Investigating the Association Between Moderate Drinking and Mental Health

A comparison of probable post-traumatic stress disorder and alcohol consumption among active female members of the UK Police Service and UK Armed Forces

BACKGROUND

The British Police Service and Armed Forces are male-dominated occupations, characterised by frequent trauma exposure and intensive demands. Female police employees and military personnel may have unique experiences and face additional strains to their male counterparts. This analysis compared the levels of post-traumatic stress disorder (PTSD), hazardous/harmful alcohol consumption, and comorbidity in female police employees and military personnel.

METHODS

Police data were obtained from the Airwave Health Monitoring Study (N = 14,145; 2007-2015) and military data from the Health and Wellbeing Cohort Study (N = 928; phase 2: 2007-2009 and phase 3: 2014-2016). Multinomial/logistic regressions analysed sample differences in probable PTSD, hazardous (14-35 units per week) and harmful (35 + units per week) alcohol consumption, and comorbid problems. We compared covariate adjustment and entropy balancing (reweighting method controlling for the same covariates) approaches.

RESULTS

There were no significant differences in probable PTSD (police: 3.74% vs military: 4.47%) or hazardous drinking (police: 19.20% vs military: 16.32%). Female military personnel showed significantly higher levels of harmful drinking (4.71%) than police employees (2.42%; Adjusted Odds Ratios [AOR] = 2.26, 95% Confidence Intervals [CIs] = 1.60-3.21), and comorbidity (1.87%) than police employees (1.00%, AOR = 2.07, 95% CI = 1.21-3.54). Entropy balancing and covariate-adjustments obtained the same results.

CONCLUSIONS

Comparable levels of probable PTSD were observed, which are slightly lower than estimates observed in the female general population. Future research should explore the reasons for this. However, female military personnel showed higher levels of harmful drinking than police employees, emphasising the need for alcohol interventions in military settings.

Lifestyle, Demographic and Socio-Economic Determinants of Mental Health Disorders of Employees in the European Countries

Ensuring the health and well-being of workers should be a top priority for employers and governments. The aim of the article is to evaluate and rank the importance of mental health determinants: lifestyle, demographic factors and socio-economic status. The research study is based on EHIS 2013-2015 data for a sample of N = 140,791 employees from 30 European countries. The results obtained using machine learning techniques such as gradient-boosted trees and SHAPley values show that the mental health of European employees is strongly determined by the BMI, age and social support from close people. The next vital features are alcohol consumption, an unmet need for health care and sports activity, followed by the affordability of medicine or treatment, income and occupation. The wide range of variables clearly indicates that there is an important role for governments to play in order to minimize the risk of mental disorders across various socio-economic groups. It is also a signal for businesses to help boost the mental health of their employees by creating holistic, mentally friendly working conditions, such as offering time-management training, implementing morning briefings, offering quiet areas, making employees feel valued, educating them about depression and burnout symptoms, and promoting a healthy lifestyle.

A latent class analysis of health risk behaviours in the UK Police Service and their associations with mental health and job strain

BACKGROUND

Health risk behaviours (e.g., harmful drinking and smoking) often cluster together and can be associated with poor mental health and stress. This study examined how health risk behaviours cluster together in individuals in a high stress occupation (UK Police Service), and the associations with mental health and job strain.

METHODS

Data was obtained from the Airwave Health Monitoring Study (25,234 male and 14,989 female police employees), which included measures of health risk behaviours (alcohol use, diet, smoking status, physical activity), poor mental health (depression, anxiety, post-traumatic stress disorder [PTSD]), and job strain (low, high, active, passive). Classes of health risk behaviours were identified using Latent Class Analysis (LCA) and the associations with mental health and job strain were analysed through multinomial logistic regressions.

RESULTS

For men and women, a 5-class solution was the best fit. Men and women with depression, anxiety, and/or PTSD (analysed as separate variables) had at least double the odds of being assigned to the "high health risk behaviours" class, compared to those with no mental health problem. Compared to those reporting low strain, men and women reporting high strain had increased odds of being assigned to the "low risk drinkers with other health risk behaviours" classes.

CONCLUSIONS

These finding highlight the importance of holistic interventions which target co-occurring health risk behaviours, to prevent more adverse physical health consequences. Police employees with poor mental health are more likely to engage in multiple health risk behaviours, which suggests they may need additional support. However, as the data was cross-sectional, the temporal associations between the classes and mental health or job strain could not be determined.

The Contribution to Stress Recovery and Attention Restoration Potential of Exposure to Urban Green Spaces in Low-Density Residential Areas

This study assessed the contributions of urban green spaces on mental health with joint consideration of people's physiological and psychological responses. The psychological and physiological responses of participants aged between 22 and 28, who visited green spaces in a low-density area of Fuzhou, Fujian Province, China, were measured using Perceived Restorativeness Scale (PRS) methods and biometric wearable sensing devices, respectively. Results showed that exposure to green space led to significant changes in PRS, electrodermal activity (EDA), facial electromyography (EMG), respiration sensor (RESP), and photoplethysmography (PPG), while there is no significant impact on skin temperature (SKT). Additionally, psychological and physiological responses were highly consistent and correlated (R < 0.8). The results also indicated that green spaces with high plant species richness, a water landscape, bumpy ground, cultural landscape, and without roadways presented a high performance on stress recovery and attention restoration. At the same time, the influence of openness was negligible in the low-density area. The study provides planners and landscape designers with specific guidance for implementing urban green spaces to improve mental health in low-density residential areas.

The prevalence of hazardous and harmful drinking in the UK Police Service, and their co-occurrence with job strain and mental health problems

AIMS

Due to the stressful nature of policing, police employees are at risk of mental health problems and problematic alcohol use. We aim to determine the prevalence of hazardous and harmful alcohol use in the UK Police Service, and to explore the associations with job strain and mental health problems.

METHODS

Cross-sectional data from the Airwave Health Monitoring Study (N = 40 986) included measures of alcohol consumption (total units in past week), mental health (depression, anxiety and post-traumatic stress disorder [PTSD]) and job strain. The associations between mental health and job strain with alcohol consumption (i.e. abstinence, low-risk [<14 units per week, reference group], hazardous [>14 to 35 units for women, >14 to 50 units for men], harmful [>35 units for women, >50 units for men]), were analysed using multinomial logistic regressions, adjusting for potential confounders (i.e. age, gender, ethnicity, marital status, children under 18, income and smoking status).

RESULTS

A total of 32.6% of police employees reported hazardous drinking, with 3.0% drinking at harmful levels. Compared to those without a mental health problem, police employees with depression, anxiety or PTSD were twice as likely to be harmful drinkers and were also 1.3 times more likely to report abstinence. Those reporting low strain (reference group) were more likely to drink hazardously compared to those reporting high strain, which was statistically moderated by mental health. When the sample was stratified by mental health status, the association between low strain (compared to all other categories) and hazardous drinking, was significant only in those without a mental health problem.

CONCLUSIONS

These findings indicate that police employees may be an occupational group at risk of alcohol harm, with one-third drinking hazardously. The J-shaped relationship between mental health and alcohol use highlights a need for an integration of mental health and alcohol services, tailored for the UK Police Service.

Assessing the wellbeing of Chinese university students: validation of a Chinese version of the college student subjective wellbeing questionnaire

BACKGROUND

In response to the rising concern with promoting the wellbeing of university students and relative lack of domain-specific wellbeing measurement instruments in China, the current study aimed to validate a Chinese version of the College Student Subjective Wellbeing Questionnaire (CSSWQ), a 16-item self-report English-language rating scale assessing four aspects of wellbeing (academic satisfaction, academic efficacy, school connectedness, and college gratitude).

METHODS

The Chinese translation of the CSSWQ, the Students' Life Satisfaction Scale, the Positive and Negative Affect Schedule, the 10-Item Big Five Personality Inventory, and demographic questions were completed by 252 Chinese students at a university in Suzhou, China.

RESULTS

Exploratory factor analysis found four factors each with the same four items as in the original English scale. Each subscale showed good internal consistency. Test-retest for a one-month interval showed generally moderate reliability. As predicted, Pearson correlational analysis found positive correlations between the Chinese CSSWQ and life satisfaction, positive affect, extraversion, and GPA, and negative correlations with neuroticism and negative affect. Monthly income had small negative correlations with academic satisfaction and academic efficacy, smoking had a small positive correlation with school connectedness, and exercise had a small positive correlation with academic efficacy.

CONCLUSION

Data for the Chinese CSSWQ in the current study showed validity and reliability, supporting the use of this instrument as a measurement of college student wellbeing in China.

Alcohol Drinking in Chinese Methadone-maintained Clients: A Self-medication for Depression and Anxiety?

Objectives:

Unhealthy alcohol use is associated with negative health outcomes in clients attending methadone maintenance therapy (MMT) programs. However, debates exist regarding the methadone dose of drinkers, and little is known about the health outcomes of drinkers with other types of alcohol use. This study examined the drinking pattern and its association with methadone dose, and depressive and anxiety symptoms in Chinese clients undergoing MMT.

Methods:

A secondary data analysis was conducted with data from a large-scale cross-sectional survey of 549 clients of 3 MMT clinics in Wuhan, China. Depression, anxiety, and alcohol dependence were measured with Zung Self-rating Depression Scale, Zung Self-rating Anxiety Scale, and Alcohol Dependence Scale, respectively. Drinking pattern was assessed using 3 indicators: weekly amount of alcohol consumed, weekly frequency of alcohol consumed, and severity of alcohol dependence.

Results:

The prevalence of current drinking, hazardous drinking, regular drinking, and alcohol abuse/dependence was 29.0%, 10.4%, 14.2%, and 8.7%, respectively. In adjustment analyses, relative to nondrinkers, drinkers had significantly lower weight-based methadone dose (β = −0.136, P = 0.008); hazardous drinkers, irregular drinkers, and drinkers without alcohol abuse/dependence had less severe depression (β = −3.67, P = 0.004; β = −2.37, P = 0.034; β = −3.20, P = 0.001) and anxiety (β = −4.90, P < 0.001; β = −3.24, P = 0.006; β = −4.52, P < 0.001), but drinkers with alcohol abuse/dependence had more severe depression (β = 5.55, P < 0.001) and anxiety (β = 4.31, P = 0.005).

Conclusion:

In Chinese MMT clinics, drinkers may use alcohol to compensate for inadequate MMT and self-medicate negative emotions. Compared with nondrinkers, the severities of depression and anxiety were lower among drinkers without alcohol abuse/dependence, but higher among those with alcohol abuse/dependence.

Relations among Externalizing Behaviors, Alcohol Expectancies and Alcohol Use Problems in a Multi-Ethnic Sample of Middle and High School Students

BACKGROUND

Alcohol expectancies and externalizing behaviors, that is, aggression and rule-breaking behaviors, are associated with underage alcohol use. The interactive influence of these risk factors on problem alcohol use among minority adolescents is investigated in the present study.

OBJECTIVES

This study examined the unique and interactive influences of alcohol expectancies and externalizing problems on specific measures of adolescents' (a) past three-month binge drinking episodes and (b) negative consequences of alcohol use.

METHODS

Cross-sectional self-report data were collected in 2014 via tablet-based computerized assessments from a predominantly minority sample of 762 (404 females, Mage = 13.73 years, SDage =1.59) 6th, 8th, and 10th grade students recruited from public middle and high schools in Miami-Dade County, FL and Prince George's County, MD. Students completed surveys on tablets in school settings regarding alcohol expectancies, expectancy valuations, externalizing problem behaviors, past 3-month binge drinking episodes, and experiences of alcohol-related negative consequences.

RESULTS

Zero-inflated negative binomial regressions indicated: (1) older adolescents were more likely to report binge drinking; and (2) a significant main effect for externalizing problem behaviors on binge use. Logistic regressions indicated (1) older adolescents were more likely to endorse an alcohol-related negative consequence and (2) the interaction between positive alcohol expectancies and externalizing behaviors was associated with endorsing an alcohol-related negative consequence.

CONCLUSIONS

Engaging adolescents who exhibit serious externalizing behaviors and report positive alcohol expectancies via developmentally appropriate, tailored interventions is one feasible strategy to address escalation of binge alcohol use and related negative consequences among minority youth.

Alcohol Consumption Frequency of Parents and Stress Status of Their Children: Korea National Health and Nutrition Examination Survey (2007-2016)

Background: The effect of stress on mental health has been increasingly acknowledged. Drinking habits are closely inter-related with stress and each affects the other. However, only limited studies addressed the effects of alcohol consumption on family members apart from spouses. The purpose of this study is to better understand the relationship between parent drinking frequency and their children’s self-reported stress. Methods: Data was collected from the Korean National Health and Nutrition Examination Survey (K-NHANES) conducted during 2007–2016. Respondents were divided into three groups: children (n = 3796), maternal (n = 22,418), and paternal (n = 16,437). After merging the children and parents data sets, we identified the final study population of 3017 and performed binary logistic regression. Results: We found that the odds of high stress cognition was 1.58-fold higher for children who have heavy drinking mother (95% CI: 1.14–2.19) and 1.45-fold higher for those who have heavy drinking father (95% CI: 1.06–1.99). In a subgroup analysis, children whose household income level was Q1 and maternal occupation was white collar showed a statistically significant association of high stress with parental drinking frequency. Conclusions: Parental drinking frequency negatively impacts stress in the children of drinkers. We suggest providing support care for children in vulnerable environments to improve their stress levels.

Religiosity and Alcohol Use: Is Religiosity Important for Abstention and Consumption Levels in the Second Half of Life?

OBJECTIVE

The aim of this study was to investigate the relative role of religiosity for alcohol abstention and consumption levels among individuals aged 40 years or above.

METHOD

A two-wave prospective survey was conducted among Norwegians aged 40 to 80 years (Time 1 in 2002/2003, and Time 2 in 2007/2008). The analytical sample of this study constituted those who responded to the questionnaire survey at both time points (n = 2671).

RESULTS

The findings showed that religiousity was strongly associated with abstention and less consumption while adjusting for demographics and health variables. The results also reflected that females and those with higher age were more likely to abstain from alcohol than males and those with lower age, respectively. Individuals with high education were less likely to abstain than those with basic education. Females and those with high age also reflected less alcohol consumption than males and individuals of lower age, respectively. Further, people who were married or with a registered partner consumed less alcohol than people who were not married or with a registered partner. High education and good physical health was associated with higher consumption. The main results were consistent across prospective and cross-sectional models.

CONCLUSION

Religiosity seems to be important both for abstention and alcohol consumption levels in the second half of life.

Sleep Problems and Life Satisfaction as Predictors of Health in Men with Sex Chromosome Aneuploidies

More knowledge is needed about men with sex chromosome aneuploidies (SCA). We present self-reported data from 53 men with SCA (M_age = 36.8 years, SD = 12.3, range 19-67). The Health Survey-Short Form (SF-36) measured eight health domains (physical functioning, role-physical, role-emotional, vitality, emotional health, social functioning, pain, general health). The Pittsburgh Sleep Quality Index measured sleep problems. The Personal Wellbeing Index measured satisfaction with eight life domains. Compared to norms, SCA reported poorer health (mean d = -0.80) and more sleep problems (mean d = -0.85). Differences between SCA and norms on personal well-being were small, except lower health satisfaction in SCA (d = -1.06). Seven of eight regression models predicting the SF-36 domains from life satisfaction and sleep problems were significant (explained variance 12.2% to 46.2%), except physical functioning (ns). Clinical assessment/intervention for a broad range of health and sleep problems is indicated for men with SCA.

Alcohol Use, Age, and Self-Rated Mental and Physical Health in a Community Sample of Lesbian and Bisexual Women

PURPOSE

Given that self-perceptions of mental and physical health are important predictors of health outcomes and well-being, particularly among older adults, this study focuses on associations among age, alcohol consumption, and indicators of both self-rated mental health and self-rated physical health in a sample of sexual minority women (SMW).

METHODS

This study uses a community sample of SMW to examine the associations among age, drinking, and self-rated mental and physical health.

RESULTS

Heavy drinking among older adult SMW (55+) was less prevalent than among young SMW, ages 18-25 and ages 26-39, but similar to rates reported among SMW ages 40-54. In addition, older SMW reported significantly higher levels of self-rated mental health, compared with SMW in the other age groups, but we found no significant associations between age and self-rated physical health. Across all age groups, moderate drinkers reported better self-rated physical health than alcohol abstainers.

CONCLUSIONS

Overall, these results suggest that, among SMW, drinking does not decline as sharply with age as it does for heterosexual women in the general population. Given the current and projected increases in the aging population and the risks that heavy drinking presents for morbidity and mortality, interventions aimed at older SMW are needed.

Consumption of Wine with Meals and Subjective Well-being: A Finnish Population-Based Study

AIMS

To examine in the general population the association of regular consumption of wine with meals, subjective well-being and risky drinking.

METHODS

A random sample of Finnish people aged 18-69 ('Finnish Drinking Habits Survey 2008', n = 2591, response rate 74%) were interviewed regarding psychological distress, self-efficacy, self-perceived health, uncontrolled drinking, negative events during drinking, hazardous drinking and consumption of alcohol. The analysis focused on comparison of those who drank wine at least once a week versus more seldom. Regression models adjusted for social determinants, smoking and chronic illness.

RESULTS

Twelve percent of Finnish adults drank wine with meals at least once a week. Drinking wine with meals was an urban phenomenon and associated with higher socioeconomic status. Regular wine with meal drinkers reported better health, higher self-efficacy and less psychological distress than others even when various confounders were adjusted for. They also reported more risky drinking and higher yearly consumption than other alcohol consumers. Especially those who drank both wine and beer during meals had higher rates of risky drinking. Those restricting themselves to only wine with meals reported less hazardous drinking than the general population.

CONCLUSION

Consumption of wine with meals was associated with high socioeconomic status and high subjective well-being. Risky drinking was prevalent among wine with meal drinkers, but only among those who drank both wine and beer with meals. Potential unknown confounders may exist, but the results underline a link between subjective well-being and drinking wine with meals.

Disentangling psychopathology, substance use and dependence: a factor analysis

BACKGROUND

The notion that substance use can induce symptoms of depression and anxiety is influential in clinical practice, however questions remain about the empirical support for this hypothesis.

METHODS

We analysed mental health and substance dependence screening records for 280 outpatients in addictions treatment. Item-level data for depression (PHQ-9), anxiety (GAD-7), severity of dependence (SDS) and self-reported weekly substance use were studied using factor analysis and correlations. Symptom-level associations between substance use and psychological distress symptoms were examined after controlling for underlying levels of psychopathology.

RESULTS

We obtained a two-factor solution accounting for approximately 48 % of total variance. Depression and anxiety symptoms loaded onto a single psychopathology factor. Severity of dependence (SDS) and substance use measures loaded onto a distinct but correlated factor. After controlling for latent levels of psychopathology, the only remaining symptom-level associations were impaired concentration linked to cannabis use and irritability linked to alcohol use. Dependence (SDS) was prominently associated with depressive rumination, and negatively correlated with residual anxiety symptoms related to substance use (e.g., craving).

CONCLUSIONS

Overall, this analysis supports a psychological understanding of comorbidity; with dependence, craving, negative reinforcement and rumination as key variables.

Etiological theories of addiction: A comprehensive update on neurobiological, genetic and behavioural vulnerability

Currently, about 246 million people around the world have used an illicit drug. The reasons for this use are multiple: e.g. to augment the sensation of pleasure or to reduce the withdrawal and other aversive effects of a given substance. This raises the problem of addiction, which remains a disease of modern society. This review offers a comprehensive update of the different theories about the etiology of addictive behaviors with emphasis on the neurobiological, environmental, psychopathological, behavioural and genetic aspects of addictions, discussed from an evolutionary perspective. The main conclusion of this review is that vulnerability to drug addiction suggests an interaction between many brain systems (including the reward, decision-making, serotonergic, oxytocin, interoceptive insula, CRF, norepinephrine, dynorphin/KOR, orexin and vasopressin systems), genetic predisposition, sociocultural context, impulsivity and drugs types. Further advances in biological and psychological science are needed to address the problems of addiction at its roots.

Alcohol use, mental well-being, self-esteem and general self-efficacy among final-year university students

PURPOSE

We aimed to quantify associations between drinking and mental well-being, self-esteem and general self-efficacy among New Zealand university students approaching graduation.

METHODS

A web-based survey was conducted across all eight New Zealand universities in 2011. Participants were enrolled in their final year of a bachelor degree or a higher qualification and were aged 25 years and under (n = 5082, response level 65 %). Measures included the Alcohol Use Disorders Identification Test-Consumption, Warwick-Edinburgh Mental Well-being Scale, and items from the Rosenberg Self-esteem Scale and General Self-efficacy Scale. Linear regression models were used to estimate associations between the psychological measures and (1) drinking patterns for all participants (abstention/moderate/hazardous); and (2) consumption indicators for non-abstaining participants (frequency/quantity/heavy drinking frequency), adjusting for a range of individual, social and personality characteristics, separately for men and women.

RESULTS

Lower mental well-being was associated with a moderate or hazardous drinking pattern for men, and a hazardous pattern for women, compared to abstaining participants. Higher self-esteem was associated with any level of heavy drinking frequency for men, while the heaviest drinking women had a pattern of lower self-esteem. There was a general pattern of higher general self-efficacy for men and women who drank alcohol.

CONCLUSIONS

We observed that higher levels of drinking were associated with small, yet statistically significant, differences in psychological outcomes for men and women. Our findings are of uncertain clinical significance; however, they underscore the importance of investigating a fuller range of social and personality factors that may confound the association of drinking and psychological outcomes.

Factors associated with non-participation in a face-to-face second survey conducted 5 years after the baseline survey

Background

Non-participation in second surveys is reported to be associated with certain baseline characteristics; however, such data are unavailable for Japanese populations. Although disease incidence during follow-up might influence participation, few reports have addressed this possibility. This study sought to identify factors associated with non-participation in a second survey of a population-based cohort, and to evaluate the influence of self-reported disease incidence on non-participation.

Methods

After excluding participants who left the area (n = 423), died (n = 163), and withdrew from the study (n = 9) among 12 078 participants in a baseline survey for the Japan Multi-Institutional Collaborative Cohort Study in the Saga region between 2005 and 2007, 11 483 people were invited by mail to participate in a face-to-face second survey between 2010 and 2012. The 5-year clinical health history of non-participants was assessed by mail or telephone. Baseline characteristics and self-reported clinical outcomes of non-participants were compared with those of participants.

Results

Among 11 483 people, 8454 (73.6%) participated in the second survey, and 2608 out of 3029 non-participants answered mail or telephone health surveys. Female sex, youngest and oldest ages, lower education, lower occupational class, current smoking, lower physical activity level, shorter sleep time, obesity, and constipation were associated with non-participation. Light drinking (0.1–22.9 g ethanol/day) was associated with participation. Non-participants reported a significantly higher incidence of cancer and a significantly lower proportion of hypertension compared with participants.

Conclusions

Both baseline characteristics and disease incidence during the follow-up period had significant associations with non-participation in the face-to-face second survey.

Mental health and alcohol use: a cross-sectional study of the Finnish general population

BACKGROUND

The connections between alcohol use, mental health problems and mental well-being have been under-researched. We examined the links between different aspects of alcohol use and positive and negative aspects of mental health, and the effect of protective social factors on these links.

METHODS

A cross-sectional general population survey of Finns aged 15-69 years was carried out in 2008 (n = 2725, response rate 74%). The included aspects of alcohol use were the frequency and volume of drinking, binge drinking and hazardous drinking using Alcohol Use Disorders Identification Test (AUDIT). The included aspects of mental health were subjective well-being (life satisfaction), self-efficacy (sense of mastery) and psychological distress using the General Health Questionnaire. The protective social factors examined were social support (loneliness, having a confidant) and socioeconomic status.

RESULTS

Binge drinking and, particularly, hazardous drinking were associated with different aspects of mental health. The proportion of respondents with poor mental well-being increased when binge drinking was more frequent than monthly, and when respondents scored ≥6 on the AUDIT scale. Abstainers reported poor sense of mastery and former drinkers additionally reported poor satisfaction with life. Frequency and volume of drinking did not have a consistent connection with mental health. These associations between alcohol use and mental health did not depend on the protective social factors.

CONCLUSIONS

Frequent binge drinking and alcohol problems are associated with poor mental health, especially with a lack of life satisfaction and psychological distress. This result applies equally to lower and higher social status groups.

Stress, lifestyle, and quality of life in midlife and older Australian women: results from the Stress and the Health of Women Study

BACKGROUND

Chronic psychological stress may pose a serious threat to health, although the mechanisms are not fully understood. This study examines the impact of stress on modifiable lifestyle factors, depressive symptoms, health-related quality of life (HRQOL) and chronic illness in older Australian women.

METHODS

Cross-sectional data were collected from a random sample of 181 older adults aged 60 to 70 years from rural and urban areas of South-East Queensland, Australia. We used structural equation modelling to examine associations between stress, modifiable lifestyle factors, HRQOL, and chronic illness.

FINDINGS

Parameter estimates show that older women who reported life stressors where they felt helpless and feared for their life (high-magnitude stressors) also reported higher body mass index (p = .03) and more chronic illness (p < .01). In contrast, duration of exposure to life stressors was associated with higher depressive symptom scores (Center for Epidemiologic Studies Depression Scale; p = .02) and sleep disturbance scores (p < .01).

CONCLUSIONS

Our findings support the link between traumatic personal histories (exposure to high-magnitude stressors) and unhealthy lifestyle factors. Findings highlight the need for more research on how stress reduction, a healthy lifestyle, and positive coping strategies can be used to reduce the effects of high-magnitude stress on HRQOL and chronic illness.

Is life satisfaction hump-shaped with alcohol consumption? Evidence from Russian panel data

There has been a growing interest in the study of the shape of the relationship between alcohol consumption and psychological well-being in recent years. Overall, evidence is however still mixed and debated, the type of measures and methods of analysis having been emphasized as key elements in these studies. This paper contributes to this debate by providing new evidence relying on a large-scale population-based study. We used the Russia Longitudinal Monitoring Survey to build an unbalanced panel of 17,953 individuals providing 97,973 observations throughout 10 rounds. We studied the shape of the relationship between alcohol consumption (defined in grams of pure alcohol consumed in the last 30 days) and life satisfaction (measured by a five-item scale) by running a set of regressions. We successively introduced a large number of control variables (age, gender, marital status, occupation, income, health condition, education, living area, smoking status, and body mass index) and individual fixed effects in order to take both potential confounders and unobserved individual heterogeneity into account. Unadjusted analyses indicated a clear hump-shaped relationship between life satisfaction and alcohol use. The association was inverse J-shaped among men and inverse U-shaped among women. When control variables and individual fixed effects were introduced, the hump-shaped curve became increasingly flattened in all samples. Among women, all specifications (linear, quadratic and based on quartile dummies) turned non-significant. The quadratic specification for alcohol use remained however significant in the full sample and among men. In addition, in these two samples, being a fourth quartile drinker was negatively associated with satisfaction.

Cross-cultural patterns of the association between varying levels of alcohol consumption and the common mental disorders of depression and anxiety: secondary analysis of the WHO Collaborative Study on Psychological Problems in General Health Care

BACKGROUND

Alcohol consumption is associated with several complications of both physical and mental health. Light or moderate alcohol consumption may have beneficial effects on physical or mental health but this effect is still controversial and research in the mental health field is relatively scarce. Our aim was to investigate the association between varying levels of alcohol consumption and the common mental disorders of depression and anxiety in a large international primary care sample.

METHODS

The sample consisted of 5438 primary care attenders from 14 countries who participated in the WHO Collaborative Study of Psychological Problems in General Health Care. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT) and the mental disorders were assessed with the Composite International Diagnostic Interview (CIDI).

RESULTS

Light to moderate alcohol consumption was associated with a lower prevalence of depression and generalized anxiety disorder compared to abstinence while excessive alcohol consumption was associated with a higher prevalence of depression. This non-linear association was not substantially affected after adjustment for a range of possible confounding variables, including the presence of chronic disease and the current physical status of participants and was evident in different drinking cultures.

CONCLUSION

The study confirms that excessive drinking is associated with an increased prevalence of depression, but also raises the possibility that light/moderate drinking may be associated with a reduced prevalence of both depression and anxiety. Any causal interpretation of this association is difficult in the context of this cross-sectional study and further longitudinal studies are needed.

Health-risk behaviors and quality of life among young men

PURPOSE

To examine the associations between substance use and other health-risk behaviors and quality of life (QOL) among young men.

METHODS

The analytical sample consisted of 5,306 young Swiss men who participated in the Cohort Study on Substance Use Risk Factors. Associations between seven distinct self-reported health-risk behaviors (risky single-occasion drinking; volume drinking; cigarette smoking; cannabis use; use of any other illicit drugs; sexual intercourse without a condom; low physical activity) were assessed via chi-square analysis. Logistic regression analyses were conducted to study the associations between each particular health-risk behavior and either physical or mental QOL (assessed with the SF-12v2) while adjusting for socio-demographic variables and the presence of all other health-risk behaviors.

RESULTS

Most health-risk behaviors co-occurred. However, low physical activity was not or negatively related to other health-risk behaviors. Almost all health-risk behaviors were associated with a greater likelihood of compromised QOL. However, sexual intercourse without a condom (not associated with both physical and mental QOL) and frequent risky single-occasion drinking (not related to mental QOL after adjusting for the presence of other health-risk behaviors; positively associated with physical QOL) differed from this pattern.

CONCLUSIONS

Health-risk behaviors are mostly associated with compromised QOL. However, sexual intercourse without a condom and frequent risky single-occasion drinking differ from this pattern and are therefore possibly particularly difficult to change relative to other health-risk behaviors.

Alcohol consumption, problem drinking, abstention and disability pension award. The Nord-Trøndelag Health Study (HUNT)

AIMS

To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption ('sick-quitting') could explain some of the increased risk for DP among abstainers.

DESIGN

Prospective population-based study.

SETTING AND PARTICIPANTS

Data were from two waves of the Nord-Trøndelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37,729 (alcohol consumption) and 34,666 (problem drinking) participants.

MEASUREMENTS

Alcohol consumption was measured by self-reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health-related behaviour, socio-economic status and social activity.

FINDINGS

Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92-1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08-3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48-2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01-2.74) were at higher risk for DP than constant abstainers.

CONCLUSIONS

Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by 'sick-quitting'.

Alcohol consumption and risk of all-cause and cardiovascular disease mortality in men

This study examined the association between consumption of alcoholic beverages and all-cause and cardiovascular disease (CVD) mortality in a cohort of men (n = 31,367). In the Cox proportional hazards model adjusted for age, year of examination, body mass index (BMI), smoking, family history of CVD, and aerobic fitness, there were no significant differences in risk of all-cause mortality across alcohol intake groups. Risk of CVD mortality was reduced 29% in quartile 1 (HR = 0.71, 95% confidence interval (CI): 0.53, 0.95) and 25% in quartile 2 (HR = 0.75, 95% CI: 0.58, 0.98). The amount of alcohol consumed to achieve this risk reduction was <6 drinks/week; less than the amount currently recommended. The addition of other potential confounders and effect modifiers including blood pressure, insulin sensitivity, lipid levels, and psychological variables did not affect the magnitude of association. Future research is needed to validate the current public health recommendations for alcohol consumption.

Mental and personality disorders and abstinence from alcohol: results from a national household survey

BACKGROUND

The beneficial outcomes associated with moderate compared with low alcohol intake or abstinence may be due to the inclusion of people as 'low consumers', who have stopped consumption because of poor health. We investigated the association between alcohol abstinence and symptoms of common mental disorder and personality disorder, distinguishing between lifelong abstinence and abstinence following previous consumption.

METHOD

Analyses were based on the British National Survey of Psychiatric Morbidity 2000, which sampled 8580 residents aged 16-74 years. Hazardous drinking (Alcohol Use Disorders Identification Test) was excluded. Symptoms of common mental disorder (depression/anxiety) were identified by the Clinical Interview Schedule. The screening questionnaire of the Structured Clinical Interview for Axis II Personality Disorders was used to identify potential personality disorder. Self-reported alcohol abstinence was divided into lifelong abstinence and previous consumption. Previous consumers were asked why they had stopped. Covariates included socio-economic status, social activity and general health status.

RESULTS

After adjustment, alcohol abstinence was associated with both common mental disorder symptoms and any personality disorder, but only for previous consumers, in whom odds ratios were 1.69 (95% CI 1.23-2.32) and 1.45 (95% CI 1.09-1.94). Associations were non-specific, being apparent for most individual mental disorder symptoms and personality disorder categories. More detailed analysis indicated that associations were again limited to previous consumers who reported ceasing alcohol consumption for health reasons.

CONCLUSIONS

Worse mental health in low alcohol consumers, particularly those who have previously ceased for health reasons, should be taken into account when interpreting associations between moderate (compared with low) alcohol consumption and beneficial health outcomes.

Prevalence and Correlates of Drinking Behaviors of Previously Deployed Military Personnel and Matched Civilian Population

We examined drinking behaviors (frequency of use, quantity of use, and frequency of binge drinking) and correlates of frequency of use and binge drinking in a representative sample of previously deployed personnel from the US military (n = 1887). Drinking behaviors were compared with a matched sample of adults in U.S. households (n = 17,533). Comparable patterns of alcohol consumption were reported in both samples: 70% of previously deployed personnel and 69% of US adults reported drinking alcohol in the past 30 days though, civilians drank on average more drinks on the days that they drank than did previously deployed military personnel. Regression analyses indicated that among previously deployed military personnel, deployment-related experiences (e.g., combat-related traumas) and psychological distress (e.g., symptoms associated with posttraumatic stress disorder) were associated with frequency of drinking behaviors. We discuss the implication of our findings for developing interventions to modify drinking behaviors for military personnel.

Continued alcohol use in patients with head and neck cancer

BACKGROUND

The effect of posttreatment alcohol consumption on health-related quality of life (QOL) and factors predicting overall QOL and continued alcohol consumption were examined in patients with head and neck cancer.

METHODS

Self-reported alcohol use and abuse 1 year after diagnosis was analyzed.

RESULTS

Although current drinkers (44.5% of 283 patients) had better overall QOL and fewer depressive symptoms, current social drinkers had the best scores, whereas current problem drinkers had the worst. Female sex, fewer depressive symptoms, less pain, and better eating function predicted better QOL. Oral function was the only predictor of 12-month alcohol use.

CONCLUSION

Depression, pain, and eating function predicted overall QOL. Alcohol consumption was not associated with QOL, but was associated with better oral function, which in turn predicted better QOL. Alcohol consumption itself does not improve QOL in this population, and these patients should be counseled regarding detrimental effects of continued drinking after treatment.

A narrative review of the Beck Depression Inventory (BDI) and implications for its use in an alcohol-dependent population

The findings from the present study reveal that the Beck Depression Inventory (BDI) is a reliable and valid instrument for measuring depression in a variety of populations. This realization should enable nurses and other health professionals to utilize the tool with added confidence and assurance. * The main finding was that the BDI would probably be a reliable and valid screening tool in an alcohol-dependent population. This conclusion appears to echo the relationship that alcohol consumption generally has with depression. This finding is important to those practitioners using the BDI in this population in that it provides further evidence to enhance their practical experience. Abstract A psychometric evaluation of the Beck Depression Inventory (BDI) was carried out on contemporary studies to ascertain its suitability for use in an alcohol-dependent population. Three criteria were used for this: factor analysis, test-retest reliability and internal consistency reliability. Factor analysis revealed that its structure is consistent with either two or three factor models, depending on the population. Test-retest results concluded that the correlation coefficient remained above the recommended threshold and internal consistency reliability highlighted alpha coefficient results consistently above suggested scores, leading to the conclusion that the BDI is probably an effective screening tool in an alcohol-dependent population.

Anxiety and depression among abstainers and low-level alcohol consumers. The Nord-Trøndelag Health Study

AIMS

The aim of this study was to examine the levels of anxiety and depression among individuals consuming low levels of alcohol.

DESIGN

Prospective and cross-sectional population-based study.

SETTING AND PARTICIPANTS

This study employed data from the Nord-Trøndelag Health Survey (HUNT-2, n = 38 930).

MEASUREMENTS

Alcohol consumption was measured by self-report of usual alcohol consumption during a 2-week period. Low-level alcohol consumption was defined as self-reported abstainers and non-abstainers currently consuming no alcohol. Anxiety and depression were measured using the Hospital Anxiety and Depression Rating Scale. Potential explanatory variables included somatic illness and symptoms, health-related behaviour, socio-economic status and social activity. In a subsample (n = 20 337), we also looked at the impact of previous heavy drinking among abstainers ('sick-quitting').

FINDINGS

A U-shaped association between alcohol consumption and the risk of anxiety and depression was found. Abstention was related to increased odds for both case-level anxiety [1.34, 95% confidence interval (CI) 1.19-1.52] and depression (1.52, 95% CI 1.30-1.77). This association was accounted for partly by adjustments for socio-economic status, social network, somatic illness, age (depression only), gender (anxiety only) and 'sick-quitting'. We also identified significant differences between participants who label themselves as abstainers compared to those who report no usual alcohol consumption, but who do not label themselves as abstainers.

CONCLUSIONS

The risk of case-level anxiety and depression is elevated in individuals with low alcohol consumption compared to those with moderate consumption. Individuals who label themselves as abstainers are at particularly increased risk. This increased risk cannot fully be explained by somatic illness, social activity or 'sick-quitting'.