In the current study, male gender and unemployed status were significantly associated risk factors for DD, as has been reported in previous investigations in other cultures (Ringen et al, 2008; Swartz et al., 2006; Verma et al., 2002). Although our sample of DD women was small, the finding that women were older compared to men at the outset of SUD is also in agreement with the literature (Cantor-Graae et al., 2001; Gearon et al., 2003). For men, our results suggest that the vast majority will have the onset of SUD prior to or in the same year as they develop the full diagnosis of SC. In women, there is a smaller prevalence of SUD, and when it occurs the SUD is as likely to occur after the onset of full SC as before. This suggests that for men, SUD may be more likely to act as a “trigger” for onset of SC, whereas for women it is equally likely that SUD may occur after SC has already started.
