.1) and perceived needs not fully met (ORs 11–13) were highest among those with concurrent disorders. Comparison with 2012 Canadian data Univariable multinomial logistic regression results over time are in Table 3 . The odds of Canadian’s experiencing mood and/or anxiety disorders were 2.5 times higher in 2022 compared to 2012. This increase in mood and/or anxiety disorders was more pronounced among youth compared to adults (OR age*year =2.0 [1.6–2.6]; p < 0.001]. While the odds of SUDs were 0.6 times lower in 2022 compared to 2012, the odds of Canadians experiencing concurrent disorders were 1.9 times higher in 2022. Sex or age did not moderate the changes in SUDs-only or concurrent disorders over the two survey years (See Supplementary Materials). Discussion In 2022, 1 in 6 (16.4%) Canadians aged 15 years and older met criteria for a mood (8.4%), anxiety (9.9%), or substance use (3.5%) disorder. Among those with at least one disorder, co-occurrence was prevalent, with 2 in 5 meeting criteria for 2 + disorder and 1 in 10 meeting criteria for a concurrent disorder. Co-occurring disorders among Canadians with mood or anxiety disorders was primarily driven by co-occurring other mood and/or anxiety disorders, though between 1 in 10 (anxiety) and 1 in 5 (mood) also reported a concurrent SUD. Conversely, among Canadians with a SUD, co-occurrence was predominately characterized by concurrent mood and/or anxiety disorders, with about 1 in 2 meeting criteria for a concurrent disorder. Youth consistency reported higher prevalences of concurrent disorders than adults. Overall, more females reported co-occurring mood and/or anxiety disorders than males while more males reported concurrent disorders, though females with an SUD-specifically had higher prevalences of concurrent disorders than males with an SUD. Lastly, while the odds of SUDs-alone decreased over time, odds for mood and/or anxiety disorders and concurrent SUD and mood and/or anxiety disorders doubled between 2012 and 2022. Concerningly, Canadians with concurrent disorders also reported the highest levels of distress and suicidality alongside the lowest levels of perceived met needs for care relative to no disorder, compared to SUD-alone or mood and/or anxiety disorder-alone. These findings highlight an urgent need for integrated, accessible care to address the rising burden of complex, co-occurring mental health and substance use disorders in Canada. The increase in the odds of concurrent disorders is concerning given integrated treatment of concurrent disorders remains difficult to access 20 and those with concurrent disorders reported their needs were often not partially or fully met. Despite long-standing calls for the need to assess and address mental health and substance use concerns concurrently 21 , including being part of various clinical best practice guidelines 22 – 25 , current workforce training and funding structures are not designed to meet these needs. This contributes to concurrent disorders often being underdiagnosed and undertreated. 9 , 10 While workforce training and health system delivery remain behind these calls to action, these gaps are not entirely health systems issues. We continue to lack concrete and clear understanding about the causal pathways to the development of concurrent disorders, and specific concurrent disorder prevention and treatment strategies that have been rigorously evaluated through large scale efficacy and effectiveness trials. 9 , 26 As such, research exploring causality, intervention efficacy and effectiveness, and health systems transformation need to move forward iteratively, and concurrently. This study also found that Canadian youth disproportionally experience higher prevalence of all mood, anxiety, and SUDs, as well as higher prevalence of comorbidity and concurrent disorders, compared to Canadians aged 26+. Most notably, mood and anxiety disorders disproportionately increased among youth between 2012 and 2022 compared to older Canadians. This aligns with evidence across high income countries showing spikes among mood and anxiety disorders among young people over the past two decades. 4 , 11 , 12 Youth is a pivotal psychosocial and developmental transition period, shaped by ongoing brain development, shifting social roles, and transitions between pediatric and adult healthcare systems. 27 – 30 Early intervention is key to long-term recovery, but many youth face barriers when navigating health care transitions between pediatric (up to age 18) and adult (18+) services. There are ongoing efforts to support smoother transitions between pediatric and adult systems with continuous access to care that is developmentally appropriate and youth-friendly across the country. 31 , 32 Strengthening early intervention and access to care for mental health and concurrent disorders may be the critical steps toward reversing identified upward shifts in youth mental health and concurrent problems, supporting long-term well-being across the lifespan. Among Canadian females with SUDs, concurrent disorders were generally more common than among males, consistent with previous studies. 6 , 13 On the other hand, for females with mood or anxiety disorders, concurrent disorders were less common when compared to males with mood or anxiety disorders. Further, this study found mood and anxiety disorders alone increased over time more-so among females compared to males, similar to previously reports using this data. 4 While this study was only able to explore binary sex at birth, the differences found in patterns of concurrent disorders and increases in mood and anxiety disorders may be both due to biological sex differences and/or sociocultural gender differences. 33 – 36 Sex-driven differences may relate to interactions between substances and hormones, genetics, anatomy, and physiology, whereas gender-driven differences may reflect different social roles, power dynamics, expectations, and experiences of stigma. These findings suggest a need for more research to disentangle sex versus gender differences, to inform sex- and gender-specific approaches to SUD and mental health care. The reasons behind shifts in the prevalence and distribution of comorbid and concurrent mood, anxiety, and substance use disorders in this study cannot be definitively characterized. Notably, previous work indicates increases in mood and anxiety disorders among youth and females started at least a decade before the COVID-19 pandemic. 4 , 11 , 12 , but there is also accumulating evidence that mood and anxiety related symptoms worsened throughout the pandemic among youth 37 and adults 38 , with disproportionate impacts on females. Previously hypothesized factors contributing to shifts in mental health and substance use over time include: changes in how people spend their time and connect with others (e.g., social media, less in-person and physical activities), shifting public perceptions of mental health and substance use, changes in and increasing anxiogenic environments attributable to political crises, environmental crises, and increasing socioeconomic disparities. 12 Overall, changes seen in this study could be pandemic-related, given lockdowns were only lifted in March 2022, although they may may reflect broader, more longstanding consequences of larger sociocultural changes. More work is needed to disambiguate reasons for shifts over time. Several limitations should be considered when interpreting these findings. First, although the 2012 and 2022 surveys shared similar content and sampling frames, differences in data collection—particularly the shift to telephone-only surveys in 2022 due to COVID-19— and response rates may have shifted participant characteristics. While phone-based surveys have shown to yield comparable prevalence estimates to face-to-face methods 39 , differences in mode and context biasing findings remain possible. Population weights were use to partially account for differences in response rates across surveys, though this cannot eliminate response bias. Second, given social phobia was not measured in 2012, comorbidity trends between 2012 and 2022 did not include social phobia; this is important as social phobia had the second highest past year prevalence across disorders in 2022. Third, there are other anxiety and mood disorders that were not assessed in this survey and thus not included in population estimates, including dysthymia, panic disorder, phobias, obsessive compulsive disorder, and post-traumatic stress disorder. Fourth, while the surveys were representative of many Canadians, as this survey does not include Canadians who are unhoused, hospitalized, in the Canadian Armed Forces, living in the territories, or living on Indigenous lands, the estimates are very likely lower than the true national prevalence. Lastly, these data come from repeated cross-sectional surveys and thus results should be interpreted as epidemiological trends, not causal analyses. Conclusion The high and rising prevalence of concurrent disorders and their association with heightened distress and unmet needs highlight an urgent need for integrated, accessible, and comprehensive support systems to address the complex realities of comorbidity. These findings underscore the critical importance of integrated mental health and substance use care in Canada, particularly for youth and females, who report disproportionately higher prevalences of concurrent disorders. Declarations Conflicts of Interest: JM is a principal in BEAM Diagnostics, Inc. and has consulted to Clairvoyant Therapeutics, Inc. No other authors have any conflicts of interest to declare. Funding: JH is funded by a Health Systems Impact Embedded Early Career Researcher award co-funded by the Canadian Institutes of Health Research, McMaster University, and St. Joseph’s Healthcare Hamilton (HS3-191640). KG is supported by the David R. (Dan) Offord Chair in Child Studies. CC is supported by an Australian National Health and Medical Research Council Investigator Grant Fellowship (GNT2026552) and a Centre of Research Excellence Grant PREMISE Next Generation (GNT2035308). 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Sci Rep 14(1):5689. https://doi.org/10.1038/s41598-024-55879-9 Khaled SM, Amro I, Bader L, Lee Holmes J, Diop A, Le Trung K (2024) Feasibility of replacing face-to‐face with telephone interviews for the World Mental Health Qatar survey during the COVID‐19 pandemic. Int J Methods Psychiatr Res 33(S1):e2009. https://doi.org/10.1002/mpr.2009 Tables Table 1 Prevalence of mood, anxiety, and substance use disorders. Overall % Of those meeting criteria for the specified disorder… Single disorder Co-occurring disorders Concurrent SUD and Mood/Anxiety disorders % with only 1 disorder % 2 + mood/anxiety % 2 + SUDs % concurrent Total population MDE all 7.7 (7.4–7.9) 41.1 (39.6–42.6) 44.1 (42.5–45.6) - 14.9 (13.8–16.0) Bipolar all 2.1 (2.0–2.2) 19.5 (17.5–21.8) 57.1 (54.3–59.9) - 23.3 (21.0–25.8) GAD all 5.3 (5.1–5.5) 28.6 (26.9–30.4 60.1 (58.5–62.1) - 11.1 (10.0–12.3) Social Phobia all 7.2 (7.0–7.4) 44.0 (42.5–45.6) 46.5 (45.0–48.0) - 9.5 (8.6–10.4) AUD all 2.1 (2.0–2.2) 44.0 (41.1–47.0) - 6.2 (4.7–8.0) 49.8 (46.8–52.8) CUD all 1.4 (1.3–1.5) 44.0 (40.6–47.5) - 5.1 (4.0–6.5) 50.9 (47.6–54.3) DUD all 0.5 (0.5–0.6) 25.8 (20.8–31.5) - 16.7 (11.9–22.9) 57.5 (51.2–63.6) Any Mood all 8.4 (8.2–8.7) 42.2 (40.7–43.6) 42.6 (41.2–44.1) - 15.2 (14.2–16.3) Any Anxiety all 9.9 (9.7–10.2) 47.2 (45.8–48.6) 43.2 (41.9–44.5) - 9.6 (8.8–10.4) Any SUD all 3.5 (3.4–3.7) 47.3 (45.0–49.7) 3.8 (2.9–4.9) 48.9 (46.6–51.2) Any Disorder all 16.4 (16.1–16.7) 60.5 (59.4–61.5) 28.2 (27.2–29.1) 0.8 (0.6–1.1) 10.6 (9.9–11.2) Stratified by sex assigned at birth MDE Males 5.9 (5.6–6.2) 38.4 (35.9–40.9) 43.6 (41.0–46.2) - 18.1 (16.1–20.2) Females 9.3 (9.0–9.6) 42.7 (40.9–44.6) 44.4 (42.5–46.3) - 12.9 (11.6–14.2) Bipolar Males 2.0 (1.9–2.2) 24.2 (20.6–28.1) 47.0 (42.5–51.5) - 28.9 (25.1–33.0) Females 2.2 (2.0–2.4) 15.4 (13.3–17.9) 66.1 (62.7–69.4) - 18.4 (15.8–21.3) GAD Males 3.7 (3.4–3.9) 25.1 (22.5–28.0) 60.9 (57.8–63.9) - 14.0 (12.0–16.2) Females 6.8 (6.5–7.1) 30.4 (28.3–32.6) 60.0 (57.7–62.3) - 9.6 (8.3–11.1) Social Phobia Males 5.0 (4.7–5.2) 43.2 (40.6–45.8) 43.7 (41.0–46.3) - 13.2 (11.6–15.0) Females 9.4 (9.1–9.7) 44.5 (42.6–46.4) 47.9 (46.0–49.8) - 7.6 (6.6–8.7) AUD Males 2.5 (2.3–2.7) 48.4 (44.6–52.3) - 9.3 (7.0–12.2) 42.3 (38.4–46.2) Females 1.7 (1.6–1.9) 38.0 (33.3–42.9) - 1.9 (1.0–3.6) 60.1 (55.1–64.8) CUD Males 1.9 (1.8–2.1) 53.8 (49.5–58.0) - 7.5 (7.0–12.2) 38.8 (34.8–42.9) Females 0.9 (0.8–1.0) 22.8 (17.3–29.4) - suppressed 77.2 (70.6–82.7) DUD Males 0.6 (0.5–0.7) 23.0 (16.4–31.4) - 21.8 (14.7–31.0) 55.2 (46.6–63.5) Females 0.4 (0.3–0.5) 30.1 (22.9–38.5) - 8.7 (4.6–16.0) 61.2 (5.2–69.6) Any Mood Males 6.7 (6.5–7.1) 40.8 (38.5–43.2) 40.5 (38.1–43.0) - 18.7 (16.8–20.7) Females 10.0 (9.7–10.4) 43.0 (41.3–44.8) 44.0 (42.3–45.8) - 13.0 (11.8–14.3) Any Anxiety Males 6.9 (6.6–7.3) 44.0 (41.8–46.3) 43.7 (41.5–45.9) - 12.3 (10.9–13.7) Females 12.8 (12.4–13.3) 48.9 (47.2–50.6) 43.0 (41.3–44.6) 8.2 (7.3–9.2) Any SUD Males 4.4 (4.1–4.6) 55.0 (52.0–58.0) - 5.5 (4.1–7.2) 39.5 (36.6–42.4) Females 2.8 (2.6–3.0) 35.6 (32.0–39.3) - 1.2 (0.7–2.3) 63.2 (59.4–66.8) Any Disorder Males 13.4 (13.0–13.9) 61.2 (59.5–62.8) 24.2 (22.8–25.7) 1.8 (1.3–2.4) 12.8 (11.7–14.0) Females 19.2 (18.8–19.7) 60.0 (58.6–61.4) 30.8 (29.5–32.1) 0.2 (0.1–0.3) 9.0 (8.3–9.9) Stratified by age MDE 15–25 13.6 (13.0–14.2) 31.2 (29.0–33.5) 47.6 (45.2–50.0) - 21.2 (19.2–23.2) 26+ 6.7 (6.4–6.9) 44.4 (42.5–46.2) 42.9 (41.0–44.8) - 12.7 (11.4–14.0) Bipolar 15–25 5.7 (5.2–6.1) 21.0 (18.1–24.0) 44.2 (40.4–48.1) - 34.8 (30.9–38.6) 26+ 1.5 (1.4–1.7) 18.6 (15.7–21.6) 64.9 (61.1–68.7) - 16.5 (13.6–19.3) GAD 15–25 8.7 (8.2–9.2) 22.8 (20.3–25.2) 60.2 (57.1–63.2) - 17.1 (14.7–19.4) 26+ 4.7 (4.5–4.9) 30.4 (28.3–32.5) 60.3 (58.1–62.6) - 9.3 (7.9–10.6) Social Phobia 15–25 16.9 (16.3–17.6) 45.8 (43.6–48.1) 39.9 (37.7–42.1) - 14.3 (12.7–15.9) 26+ 5.6 (5.4–5.8) 43.2 (41.1–45.2) 49.7 (47.7–51.7) - 7.1 (6.1–8.2) AUD 15–25 4.1 (3.7–4.5) 41.6 (37.1–46.1) - 6.6 (4.4–8.8) 51.8 (47.1–56.6) 26+ 1.8 (1.7–1.9) 44.9 (41.3–48.6) - 6.0 (3.0–5.8) 49.0 (37.0–46.9) CUD 15–25 4.6 (4.2–5.0) 32.7 (28.7–36.7) - 5.9 (3.9–7.9) 61.3 (57.2–65.5) 26+ 0.9 (0.8–1.0) 53.6 (48.6–58.7) - 4.4 (3.0–5.8) 42.0 (37.0–46.9) DUD 15–25 1.0 (0.8–1.2) 14.4 (9.0–19.9) - 5.9 (3.9–7.9) 79.6 (73.3–86.0) 26+ 0.4 (0.4–0.5) 30.1 (23.3–36.8) - 20.8 (13.8–27.7) 49.2 (41.8–56.5) Any Mood 15–25 16.0 (15.3–16.6) 34.1 (32.0–36.3) 44.6 (42.4–46.8) - 21.3 (19.4–23.3) 26+ 7.2 (7.0–7.5) 45.1 (43.3–46.9) 41.9 (40.1–43.8) - 13.0 (11.8–14.3) Any Anxiety 15–25 20.3 (19.6–21.0) 48.1 (45.9–50.2) 38.3 (36.2–40.3) - 13.7 (12.3–15.1) 26+ 8.2 (8.0–8.5) 46.9 (45.1–48.6) 45.2 (43.5–46.9) - 7.9 (7.0–8.9) Any SUD 15–25 8.1 (7.6–8.6) 41.4 (38.4–44.5) - 3.3 (3.4–4.7) 55.2 (52.1–58.4) 26+ 2.8 (2.6–3.0) 50.1 (47.1–53.2) - 4.0 (2.9–5.5) 45.9 (42.9–48.9) Any Disorder 15–25 31.9 (31.1–32.7) 58.1 (56.4–59.7) 27.1 (25.6–28.5) 0.8 (0.6–1.2) 14.0 (12.9–15.2) 26+ 13.9 (13.5–14.2) 61.4 (60.1–62.7) 28.6 (27.4–29.8) 0.8 (0.6–1.1) 9.3 (8.5–10.1) Table 2 Conditional pairwise probabilities Caption: Conditional probabilities of the column given the row are shown, e.g. the probability of an individual having MDE given they have bipolar disorder is 0.635. MDE Bipolar GAD Social Phobia AUD CUD DUD MDE 1.000 0.316 0.18 0.333 0.091 0.071 0.024 Bipolar 0.635 1.000 0.35 0.395 0.132 0.111 0.034 GAD 0.457 0.144 1.000 0.491 0.057 0.042 0.027 Social Phobia 0.35 0.357 0.118 1.000 0.052 0.048 0.02 AUD 0.326 0.142 0.135 0.179 1.000 0.131 0.08 CUD 0.386 0.158 0.172 0.25 0.198 1.000 0.075 DUD 0.351 0.268 0.138 0.268 0.32 0.196 1.000 Table 3 Multinomial logistic regressions of mood/anxiety disorders, substance use disorders, and concurrent disorders (i.e., co-occurring mood/anxiety and a substance use disorder) presented as Odds Ratios and 95% Confidence Intervals. Mood/anxiety-only SUD-only Concurrent disorders Demographic & clinical correlates (reference = no disorder) Youth (vs. adult) 2.1 (1.64–2.8); <0.001 2.0 (1.2–3.5); 0.013 2.9 (1.6–5.1); <0.001 Female (vs. male) 1.5 (1.2–1.8); <0.001 0.3 (0.2–0.6); <0.001 0.8 (0.5–1.3); 0.439 Rural (vs. urban) 0.9 (0.7–1.2); 0.349 1.3 (0.8–2.1); 0.275 1.2 (0.7–2.2); 0.558 Racialized (vs. White) 1.0 (0.8–1.3); 0.919 0.4 (0.2–0.7); 0.001 0.7 (0.41–1.3); 0.244 Immigrant status 0.8 (0.6–1.1); 0.114 0.8 (0.4–1.4); 0.346 0.5 (0.3–1.0); 0.038 Working (vs. no job) 1.2 (0.7–1.8); 0.506 0.8 (0.3–2.2); 0.659 1.2 (0.5–3.0); 0.738 Had a job, didn’t work (vs. no job) 0.8 (0.7–1.0); 0.076 0.4 (0.3–0.7); 0.001 0.5 (0.3–0.8); 0.003 Relationship (vs. single/divorced) 0.9 (0.7–1.1); 0.23 0.5 (0.3–0.9); 0.017 0.5 (0.3–0.8); 0.006 Income 1.0 (1.0–1.1); 0.31 1.0 (0.9–1.0); 0.262 0.9 (0.9–1.0); 0.116 High school (vs. < high school) 1.0 (0.7–1.4); 0.906 1.3 (0.6–3.1); 0.517 1.0 (0.5–1.9); 0.939 Certificate/diploma (vs. < high school) 0.9 (0.5–1.4); 0.536 0.7 (0.2–2.3); 0.601 0.9 (0.3–2.5); 0.806 University degree (vs. < high school) 0.8 (0.6–1.2); 0.322 1.0 (0.4–2.4); 0.92 0.7 (0.4–1.5); 0.356 Psychological distress 11.7 (8.2–16.7); <0.001 2.2 (0.9–5.6); 0.103 13.3 (7.5–23.7); <0.001 Suicidality 2.3 (1.5–3.5); <0.001 1.5 (0.6–3.4); 0.367 3.1 (1.7–5.7); <0.001 Perceived needs Needs met (vs. no need) 4.3 (3.3–5.6); <0.001 2.0 (1.1–3.6); 0.031 6.0 (3.2–11.1); <0.001 Needs partially met (vs. no need) 9.7 (7.1–13.1); <0.001 4.1 (2.0–8.4); <0.001 13.1 (6.4–26.8); <0.001 Needs not met (vs. no need) 7.3 (5.2–10.2); <0.001 3.5 (1.4–8.8); 0.007 10.9 (4.9–24.3); <0.001 Received mental health treatment 2.4 (1.8–3.1); <0.001 1.6 (0.8–3.2); 0.151 1.8 (1.0–3.0); 0.037 Comparisons over time 2022 (vs. 2012) 2.5 (2.2–2.8); <0.001 0.6 (0.5–0.7); <0.001 1.9 (1.4–2.4); <0.001 Additional Declarations The authors declare potential competing interests as follows: JM is a principal in BEAM Diagnostics, Inc. and has consulted to Clairvoyant Therapeutics, Inc. No other authors have any conflicts of interest to declare. Supplementary Files HalladayStatsCanComorbiditySuppMatsAug2025.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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03:48:38","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14637,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7872114/v1/d2d15e6a2b2778f105a1a3da.png"},{"id":93736890,"identity":"32517cf3-0a82-4d50-991a-d8fa909d40e9","added_by":"auto","created_at":"2025-10-17 03:48:35","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":154342,"visible":true,"origin":"","legend":"","description":"","filename":"rs78721140structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7872114/v1/41b361054254a9ae78b41afb.xml"},{"id":93736891,"identity":"bf9e25e7-6426-4a9e-bc60-f25aba2cd340","added_by":"auto","created_at":"2025-10-17 03:48:35","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":162296,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7872114/v1/90b98e4424dfb951a090cab3.html"},{"id":93736886,"identity":"dbc98424-193b-4585-aeb2-b6d398cfcec5","added_by":"auto","created_at":"2025-10-17 03:48:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88076,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComorbidity to Diagnosis Inflation Ratios (CDIRs)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCDIR values greater than 1 indicate that on average for the disorder indicated on the y-axis, there is at least one or more co-occurring disorders. The x-axis indicates the average number or co-occurring disorders.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7872114/v1/fa4baa016fff44bc9a3e74cb.png"},{"id":93736885,"identity":"da84231e-63eb-4076-8c3e-bc75b93b0547","added_by":"auto","created_at":"2025-10-17 03:48:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":69839,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eShoelace plot in the total population\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7872114/v1/5a00b602733219b3547861ff.png"},{"id":93737500,"identity":"b0f6ab1e-af04-4d00-b431-55247f20c5db","added_by":"auto","created_at":"2025-10-17 04:04:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1686575,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7872114/v1/dffd2852-bc2e-464a-9086-8d821f436665.pdf"},{"id":93736889,"identity":"9e2747a2-4c6f-41c5-9f7b-77c9c84a8d56","added_by":"auto","created_at":"2025-10-17 03:48:35","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":339690,"visible":true,"origin":"","legend":"","description":"","filename":"HalladayStatsCanComorbiditySuppMatsAug2025.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7872114/v1/9132d77ae4e3ecc990951adb.xlsx"}],"financialInterests":"The authors declare potential competing interests as follows: JM is a principal in BEAM Diagnostics, Inc. and has consulted to Clairvoyant Therapeutics, Inc. No other authors have any conflicts of interest to declare.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eCo-occurring mood, anxiety, and substance use disorders in Canada 2022: Prevalence, patterns, correlates, and changes over time\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSubstance use and other mental health disorders represent major global health concerns. These conditions are the primary contributors to morbidity world-wide.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e In recent 2022 national surveys using structured diagnostic interviews in Canada, Australia, and the Netherlands, between 17\u0026ndash;19% of people met criteria for a lifetime substance use disorder (SUD), 14\u0026ndash;28% met criteria for lifetime mood disorders, and 15\u0026ndash;29% met criteria for lifetime anxiety disorders.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Co-occurring disorders are also common, with roughly half of people with a disorder experiencing two or more diagnosable conditions.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAt a population level, mood and anxiety disorders have increased over time while SUDs have remained stable or decreased.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Given mood and anxiety disorders represent the most common mental health comorbidity\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, simultaneous increases in their population prevalences are expected. That said, co-occurring SUDs and mood and anxiety disorders are also common\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, and their co-occurrence is typically associated with greater complexity and severity of symptoms, more difficult service access, and poorer prognosis.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In Canada, co-occurring SUD with another non-substance mental disorder is referred to as a concurrent disorder. Among Canadians aged 15\u0026ndash;64 in 2012, 1.2% experienced a concurrent SUD and mood/anxiety disorders in the past year.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Those with concurrent disorders versus those without, reported worse mental health, more service use, and higher unmet needs.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e While updated prevalences have not yet been explored in Canada, recent analyses of Australian population data found that despite declines in the population prevalence of SUDs, the severity of SUDs have increased\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and the prevalence of co-occurring SUD and other disorders have remained stable.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDifferences in the presence and patterns of disorders, as well as their changes over time, have been found based on developmental age and sex assigned at birth. For example, in the aforementioned 2022 national surveys, the prevalences of any past 12-month mental disorders was between 17\u0026ndash;28% among females compared to 12\u0026ndash;24% for males, and 26\u0026ndash;40% for youth (ages\u0026thinsp;~\u0026thinsp;15\u0026ndash;24) compared to 17\u0026ndash;35% in adult age groups.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Over time, mood/anxiety disorders have disproportionately increased among youth\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e and females.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Additionally, while males often report higher rates of SUDs, females report higher prevalences of concurrent disorders.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e As such, identifying age and sex specific prevalences, correlates, and changes are critical to determine whether sub-group targeted policies, prevention efforts, and service planning and delivery are needed.\u003c/p\u003e\u003cp\u003eInformed by recent analyses of Australian population data\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, this study updates our understanding of common comorbidities among Canadians using 2022 population data. Specifically, this study first identifies the past-year (a) prevalence of SUDs (alcohol, cannabis, and other drugs use), mood (depression and bipolar), and anxiety (generalized anxiety and social phobia) disorders and (b) prevalence of co-occurring conditions. Second, demographic and clinical correlates of reporting various patterns of disorders are explored (e.g., SUD only, mood and/or anxiety only, concurrent disorders, none). Third, the prevalence SUD-alone, mood and/or anxiety-alone, or concurrent disorders between 2012 and 2022 are compared. Age and sex differences are explored across objectives. A contemporary understanding the prevalence of common comorbidities will assist with evidence-informed service planning, such as the need for integrated or concurrent treatment, and investments in new treatment or programs where needed. Our hypotheses and analysis plans were pre-registered: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17605/OSF.IO/DCVFA\u003c/span\u003e\u003cspan address=\"10.17605/OSF.IO/DCVFA\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign and Sampling\u003c/h2\u003e\u003cp\u003eData come from the 2022 Mental Health and Access to Care Survey (MHACS),\u003csup\u003e14\u003c/sup\u003e a representative cross-sectional survey of Canadians 15 years of age or older and living in the provinces. Data are representative of the general ambulatory population. Individuals living on reserves or other Indigenous settlements, in the territories, and full-time members of the Canadian Forces are excluded.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Data were collected using computer-assisted telephone interviews due to the COVID-19 pandemic, with an overall response rate of 25% (n\u0026thinsp;=\u0026thinsp;9,861). Total nonresponse is addressed through weighting procedures. The 2012 Canadian Community Health Survey\u0026rsquo;s Mental Health Component (CCHS-MH)\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e was used to compare changes in co-occurring conditions across survey years. It was a similarly structured survey but was collected using interviewer-delivered standardized computer-assisted interviewing, with 87% conducted in-person in participant\u0026rsquo;s homes and 13% conducted over the phone. The overall response rate was 68.9% (n\u0026thinsp;=\u0026thinsp;25,113).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eMood, Anxiety, and Substance Use Disorders\u003c/h2\u003e\u003cp\u003eDiagnostic information for all disorders was obtained from the Statistics Canada adaptation of the World Health Organization Composite International Diagnostic Interview (WHO CIDI). Information from this interview was used to assess if individuals met criteria for having the disorders as per the Diagnostic Statistical Manual 4 (DSM-4) criteria in their lifetime. Participants were then asked about whether experiences occurred during the past 12-months. Variables were created for major depressive disorder (MDE), bipolar disorder, generalized anxiety disorder (GAD), social phobia, any alcohol disorder (AUD; abuse and/or dependence), any cannabis disorder (CUD; abuse and/or dependence), and any non-cannabis drug disorder (DUD; abuse and/or dependence; includes sedatives, tranquilizers, simulants, pain killers, cocaine, club drugs, hallucinogens, heroin, fentanyl, down, inhalants, solvents, or other illegal drugs).\u003c/p\u003e\u003cp\u003eFor descriptive statistics, three variables where created which combined diagnoses of (1) MDE and bipolar into any mood disorder, (2) GAD and social phobia into any anxiety disorder, and (3) AUD, CUD, and DUD into any SUD. As previously defined, \u0026ldquo;concurrent disorders\u0026rdquo; are SUDs occurring alongside any mood or anxiety disorder. The term \u0026ldquo;co-occurring disorder\u0026rdquo; will hereby be used when individuals meet criteria for more than one disorder within a broader domain; for example, meeting criteria for both GAD and social phobia (co-occurring anxiety disorders) or both AUD and DUD (co-occurring SUDs). An omnibus variable was then created for subsequent analyses indicating whether an individual had a mood and/or anxiety disorder only (MDE, bipolar, GAD, or social phobia), a SUD only (AUD, CUD, or DUD), or concurrent disorders (i.e., SUD\u0026thinsp;+\u0026thinsp;mood/anxiety).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSociodemographic and other correlates\u003c/h3\u003e\n\u003cp\u003eMental health related covariates included psychological distress, measured using the K10 scale (high distress\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;20)\u003csup\u003e16\u003c/sup\u003e, suicidality (1\u0026thinsp;=\u0026thinsp;anyone who experienced suicidal thoughts, plans, or attempts in the past year, 0\u0026thinsp;=\u0026thinsp;otherwise), perceived need for care (1\u0026thinsp;=\u0026thinsp;no perceived need, 2\u0026thinsp;=\u0026thinsp;perceived needs met, 3\u0026thinsp;=\u0026thinsp;perceived needs partially met, 4\u0026thinsp;=\u0026thinsp;perceived needs not met; measured with the Perceived Need for Help Questionnaire and related algorithms\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e), and mental health treatment in the past 12-months (0\u0026thinsp;=\u0026thinsp;no, 1\u0026thinsp;=\u0026thinsp;yes).\u003c/p\u003e\u003cp\u003eOther sociodemographic covariates include year of data collection (2022 vs. 2012), biological sex (female vs. male), developmental age group\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e (youth 15\u0026ndash;24 vs. adults age 25+), racialized (racialized vs. White), rurality (rural vs. population centre), immigrant background (immigrant vs. Canadian born), marital status (married/common-law vs single/divorced), past week work status (1\u0026thinsp;=\u0026thinsp;worked, 2\u0026thinsp;=\u0026thinsp;had a job but did not work, 3\u0026thinsp;=\u0026thinsp;no job or permanently unable to work), education (1\u0026thinsp;=\u0026thinsp;less than high school, 2\u0026thinsp;=\u0026thinsp;high school, 3\u0026thinsp;=\u0026thinsp;trades certificate/diploma, 4\u0026thinsp;=\u0026thinsp;University certificate or above), and income (1\u0026ndash;14, from no income to \u003cspan\u003e$\u003c/span\u003e100,000+, coded continuously).\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eAll descriptive analyses were performed in R software version 4.4.2 and multinomial regression performed in Stata version 18.5 using survey weights based on the Canadian population, and replicate bootstrap weights to adjust the estimation of variances to account for the complex survey design. Survey weights were normalized between the two surveys prior to analysis.\u003c/p\u003e\u003cp\u003eFor the first objective, prevalences of each diagnosis of interest, as well as proportion of people who have only that diagnosis, 2\u0026thinsp;+\u0026thinsp;diagnoses within their domain (mood/anxiety or SUD), and concurrent disorders (SUD\u0026thinsp;+\u0026thinsp;mood/anxiety) were calculated. Patterns of co-occurrence between each individual diagnosis were quantified through pairwise bivariate tetrachoric correlations and pairwise conditional probabilities. These descriptives were stratified by sex and age. For each disorder, the comorbidity to diagnosis inflation ratio (CDIR)\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e was also calculated by dividing the total number of co-occurring disorder pairs by the total number of diagnoses for each disorder.\u003c/p\u003e\u003cp\u003eFor the second objective, multivariable multinomial logistic regression was used to examine demographic and clinical factors associated with having no disorder, mood and/or anxiety disorders-only, SUDs-only, or concurrent disorders.\u003c/p\u003e\u003cp\u003eFor the third objective, changes in disorder (co)occurrence over time were assessed using multinomial logistic regressions using the same dependent variables as objective two with year as key predictor and interactions tested for age and sex; social phobia was excluded from these analyses due to a lack of measurement in 2012. Significance was set at p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\u003cp\u003eAcross both surveys, missing data for diagnostic variables and most demographic and clinical correlates was minimal (\u0026lt;\u0026thinsp;5%), with the exception of work status at 10%. Overall, 21.6% of participants (27.3% 2022, 19.3% 2012) had missing data on at least one variable. A series of univariable robust Poisson regressions predicting any missing (1) compared to no missing (0) adjusting for year found missingness to be related to lower income, lower education, higher distress, and being single, unemployed, Canadian born, White, female, and older age. Missingness was not significantly related to mood, anxiety, or SUD status. See Supplementary Materials for full results. While our pre-registration indicated we would use multiple imputation where missingness was \u0026gt;\u0026thinsp;5%, we opted to use random forest imputation based on recent guidance from Statistics Canada.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence and patterns of mood, anxiety, and substance use disorders\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides the past 12-month prevalence of each disorder among Canadians 15 years of age and older in 2022, including the prevalence of those with a single disorder, prevalence with co-occurring disorders within the same overarching domain (e.g., mood/anxiety or SUD), and the prevalence with concurrent mood/anxiety and SUDs. The past 12-month prevalence of any measured disorder was 16.4% (16.1\u0026ndash;16.7), with mood disorders being 8.4% (8.2\u0026ndash;8.7), anxiety disorders 9.9% (9.7\u0026ndash;10.2), and SUDs 3.5% (3.4\u0026ndash;3.7). Over two-thirds (39.5%) of Canadians with at least one disorder met criteria for two or more disorders, with 10.6% experiencing concurrent disorders. About half of those with a SUD had a concurrent mood and/or anxiety disorder (48.9%), while about 1 in 7 (15.2%) of those with a mood disorder and 1 in 10 (9.6%) of those with an anxiety disorder had a concurrent SUD. When stratified by sex, overall, females had a higher prevalence of co-occurring mood and/or anxiety disorders than males (30.8% vs 24.2%), while males had a higher prevalence of concurrent disorders than females (12.8% vs 9.0%). However, females with a SUD had a higher prevalence of concurrent disorders than males with a SUD (63.2% vs 39.5%). When stratified by age, youth consistent reported higher prevalences of concurrent disorders compared to adults (overall 14.0% vs 9.3%).\u003c/p\u003e\u003cp\u003eWhen looking at disorders individually, over half of those who had any specific mood, anxiety, or SUD had at least one other disorder, with high levels of co-occurrence within specific mood and/or anxiety disorders (i.e., 2\u0026thinsp;+\u0026thinsp;mood or anxiety disorders) and high prevalences of concurrent disorders among those with SUDs. When stratified, both having more than one disorder (average 68.0% females vs 63.4% males) and any concurrent disorder specifically (average 35.3% females vs 30.1% males) were higher among females. Similarly, any co-occurring disorder (average 70.1% youth vs 62.1% adults) and any concurrent disorder (average 40.0% youth vs 26.5% adults) were higher among youth.\u003c/p\u003e\u003cp\u003eThose with bipolar disorder (80.5), DUD (74.2%), GAD (71.4%), had the highest prevalence of 2\u0026thinsp;+\u0026thinsp;disorders, while CUD (56.0%), AUD (56.0%), Social Phobia (56.0%) had the lowest. These patterns were largely reflected in CDIRs (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), correlations (See Supplementary Materials), and conditional probabilities (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). For example, the strongest correlations were between bipolar disorder and mood disorder (0.71), reflecting the conditional probability of MDE among those with bipolar disorder being 63.5%, and the probability of bipolar disorder among those with MDE being 31.6%.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides descriptives related to patterns of disorders among all Canadians who met criteria for at least one past 12-month mental disorder. The most common pattern of disorder(s) was anxiety-disorder(s)-only, representing 34.8% (33.6\u0026ndash;36.0), followed by mood disorder(s)-only representing 23.7% (22.7\u0026ndash;24.7%), and mood and anxiety disorders without SUDs representing 19.9% (19.0-20.9) of those with at least one disorder. Eleven percent (11% [10.4\u0026ndash;11.7]) of Canadians with at least one disorder experienced SUD(s)-only and 10.5% (CI 9.4% to 11.7%) experienced a concurrent SUD and mood and/or anxiety disorder(s). While the percentage of these disorder patterns differed across sex and age groups, the ranking of common patterns remained consistent\u0026ndash;except for males, where SUD-only is more prevalent than co-occurring mood and/or anxiety disorders.\u003c/p\u003e\u003cp\u003eSee Supplementary Materials for additional figures and stratified results.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDemographics and clinical correlates of disorder patterns\u003c/h3\u003e\n\u003cp\u003eMultivariable multinomial logistic regression results are in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Youth, females, higher distress, suicidality, perceived need for care, or past 12-month mental health treatment had significantly greater odds of experiencing mood and/or anxiety disorder(s)-only, compared to no disorder. The odds SUD-only were higher among males, White Canadians, unemployed individuals, and individuals with perceived needs not fully met. The odds of concurrent disorders were higher among youth, unemployed individuals, and those endorsing higher distress, suicidality, and perceived need for care. Youth had 2 times the odds of meeting criteria for mood and/or anxiety disorders and 3 times the odds of meeting criteria for concurrent disorders compared to adults. While females had a higher odds of mood and/or anxiety disorders (OR\u0026thinsp;=\u0026thinsp;1.5), and lower odds of SUDs (OR\u0026thinsp;=\u0026thinsp;0.3), the odds of concurrent disorders were the same between males and females. Concerningly, suicidality (OR\u0026thinsp;=\u0026thinsp;3.1) and perceived needs not fully met (ORs 11\u0026ndash;13) were highest among those with concurrent disorders.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eComparison with 2012 Canadian data\u003c/h2\u003e\u003cp\u003eUnivariable multinomial logistic regression results over time are in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The odds of Canadian\u0026rsquo;s experiencing mood and/or anxiety disorders were 2.5 times higher in 2022 compared to 2012. This increase in mood and/or anxiety disorders was more pronounced among youth compared to adults (OR\u003csub\u003eage*year\u003c/sub\u003e=2.0 [1.6\u0026ndash;2.6]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001]. While the odds of SUDs were 0.6 times lower in 2022 compared to 2012, the odds of Canadians experiencing concurrent disorders were 1.9 times higher in 2022. Sex or age did not moderate the changes in SUDs-only or concurrent disorders over the two survey years (See Supplementary Materials).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn 2022, 1 in 6 (16.4%) Canadians aged 15 years and older met criteria for a mood (8.4%), anxiety (9.9%), or substance use (3.5%) disorder. Among those with at least one disorder, co-occurrence was prevalent, with 2 in 5 meeting criteria for 2\u0026thinsp;+\u0026thinsp;disorder and 1 in 10 meeting criteria for a concurrent disorder. Co-occurring disorders among Canadians with mood or anxiety disorders was primarily driven by co-occurring other mood and/or anxiety disorders, though between 1 in 10 (anxiety) and 1 in 5 (mood) also reported a concurrent SUD. Conversely, among Canadians with a SUD, co-occurrence was predominately characterized by concurrent mood and/or anxiety disorders, with about 1 in 2 meeting criteria for a concurrent disorder. Youth consistency reported higher prevalences of concurrent disorders than adults. Overall, more females reported co-occurring mood and/or anxiety disorders than males while more males reported concurrent disorders, though females with an SUD-specifically had higher prevalences of concurrent disorders than males with an SUD. Lastly, while the odds of SUDs-alone decreased over time, odds for mood and/or anxiety disorders and concurrent SUD and mood and/or anxiety disorders doubled between 2012 and 2022. Concerningly, Canadians with concurrent disorders also reported the highest levels of distress and suicidality alongside the lowest levels of perceived met needs for care relative to no disorder, compared to SUD-alone or mood and/or anxiety disorder-alone. These findings highlight an urgent need for integrated, accessible care to address the rising burden of complex, co-occurring mental health and substance use disorders in Canada.\u003c/p\u003e\u003cp\u003eThe increase in the odds of concurrent disorders is concerning given integrated treatment of concurrent disorders remains difficult to access\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e and those with concurrent disorders reported their needs were often not partially or fully met. Despite long-standing calls for the need to assess and address mental health and substance use concerns concurrently\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, including being part of various clinical best practice guidelines\u003csup\u003e\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, current workforce training and funding structures are not designed to meet these needs. This contributes to concurrent disorders often being underdiagnosed and undertreated.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e While workforce training and health system delivery remain behind these calls to action, these gaps are not entirely health systems issues. We continue to lack concrete and clear understanding about the causal pathways to the development of concurrent disorders, and specific concurrent disorder prevention and treatment strategies that have been rigorously evaluated through large scale efficacy and effectiveness trials.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e As such, research exploring causality, intervention efficacy and effectiveness, and health systems transformation need to move forward iteratively, and concurrently.\u003c/p\u003e\u003cp\u003eThis study also found that Canadian youth disproportionally experience higher prevalence of all mood, anxiety, and SUDs, as well as higher prevalence of comorbidity and concurrent disorders, compared to Canadians aged 26+. Most notably, mood and anxiety disorders disproportionately increased among youth between 2012 and 2022 compared to older Canadians. This aligns with evidence across high income countries showing spikes among mood and anxiety disorders among young people over the past two decades.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Youth is a pivotal psychosocial and developmental transition period, shaped by ongoing brain development, shifting social roles, and transitions between pediatric and adult healthcare systems.\u003csup\u003e\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Early intervention is key to long-term recovery, but many youth face barriers when navigating health care transitions between pediatric (up to age 18) and adult (18+) services. There are ongoing efforts to support smoother transitions between pediatric and adult systems with continuous access to care that is developmentally appropriate and youth-friendly across the country.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Strengthening early intervention and access to care for mental health and concurrent disorders may be the critical steps toward reversing identified upward shifts in youth mental health and concurrent problems, supporting long-term well-being across the lifespan.\u003c/p\u003e\u003cp\u003eAmong Canadian females with SUDs, concurrent disorders were generally more common than among males, consistent with previous studies.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e On the other hand, for females with mood or anxiety disorders, concurrent disorders were less common when compared to males with mood or anxiety disorders. Further, this study found mood and anxiety disorders alone increased over time more-so among females compared to males, similar to previously reports using this data.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e While this study was only able to explore binary sex at birth, the differences found in patterns of concurrent disorders and increases in mood and anxiety disorders may be both due to biological sex differences and/or sociocultural gender differences.\u003csup\u003e\u003cspan additionalcitationids=\"CR34 CR35\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Sex-driven differences may relate to interactions between substances and hormones, genetics, anatomy, and physiology, whereas gender-driven differences may reflect different social roles, power dynamics, expectations, and experiences of stigma. These findings suggest a need for more research to disentangle sex versus gender differences, to inform sex- and gender-specific approaches to SUD and mental health care.\u003c/p\u003e\u003cp\u003eThe reasons behind shifts in the prevalence and distribution of comorbid and concurrent mood, anxiety, and substance use disorders in this study cannot be definitively characterized. Notably, previous work indicates increases in mood and anxiety disorders among youth and females started at least a decade before the COVID-19 pandemic.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, but there is also accumulating evidence that mood and anxiety related symptoms worsened throughout the pandemic among youth\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e and adults\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e, with disproportionate impacts on females. Previously hypothesized factors contributing to shifts in mental health and substance use over time include: changes in how people spend their time and connect with others (e.g., social media, less in-person and physical activities), shifting public perceptions of mental health and substance use, changes in and increasing anxiogenic environments attributable to political crises, environmental crises, and increasing socioeconomic disparities.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Overall, changes seen in this study could be pandemic-related, given lockdowns were only lifted in March 2022, although they may may reflect broader, more longstanding consequences of larger sociocultural changes. More work is needed to disambiguate reasons for shifts over time.\u003c/p\u003e\u003cp\u003eSeveral limitations should be considered when interpreting these findings. First, although the 2012 and 2022 surveys shared similar content and sampling frames, differences in data collection\u0026mdash;particularly the shift to telephone-only surveys in 2022 due to COVID-19\u0026mdash; and response rates may have shifted participant characteristics. While phone-based surveys have shown to yield comparable prevalence estimates to face-to-face methods\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e, differences in mode and context biasing findings remain possible. Population weights were use to partially account for differences in response rates across surveys, though this cannot eliminate response bias. Second, given social phobia was not measured in 2012, comorbidity trends between 2012 and 2022 did not include social phobia; this is important as social phobia had the second highest past year prevalence across disorders in 2022. Third, there are other anxiety and mood disorders that were not assessed in this survey and thus not included in population estimates, including dysthymia, panic disorder, phobias, obsessive compulsive disorder, and post-traumatic stress disorder. Fourth, while the surveys were representative of many Canadians, as this survey does not include Canadians who are unhoused, hospitalized, in the Canadian Armed Forces, living in the territories, or living on Indigenous lands, the estimates are very likely lower than the true national prevalence. Lastly, these data come from repeated cross-sectional surveys and thus results should be interpreted as epidemiological trends, not causal analyses.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe high and rising prevalence of concurrent disorders and their association with heightened distress and unmet needs highlight an urgent need for integrated, accessible, and comprehensive support systems to address the complex realities of comorbidity. These findings underscore the critical importance of integrated mental health and substance use care in Canada, particularly for youth and females, who report disproportionately higher prevalences of concurrent disorders.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflicts of Interest:\u003c/h2\u003e\u003cp\u003eJM is a principal in BEAM Diagnostics, Inc. and has consulted to Clairvoyant Therapeutics, Inc. No other authors have any conflicts of interest to declare.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003e JH is funded by a Health Systems Impact Embedded Early Career Researcher award co-funded by the Canadian Institutes of Health Research, McMaster University, and St. Joseph\u0026rsquo;s Healthcare Hamilton (HS3-191640). KG is supported by the David R. (Dan) Offord Chair in Child Studies. CC is supported by an Australian National Health and Medical Research Council Investigator Grant Fellowship (GNT2026552) and a Centre of Research Excellence Grant PREMISE Next Generation (GNT2035308). JM is supported by the Peter Boris Chair in Addictions Research and a Canada Research Chair in Translational Addiction Research (CRC-2020-00170). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I et al (2015) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990\u0026ndash;2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386(9995):743\u0026ndash;800\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE et al (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. 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Int J Methods Psychiatr Res 33(S1):e2009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/mpr.2009\u003c/span\u003e\u003cspan address=\"10.1002/mpr.2009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePrevalence of mood, anxiety, and substance use disorders.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eOverall %\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eOf those meeting criteria for the specified disorder\u0026hellip;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle disorder\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCo-occurring disorders\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eConcurrent SUD and Mood/Anxiety disorders\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% with only 1 disorder\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% 2\u0026thinsp;+\u0026thinsp;mood/anxiety\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% 2\u0026thinsp;+\u0026thinsp;SUDs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% concurrent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eTotal population\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMDE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003cp\u003e(7.4\u0026ndash;7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003cp\u003e(39.6\u0026ndash;42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.1\u003c/p\u003e\n \u003cp\u003e(42.5\u0026ndash;45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003cp\u003e(13.8\u0026ndash;16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBipolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003cp\u003e(2.0\u0026ndash;2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003cp\u003e(17.5\u0026ndash;21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003cp\u003e(54.3\u0026ndash;59.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003cp\u003e(21.0\u0026ndash;25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003cp\u003e(5.1\u0026ndash;5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003cp\u003e(26.9\u0026ndash;30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.1\u003c/p\u003e\n \u003cp\u003e(58.5\u0026ndash;62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003cp\u003e(10.0\u0026ndash;12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial Phobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003cp\u003e(7.0\u0026ndash;7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003cp\u003e(42.5\u0026ndash;45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003cp\u003e(45.0\u0026ndash;48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003cp\u003e(8.6\u0026ndash;10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003cp\u003e(2.0\u0026ndash;2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003cp\u003e(41.1\u0026ndash;47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003cp\u003e(4.7\u0026ndash;8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.8\u003c/p\u003e\n \u003cp\u003e(46.8\u0026ndash;52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003cp\u003e(1.3\u0026ndash;1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003cp\u003e(40.6\u0026ndash;47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003cp\u003e(4.0\u0026ndash;6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.9\u003c/p\u003e\n \u003cp\u003e(47.6\u0026ndash;54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e(0.5\u0026ndash;0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003cp\u003e(20.8\u0026ndash;31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003cp\u003e(11.9\u0026ndash;22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.5\u003c/p\u003e\n \u003cp\u003e(51.2\u0026ndash;63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003cp\u003e(8.2\u0026ndash;8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.2 (40.7\u0026ndash;43.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.6 (41.2\u0026ndash;44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003cp\u003e(14.2\u0026ndash;16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003cp\u003e(9.7\u0026ndash;10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.2 (45.8\u0026ndash;48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.2 (41.9\u0026ndash;44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003cp\u003e(8.8\u0026ndash;10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny SUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003cp\u003e(3.4\u0026ndash;3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.3 (45.0\u0026ndash;49.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8 (2.9\u0026ndash;4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003cp\u003e(46.6\u0026ndash;51.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003cp\u003e(16.1\u0026ndash;16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.5 (59.4\u0026ndash;61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.2 (27.2\u0026ndash;29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8 (0.6\u0026ndash;1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003cp\u003e(9.9\u0026ndash;11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eStratified by sex assigned at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMDE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003cp\u003e(5.6\u0026ndash;6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003cp\u003e(35.9\u0026ndash;40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003cp\u003e(41.0\u0026ndash;46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003cp\u003e(16.1\u0026ndash;20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003cp\u003e(9.0\u0026ndash;9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003cp\u003e(40.9\u0026ndash;44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003cp\u003e(42.5\u0026ndash;46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003cp\u003e(11.6\u0026ndash;14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBipolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003cp\u003e(1.9\u0026ndash;2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003cp\u003e(20.6\u0026ndash;28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.0\u003c/p\u003e\n \u003cp\u003e(42.5\u0026ndash;51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003cp\u003e(25.1\u0026ndash;33.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003cp\u003e(2.0\u0026ndash;2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003cp\u003e(13.3\u0026ndash;17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.1\u003c/p\u003e\n \u003cp\u003e(62.7\u0026ndash;69.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003cp\u003e(15.8\u0026ndash;21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003cp\u003e(3.4\u0026ndash;3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.1\u003c/p\u003e\n \u003cp\u003e(22.5\u0026ndash;28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.9\u003c/p\u003e\n \u003cp\u003e(57.8\u0026ndash;63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003cp\u003e(12.0\u0026ndash;16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003cp\u003e(6.5\u0026ndash;7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003cp\u003e(28.3\u0026ndash;32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.0\u003c/p\u003e\n \u003cp\u003e(57.7\u0026ndash;62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003cp\u003e(8.3\u0026ndash;11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSocial Phobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003cp\u003e(4.7\u0026ndash;5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003cp\u003e(40.6\u0026ndash;45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003cp\u003e(41.0\u0026ndash;46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003cp\u003e(11.6\u0026ndash;15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003cp\u003e(9.1\u0026ndash;9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.5\u003c/p\u003e\n \u003cp\u003e(42.6\u0026ndash;46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.9\u003c/p\u003e\n \u003cp\u003e(46.0\u0026ndash;49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.6 (6.6\u0026ndash;8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003cp\u003e(2.3\u0026ndash;2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.4\u003c/p\u003e\n \u003cp\u003e(44.6\u0026ndash;52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003cp\u003e(7.0\u0026ndash;12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003cp\u003e(38.4\u0026ndash;46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003cp\u003e(1.6\u0026ndash;1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003cp\u003e(33.3\u0026ndash;42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003cp\u003e(1.0\u0026ndash;3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.1\u003c/p\u003e\n \u003cp\u003e(55.1\u0026ndash;64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003cp\u003e(1.8\u0026ndash;2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003cp\u003e(49.5\u0026ndash;58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003cp\u003e(7.0\u0026ndash;12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.8\u003c/p\u003e\n \u003cp\u003e(34.8\u0026ndash;42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003cp\u003e(0.8\u0026ndash;1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.8\u003c/p\u003e\n \u003cp\u003e(17.3\u0026ndash;29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003esuppressed\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.2\u003c/p\u003e\n \u003cp\u003e(70.6\u0026ndash;82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e(0.5\u0026ndash;0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003cp\u003e(16.4\u0026ndash;31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003cp\u003e(14.7\u0026ndash;31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.2\u003c/p\u003e\n \u003cp\u003e(46.6\u0026ndash;63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(0.3\u0026ndash;0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003cp\u003e(22.9\u0026ndash;38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003cp\u003e(4.6\u0026ndash;16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.2\u003c/p\u003e\n \u003cp\u003e(5.2\u0026ndash;69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAny Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003cp\u003e(6.5\u0026ndash;7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.8\u003c/p\u003e\n \u003cp\u003e(38.5\u0026ndash;43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003cp\u003e(38.1\u0026ndash;43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003cp\u003e(16.8\u0026ndash;20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003cp\u003e(9.7\u0026ndash;10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.0\u003c/p\u003e\n \u003cp\u003e(41.3\u0026ndash;44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003cp\u003e(42.3\u0026ndash;45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003cp\u003e(11.8\u0026ndash;14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAny Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003cp\u003e(6.6\u0026ndash;7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003cp\u003e(41.8\u0026ndash;46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003cp\u003e(41.5\u0026ndash;45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003cp\u003e(10.9\u0026ndash;13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.8 (12.4\u0026ndash;13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003cp\u003e(47.2\u0026ndash;50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.0\u003c/p\u003e\n \u003cp\u003e(41.3\u0026ndash;44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003cp\u003e(7.3\u0026ndash;9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAny SUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003cp\u003e(4.1\u0026ndash;4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.0\u003c/p\u003e\n \u003cp\u003e(52.0\u0026ndash;58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003cp\u003e(4.1\u0026ndash;7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.5\u003c/p\u003e\n \u003cp\u003e(36.6\u0026ndash;42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003cp\u003e(2.6\u0026ndash;3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003cp\u003e(32.0\u0026ndash;39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003cp\u003e(0.7\u0026ndash;2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003cp\u003e(59.4\u0026ndash;66.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAny Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003cp\u003e(13.0\u0026ndash;13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.2\u003c/p\u003e\n \u003cp\u003e(59.5\u0026ndash;62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003cp\u003e(22.8\u0026ndash;25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003cp\u003e(1.3\u0026ndash;2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003cp\u003e(11.7\u0026ndash;14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003cp\u003e(18.8\u0026ndash;19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.0\u003c/p\u003e\n \u003cp\u003e(58.6\u0026ndash;61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003cp\u003e(29.5\u0026ndash;32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e(0.1\u0026ndash;0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003cp\u003e(8.3\u0026ndash;9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eStratified by age\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMDE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003cp\u003e(13.0\u0026ndash;14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003cp\u003e(29.0\u0026ndash;33.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003cp\u003e(45.2\u0026ndash;50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003cp\u003e(19.2\u0026ndash;23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003cp\u003e(6.4\u0026ndash;6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003cp\u003e(42.5\u0026ndash;46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003cp\u003e(41.0\u0026ndash;44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003cp\u003e(11.4\u0026ndash;14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBipolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003cp\u003e(5.2\u0026ndash;6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003cp\u003e(18.1\u0026ndash;24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.2\u003c/p\u003e\n \u003cp\u003e(40.4\u0026ndash;48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003cp\u003e(30.9\u0026ndash;38.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003cp\u003e(1.4\u0026ndash;1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003cp\u003e(15.7\u0026ndash;21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.9\u003c/p\u003e\n \u003cp\u003e(61.1\u0026ndash;68.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003cp\u003e(13.6\u0026ndash;19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003cp\u003e(8.2\u0026ndash;9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.8\u003c/p\u003e\n \u003cp\u003e(20.3\u0026ndash;25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.2\u003c/p\u003e\n \u003cp\u003e(57.1\u0026ndash;63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003cp\u003e(14.7\u0026ndash;19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003cp\u003e(4.5\u0026ndash;4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003cp\u003e(28.3\u0026ndash;32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.3\u003c/p\u003e\n \u003cp\u003e(58.1\u0026ndash;62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003cp\u003e(7.9\u0026ndash;10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSocial Phobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003cp\u003e(16.3\u0026ndash;17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003cp\u003e(43.6\u0026ndash;48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003cp\u003e(37.7\u0026ndash;42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003cp\u003e(12.7\u0026ndash;15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003cp\u003e(5.4\u0026ndash;5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003cp\u003e(41.1\u0026ndash;45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.7\u003c/p\u003e\n \u003cp\u003e(47.7\u0026ndash;51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003cp\u003e(6.1\u0026ndash;8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003cp\u003e(3.7\u0026ndash;4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003cp\u003e(37.1\u0026ndash;46.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003cp\u003e(4.4\u0026ndash;8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.8\u003c/p\u003e\n \u003cp\u003e(47.1\u0026ndash;56.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003cp\u003e(1.7\u0026ndash;1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003cp\u003e(41.3\u0026ndash;48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003cp\u003e(3.0\u0026ndash;5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.0\u003c/p\u003e\n \u003cp\u003e(37.0\u0026ndash;46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003cp\u003e(4.2\u0026ndash;5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003cp\u003e(28.7\u0026ndash;36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003cp\u003e(3.9\u0026ndash;7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.3\u003c/p\u003e\n \u003cp\u003e(57.2\u0026ndash;65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003cp\u003e(0.8\u0026ndash;1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003cp\u003e(48.6\u0026ndash;58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003cp\u003e(3.0\u0026ndash;5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.0\u003c/p\u003e\n \u003cp\u003e(37.0\u0026ndash;46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e(0.8\u0026ndash;1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003cp\u003e(9.0\u0026ndash;19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003cp\u003e(3.9\u0026ndash;7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.6\u003c/p\u003e\n \u003cp\u003e(73.3\u0026ndash;86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e(0.4\u0026ndash;0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003cp\u003e(23.3\u0026ndash;36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003cp\u003e(13.8\u0026ndash;27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.2\u003c/p\u003e\n \u003cp\u003e(41.8\u0026ndash;56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAny Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003cp\u003e(15.3\u0026ndash;16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003cp\u003e(32.0\u0026ndash;36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003cp\u003e(42.4\u0026ndash;46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003cp\u003e(19.4\u0026ndash;23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003cp\u003e(7.0\u0026ndash;7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003cp\u003e(43.3\u0026ndash;46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.9\u003c/p\u003e\n \u003cp\u003e(40.1\u0026ndash;43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003cp\u003e(11.8\u0026ndash;14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAny Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003cp\u003e(19.6\u0026ndash;21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.1\u003c/p\u003e\n \u003cp\u003e(45.9\u0026ndash;50.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003cp\u003e(36.2\u0026ndash;40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003cp\u003e(12.3\u0026ndash;15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003cp\u003e(8.0\u0026ndash;8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.9\u003c/p\u003e\n \u003cp\u003e(45.1\u0026ndash;48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003cp\u003e(43.5\u0026ndash;46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003cp\u003e(7.0\u0026ndash;8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAny SUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003cp\u003e(7.6\u0026ndash;8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003cp\u003e(38.4\u0026ndash;44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003cp\u003e(3.4\u0026ndash;4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.2\u003c/p\u003e\n \u003cp\u003e(52.1\u0026ndash;58.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003cp\u003e(2.6\u0026ndash;3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.1\u003c/p\u003e\n \u003cp\u003e(47.1\u0026ndash;53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003cp\u003e(2.9\u0026ndash;5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.9\u003c/p\u003e\n \u003cp\u003e(42.9\u0026ndash;48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAny Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003cp\u003e(31.1\u0026ndash;32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.1\u003c/p\u003e\n \u003cp\u003e(56.4\u0026ndash;59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003cp\u003e(25.6\u0026ndash;28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003cp\u003e(0.6\u0026ndash;1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003cp\u003e(12.9\u0026ndash;15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003cp\u003e(13.5\u0026ndash;14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003cp\u003e(60.1\u0026ndash;62.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003cp\u003e(27.4\u0026ndash;29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003cp\u003e(0.6\u0026ndash;1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003cp\u003e(8.5\u0026ndash;10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eConditional pairwise probabilities\u003c/strong\u003e Caption: Conditional probabilities of the column given the row are shown, e.g. the probability of an individual having MDE given they have bipolar disorder is 0.635.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMDE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBipolar\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGAD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSocial Phobia\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAUD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCUD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDUD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMDE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBipolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial Phobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultinomial logistic regressions of mood/anxiety disorders, substance use disorders, and concurrent disorders (i.e., co-occurring mood/anxiety and a substance use disorder) presented as Odds Ratios and 95% Confidence Intervals.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMood/anxiety-only\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSUD-only\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eConcurrent disorders\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic \u0026amp; clinical correlates (reference\u0026thinsp;=\u0026thinsp;no disorder)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYouth (vs. adult)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.1 (1.64\u0026ndash;2.8); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.0 (1.2\u0026ndash;3.5); 0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.9 (1.6\u0026ndash;5.1); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale (vs. male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.5 (1.2\u0026ndash;1.8); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.3 (0.2\u0026ndash;0.6); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8 (0.5\u0026ndash;1.3); 0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural (vs. urban)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9 (0.7\u0026ndash;1.2); 0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3 (0.8\u0026ndash;2.1); 0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2 (0.7\u0026ndash;2.2); 0.558\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRacialized (vs. White)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (0.8\u0026ndash;1.3); 0.919\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.4 (0.2\u0026ndash;0.7); 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7 (0.41\u0026ndash;1.3); 0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImmigrant status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8 (0.6\u0026ndash;1.1); 0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8 (0.4\u0026ndash;1.4); 0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5 (0.3\u0026ndash;1.0); 0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorking (vs. no job)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2 (0.7\u0026ndash;1.8); 0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8 (0.3\u0026ndash;2.2); 0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2 (0.5\u0026ndash;3.0); 0.738\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHad a job, didn\u0026rsquo;t work (vs. no job)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8 (0.7\u0026ndash;1.0); 0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.4 (0.3\u0026ndash;0.7); 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.5 (0.3\u0026ndash;0.8); 0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelationship (vs. single/divorced)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9 (0.7\u0026ndash;1.1); 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5 (0.3\u0026ndash;0.9); 0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.5 (0.3\u0026ndash;0.8); 0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (1.0\u0026ndash;1.1); 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (0.9\u0026ndash;1.0); 0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9 (0.9\u0026ndash;1.0); 0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school (vs. \u0026lt; high school)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (0.7\u0026ndash;1.4); 0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3 (0.6\u0026ndash;3.1); 0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (0.5\u0026ndash;1.9); 0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCertificate/diploma (vs. \u0026lt; high school)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9 (0.5\u0026ndash;1.4); 0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7 (0.2\u0026ndash;2.3); 0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9 (0.3\u0026ndash;2.5); 0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity degree (vs. \u0026lt; high school)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8 (0.6\u0026ndash;1.2); 0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (0.4\u0026ndash;2.4); 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7 (0.4\u0026ndash;1.5); 0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.7 (8.2\u0026ndash;16.7); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2 (0.9\u0026ndash;5.6); 0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.3 (7.5\u0026ndash;23.7); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSuicidality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.3 (1.5\u0026ndash;3.5); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5 (0.6\u0026ndash;3.4); 0.367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.1 (1.7\u0026ndash;5.7); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeeds met (vs. no need)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.3 (3.3\u0026ndash;5.6); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.0 (1.1\u0026ndash;3.6); 0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.0 (3.2\u0026ndash;11.1); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeeds partially met (vs. no need)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.7 (7.1\u0026ndash;13.1); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.1 (2.0\u0026ndash;8.4); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.1 (6.4\u0026ndash;26.8); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeeds not met (vs. no need)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.3 (5.2\u0026ndash;10.2); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.5 (1.4\u0026ndash;8.8); 0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.9 (4.9\u0026ndash;24.3); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReceived mental health treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.4 (1.8\u0026ndash;3.1); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.6 (0.8\u0026ndash;3.2); 0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8 (1.0\u0026ndash;3.0); 0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparisons over time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2022 (vs. 2012)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.5 (2.2\u0026ndash;2.8); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.6 (0.5\u0026ndash;0.7); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.9 (1.4\u0026ndash;2.4); \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Substance Use Disorders, Depression, Anxiety, Trends","lastPublishedDoi":"10.21203/rs.3.rs-7872114/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7872114/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study examines: (1) the 2022 prevalence and co-occurrence of past 12 month mood, anxiety, and substance use disorders (SUD)among Canadian’s aged 15+; and (2) changes in the prevalence of co-occurring disorders from 2012 to 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eData from the 2022 Mental Health and Access to Care Survey (MHACS; n=9,861) and the 2012 Canadian Community Health Survey’s Mental Health Component (CCHS-MH; n=25,113) were analyzed. Diagnoses for past 12 month mood (major depressive episode, bipolar), anxiety (generalized anxiety, social phobia), and substance use (alcohol, cannabis, and drug) disorders were assessed using the World Health Organization Composite International Diagnostic Interview. Multivariable multinomial regression examined demographic and clinical correlates, as well as changes over time, of mood/anxiety disorder(s) alone, SUD(s) alone, and concurrent disorders (mood/anxiety+SUD). Age (youth aged 15-24 vs adults 26+) and sex (females vs males) differences were explored through stratified analyses and interactions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn 2022, 16.4% of Canadians met criteria for a mood (8.4%), anxiety (9.9%), or SUD (3.5%). Of those with at least one disorder, co-occurrence was common: 39.5% had 2+ disorders with 10.6% experiencing concurrent SUD and mood/anxiety disorders. Among those with an SUD, 48.9% had a concurrent mood/anxiety disorder, while 15.2% and 9.6% of those with a mood and anxiety disorders respectively had a concurrent SUD. Youth, unemployed individuals, and those with high distress or suicidality had elevated odds of concurrent disorders. Males had higher overall concurrent disorder prevalences, but among those with SUDs, concurrent disorders were higher among females. While the odds of SUD-alone declined, mood/anxiety disorders and concurrent disorders doubled from 2012 to 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eFindings highlight the urgent need for integrated mental health and substance use services in Canada, particularly for youth and females, who are disproportionately affected.\u003c/p\u003e","manuscriptTitle":"Co-occurring mood, anxiety, and substance use disorders in Canada 2022: Prevalence, patterns, correlates, and changes over time","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 03:48:30","doi":"10.21203/rs.3.rs-7872114/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"322a62d8-4d54-4c23-a203-4fe7b6054792","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56375011,"name":"Psychiatry"},{"id":56375012,"name":"Epidemiology"}],"tags":[],"updatedAt":"2025-10-17T03:48:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 03:48:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7872114","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7872114","identity":"rs-7872114","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}