The temporal relationship of the onsets of alcohol dependence and major depression: using a genetically informative study design

Antidepressants and alcohol use disorder: A multicenter study on the mediating role of depression symptom changes

BACKGROUND

Alcohol use disorder (AUD) and depression are highly prevalent and tied to significant psychological, physiological, social and economic consequences. Their co-occurrence presents a complex clinical challenge, as the impact of antidepressant medication on AUD outcomes remains equivocal. In this multicenter, longitudinal study we investigated the relationship between antidepressant medication and changes in depression symptoms and alcohol use in AUD patients.

METHODS

We analyzed data from 153 detoxified AUD patients who attended a 12-week residential treatment program between 2015 and 2019. Within a mediation analysis, adopting a bootstrapping approach and a quasi-Bayesian framework, we estimated the total, direct, and mediated effects of antidepressants on the percentage of days abstinent to assess the role of changes in depression symptoms as a mediating factor.

RESULTS

The mediation analysis revealed a dual impact pathway model with a negative direct effect of antidepressants on abstinence (p = 0.004) and a positive indirect effect, mediated through the reduction of depression symptoms (p = 0.002).

CONCLUSIONS

The findings of the mediation analysis show that patients treated with antidepressants and whose depression symptoms do not improve over time show more relapses, while patients treated with antidepressants who achieve a reduction in depression symptoms show fewer relapses over time. Thus, to optimize treatment outcome, depression symptoms should be vigilantly monitored when antidepressants are prescribed during AUD treatment.

The predictive effect of family genetic risk scores as an indirect measure of causal effects of one disorder on another

BACKGROUND

One potential cause of comorbidity is the direct causal effect of one disorder - A - on risk for subsequent onset of disorder B. Could genetic risk scores be utilized to test for such an effect? If disorder A causally impacts on risk for disorder B, then genetic risk for disorder A should be lower in cases of disorder A with v. without a prior onset of B.

METHODS

In all individuals (n = 905 736) born in Sweden from 1980 to 1990, from six psychiatric and drug use disorders (major depression, anxiety disorders, alcohol use disorder, drug use disorder, bipolar disorder, and schizophrenia), we formed 14 pairs of disorders A and B. In these pairs, we compared, using Cox proportional hazards models, the predictive effect of the familial-genetic risk score (FGRS) for disorder B in those who had v. had not had a prior onset of disorder A.

RESULTS

In all pairs, the impact of the FGRS for disorder B was significantly stronger in cases without v. with a prior history of disorder A. These effects were similar across sex, stable across levels of FGRS and not likely due to clinician bias. In many of our disorder pairs, previous clinical studies suggest a mechanism for a causal effect of disorder A on B.

CONCLUSIONS

Our findings provide indirect evidence that the occurrence of one psychiatric or substance use disorder often has a causal effect on risk for subsequent disorders. This mechanism may substantially contribute to the widespread comorbidity among psychiatric conditions.

Past-year intimate partner violence perpetration among people with and without depression: an individual participant data (IPD) meta-mediation analysis

PURPOSE

To investigate whether (1) depression is associated with increased risk of past-year intimate partner violence (IPV) perpetration, disaggregated by sex, after controlling for potential confounders; (2) observed associations are mediated by alcohol misuse or past-year IPV victimisation.

METHODS

Systematic review and individual participant data (IPD) meta-mediation analysis of general population surveys of participants aged 16 years or older, that were conducted in a high-income country setting, and measured mental disorder and IPV perpetration in the last 12 months.

RESULTS

Four datasets contributed to meta-mediation analyses, with a combined sample of 12,679 participants. Depression was associated with a 7.4% and 4.8% proportion increase of past-year physical IPV perpetration among women and men, respectively. We found no evidence of mediation by alcohol misuse. Among women, past-year IPV victimisation mediated 45% of the total effect of depression on past-year IPV perpetration. Past-year severe IPV victimisation mediated 60% of the total effect of depression on past-year severe IPV perpetration. We could not investigate IPV victimisation as a mediator among men due to perfect prediction.

CONCLUSIONS

Mental health services, criminal justice services, and domestic violence perpetrator programmes should be aware that depression is associated with increased risk of IPV perpetration. Interventions to reduce IPV victimisation might help prevent IPV perpetration by women. Data collection on mental disorder and IPV perpetration should be strengthened in future population-based surveys, with greater consistency of data collection across surveys, as only four studies were able to contribute to the meta-mediation analysis.

Alcohol drinking in male patients with chronic schizophrenia: prevalence and its relationship to clinical symptoms

Background

It is common practice to associate schizophrenia (SCZ) patients with substance use. The most commonly used substances in China are tobacco and alcohol. However, few studies have focused on alcohol consumption itself in patients with SCZ. Thus the purpose of this study was to detect the prevalence of alcohol use and associated clinical factors in Chinese patients with SCZ.

Methods

A total of 616 male inpatients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for SCZ participated in this study. A detailed questionnaire, including data on alcohol consumption was used to collect demographic and clinical information on all patients. The five-factor model of the positive and negative syndrome scale (PANSS) was adopted to assess psychiatric symptoms.

Results

In this study, 31.49% of SCZ inpatients had a history of alcohol use, and 82.9% of these patients abstained from alcohol use after the onset of SCZ. Compared to nondrinkers, patients who drank were more likely to smoke (p = 0.004), more likely to have suicide attempts (p = 0.002) and suicidal ideation (p = 0.001), more severe positive (p < 0.001) and depressive symptoms (p = 0.034), but less severe negative symptoms (p = 0.04).

Conclusion

These findings suggest that alcohol use is common during the lifetime of SCZ patients and that alcohol use may be associated with clinical symptoms in SCZ patients.

Reduced connectivity of the cognitive control neural network at rest in young adults who had their first drink of alcohol prior to age 18

The cognitive control network (CCN) is an important network responsible for performing and modulating executive functions. In adolescents, alcohol use has been associated with weaker cognitive control, higher reward sensitivity, and later-in-life alcohol problems. Given that the CCN continues to develop into young adulthood, it is important to understand relations between early alcohol use, the CCN, and reward networks. Participants included individuals 18-23 years without alcohol use disorder. Based upon self-reported age of first alcoholic drink, participants were split into two groups: Early (onset) Drinkers (first drink < age 18, N = 52) and Late (onset) Drinkers (first drink > age 18, N = 44). All participants underwent an 8-minute resting-state fMRI scan. Seed regions of interest included the anterior dorsolateral prefrontal cortex (DLPFC), amygdala, and ventral striatum. Early Drinkers demonstrated significant reduced connectivity of CCN regions, including bilateral anterior DLPFC, compared to Late Drinkers. There were no significant differences between Early and Late Drinkers in connectivity between reward and CCN regions. These results suggest that individuals who begin drinking alcohol earlier in life may have alterations in the development of the CCN; however, longitudinal research is necessary to determine whether lower connectivity precedes or follows early alcohol use, and any other relevant factors.

Longitudinal associations between alcohol use, smoking, genetic risk scoring and symptoms of depression in the general population: a prospective 6-year cohort study

BACKGROUND

Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms.

METHODS

In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables.

RESULTS

In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms (p < 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use (p = 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms (p = 0.001-0.028). Results of genetic risk score analyses aligned with these findings.

CONCLUSIONS

While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.

Time perspective and family history of alcohol dependence moderate the effect of depression on alcohol dependence: A study in Chinese psychiatric clinics

BACKGROUND

Depression and alcohol dependence (AD) are among the most prevalent psychiatric disorders that commonly co-occur. Therefore, gaining a better grasp of factors related to this comorbidity is particularly interesting for clinicians. Past research has highlighted the significant role that time perspective and family history of alcohol dependence (FH) play in the occurrence of depression and AD. However, much remains unexplored in the understanding of the association between them. This study explored how temporal profile and other sociodemographic characteristics of patients diagnosed with AD impact the severity of depression and AD in them.

METHODS

This study was multi-centered, including 381 patients. Cross-sectional information was collected from both inpatient and outpatient psychiatric clinics in China. Data were acquired using validated self-report scales, including Michigan Alcoholism Screening Test, Zung Self-Rating Depression Scale, and Zimbardo Time Perspective Inventory-Chinese version. Multiple linear regression analyzes were conducted to control social demographic variables and construct prediction models to inspect the influence factors of variables. Moderation models were constructed to inspect further interplay between variables using hierarchical regression and PROCESS Macro.

RESULTS

Results showed that of all the patients in Chinese psychiatry clinics diagnosed with AD according to the International Classification of Diseases-10, 59.9% met the criteria of depression according to the questionnaire, and time perspective was correlated with the severity of depression. Furthermore, using regression analysis, we found that time perspective and depression could predict AD severity. The moderating role of a past negative time perspective and FH was confirmed between depression and AD. We found that, in our study, only in patients with FH and relatively moderate to high scores of past negative time perspective could the severity of depression predict the severity of AD. Therefore, during the treatment and care of patients with AD, their depression level, time perspective score, and FH should be considered.

The role of mood disorders in the progression of and recovery from alcohol and drug use problems: A latent transition analysis

INTRODUCTION

Longitudinal research assessing whether mood disorders predict substance use behaviors is limited. We extend our prior work evaluating transition patterns with alcohol use to assess patterns with alcohol and drug use problems.

METHOD

Using National Epidemiologic Survey on Alcohol and Related Conditions prospective data, waves 1 and 2, we completed latent class analyses to empirically define classes of alcohol and drug problems from DSM disorder criteria. Latent transition analyses were used to assess associations of lifetime mood disorders at baseline with transitions across classes of alcohol and drug problems during follow-up.

RESULTS

A three-class model of alcohol and drug problems was identified (No problems, Alcohol Problems Only, and Alcohol and Drug Problems) for males and females. Females with mood disorders were over two times more likely to transition from No Problems, and Alcohol Problems Only at baseline to having both Alcohol and Drug Problems at follow-up relative to those without mood disorders (aOR=2.30, 95 % CI=1.31-4.05, p = 0.004, and aOR=2.64, CI=1.24-5.62, p = 0.011, respectively). Furthermore, females with mood disorders were significantly less likely to recover from baseline Alcohol and Drug Problems to Alcohol Problems Only at follow-up (aOR=0.35, CI=0.12-0.98, p = 0.047) relative to those without mood disorders. There were no significant findings for males.

DISCUSSION

Our study provides evidence that mood disorders impact transitions through classes of alcohol and drug problems among females. The findings emphasize the need for ongoing evaluation of substance use among those with mood conditions, and recognition and treatment of mood disorders among those recovering from substance use problems.

Predictive Model of Suicide Risk in Young People: The Mediating Role of Alcohol Consumption

Suicidal behavior is one of the public health problems that cause most deaths in young people and has been associated with emotional and affective problems, so predictive models are required to account for the relationship between depression, anxiety, hopelessness, and alcohol consumption to propose actions for its prevention. The Plutchik Suicide Risk Scale, the CAGE Questionnaire, the Hopelessness Scale, the Depression Inventory and the Beck Anxiety Scale were applied. A total of 1.379 young people (M = 20.45; SD = 3.23) from the cities of Manizales (n = 739; 53.6%) and Medellín (n = 640; 46.5%) in Colombia were evaluated. The variables of anxiety, hopelessness and depression explained 51% (R² = 0.509; 95% CI = 0.467-0.552; p = 0.001) of the variation in suicidal risk. Likewise, alcohol consumption is a mediating variable between depression and anxiety in the prediction of suicidal risk, whose total, direct and indirect effects are statistically significant. The findings support the role of alcohol consumption as a mediating variable between anxiety, depression, hopelessness and suicidal risk in young people, given the difficulties it causes in information processing, regulation of emotions and therefore in having an adequate coping with the demands of the environment. This justifies the importance of directing suicide prevention actions through strategies for the reduction of alcohol consumption and the management of emotions in young people. HIGHLIGHTSAlcohol modulates the effect of depression and anxiety on suicide riskThis is a study on the risk of suicide in young people in ColombiaThe findings have implications for timely clinical interventions.

Lifestyle-related behaviors and depressive symptoms in college students

This study sought to examine the association between lifestyle-related behaviors and depressive symptoms among college students. This cross-sectional study analyzed baseline data of a dynamic-cohort study from a public university in Central-Western Brazil, in all 21 undergraduate full-time courses. Students up to 25 years old who were enrolled for the first time in a university were included in the study, except pregnant and/or nursing women. All students who met the eligibility criteria were invited to participate in the study. From a total of 1,212 eligible students, 1,038 were included (85.6%). All participants answered a self-administered questionnaire on smoking, alcohol consumption, screen time, sleep duration, and meal patterns. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariate Poisson regression models stratified by sex were used to estimate the associations. Depressive symptoms was observed in 31.6% (males 23.6%; females 39.9%; p-value chi-square test = 0.01) of the students. Smoking, drinking spirits, and having irregular meal habits were directly associated with depressive symptoms in both males and females. The co-occurrence of two risk behaviors (men: aPR = 2.23, 95%CI: 1.25; 3.99; women: aPR = 1.54, 95%CI: 1.03; 2.30) and three or more risk behaviors (men: aPR = 3.42, 95%CI: 1.90; 6.16; women: aPR = 2.09, 95%CI: 1.39; 3.15) increased the occurrence of depressive symptoms among the students. Lifestyle-related unhealthy behaviors were associated with an increased occurrence of depressive symptoms among college students. These findings suggest the need of interventions encouraging changes in lifestyle to promote mental health and to improve the quality of life in this group.

How people experience and respond to their distress predicts problem drinking more than does the amount of distress

Although broad dispositional negative affect predicts problematic alcohol use, emerging evidence suggests that individual differences in how people experience and respond to negative affect may play an important role in risk. In a sample of 358 college students assessed twice across their first year of college, the current study investigated the predictive roles of trait negative affect, affective lability (the tendency to experience rapid and intense shifts in mood), negative urgency (the tendency to act rashly when highly emotional), and problem drinking via self-report measures completed online. Data were analyzed using structural equation modeling (SEM). Individual differences in how negative affect is experienced and responded to, represented by affective lability and negative urgency, predicted problem drinking above and beyond trait negative affect, and trait negative affect had no incremental predictive power. Additionally, affective lability predicted increases in negative urgency, but the opposite was not true. A focus on characteristic ways in which individuals experience and respond to negative affect, rather than negative affect itself, may improve risk assessment and clarify the etiology of problem drinking. Continued work toward the development of comprehensive affect-based risk models for problem drinking is needed.

Affective factors explaining the association between depressive functioning and alcohol outcomes among college students

Rates of co-occurring depression and alcohol use are higher among college students than in the general population. Further research is needed to illuminate how the mechanisms with which individuals process negative emotions may clarify the link between depressive symptoms and drinking. Objective: To assess how three potential mediators representing affective functioning (ie, need for affect, distress tolerance, emotion regulation) explain the relationship between depressive symptoms and alcohol use (ie, quantity and problems). Participants: The sample consisted of 227 college student heavy drinkers. Methods: Participants completed computerized self-report surveys in Fall 2016. Results: Path analyses revealed need for affect mediated the association between depressive symptoms and alcohol quantity, while emotion regulation mediated the relationship between depressive symptoms and alcohol-related problems. Conclusions: Findings highlight the importance of various affective functioning mechanisms to the depressive symptom-drinking link. Future research could target these mechanisms in college interventions for co-occurring mood symptoms and alcohol use.

Correlation of Alcohol Use Disorders with Common Mental Disorders and Its Association with Socio-demographic Characteristics Among Community in Ethiopia: A Cross-sectional Study

Background

Alcohol use disorders occurring together with common mental disorders are common and have been recognized worldwide as a crucial public health concern. However, there is a scarcity of data about the correlation of alcohol use disorders with common mental disorders and its association with socio-demographic characteristics among community in Ethiopia, especially in the study area. The aim of the study is to assess the correlation of alcohol use disordesr with common mental disorders and its association with socio-demographic characteristics among adults of selected woredas of the Ilu Aba Bor zone.

Methods

Community-based cross-sectional study was employed on 690 participants selected by using the multistage sampling technique. Data were collected by using the alcohol use disorder identification test (AUDIT) and self-reporting questionnaire (SRQ-20) scale. Data analysis were done using SPSS version 20. Pearson correlation was used to see the relation of two variables. The strength of the association was determined at p-value <0.005.

Results

14.1% of the study sample positive for alcohol use disorders and 27.2% for common mental disorders. There is a significant positive relationship between alcohol use disorders and common mental disorders, r(688)=0.314, p=0.001. From socio-demographic characteristics, multivariable logistic regression analysis revealed marital status being single, orthodox religion followers, and living in urban had a significant association with alcohol use disorders.

Conclusion

In the Ilu Aba Bor zone, 14.1% of participants reported alcohol use disorders, and 27.2% have a common mental disorders. There is a significant positive relationship between alcohol use disorders and common mental disorders. Being single, orthodox religion, and living in urban had a significant association with alcohol use disorders. Detection and treatment of people with alcohol use disorders and common mental disorders in the community have been recommended at the same time through integrated treatment.

An ecological momentary assessment of mood, coping and alcohol use among emerging adults in psychiatric treatment

Background: Emerging adulthood is a critical period for the onset of both mental health disorders and problematic alcohol use. Coping strategies can play an important role in mitigating the onset and progression of these conditions in emerging adulthood. The current study examined daily mood, coping strategy use, and alcohol use during an individualized, ecological momentary intervention (EMI).Objectives: To examine the within-person relationship between mood, coping strategy use, and alcohol use.Methods: Emerging adults (N = 20, 55% female) in a partial hospital program for anxiety or mood disorders who endorsed drinking to cope completed a 6-week EMI to increase non-substance coping skills. The study also measured mood, coping strategy use, and alcohol use over the course of the intervention.Results: Mood and coping variables did not predict the likelihood of drinking on a given day. On drinking days, the number of pre-consumption coping strategies were related to reduced alcohol use (p =.02) and there was a significant interaction between negative mood and coping in predicting alcohol use (p <.01). When pre-consumption negative mood was high, coping strategies predicted decreased alcohol use (p =.02), but when negative mood was low, this relationship was nonsignificant.Conclusions: Using coping skills was associated with reduced alcohol use on days when negative mood was high. Increasing non-substance coping skills may help emerging adults reduce their alcohol use in response to negative mood.

Longitudinal associations between negative urgency, symptoms of depression, cannabis and alcohol use in veterans

There is a high comorbidity between symptoms of depression and cannabis and alcohol use in civilian and veteran populations. Prospective studies attempting to clarify the directionality of these comorbidities have yielded mixed results. Further, the relations between these constructs and impulsive personality, particularly negative urgency (NU, the tendency to act rashly when experiencing emotional distress) warrants further attention, as NU relates to symptoms of depression and alcohol and cannabis use. Importantly, NU partially accounts for the association between symptoms of depression and cannabis and alcohol problems in cross-sectional studies. This study examined alternative theories of directionality in order to better understand the longitudinal associations between symptoms of depression, NU, and cannabis or alcohol use. Three semiannual waves of data (baseline, 6-month, and 12-month) were collected in parallel assessments from a sample of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (N = 361). Autoregressive cross-lagged panel models were used to test four alternative theory-driven models about the longitudinal associations between the interaction of symptoms of depression and NU and cannabis or alcohol use. Models revealed unique direction of effects specific to each substance, such that the interaction between symptoms of depression and NU at 6 months postbaseline predicted more alcohol use at 12 months postbaseline, whereas more cannabis use at 6 months postbaseline predicted more severe symptoms of depression at 12 months postbaseline. Results suggests alternate directions of effect for cannabis and alcohol use. Future research should examine these patterns over wider assessment periods in order to see more variability and change over time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effect of alcohol use disorders and alcohol intake on the risk of subsequent depressive symptoms: a systematic review and meta-analysis of cohort studies

BACKGROUND AND AIMS

Alcohol use disorders (AUD) are often comorbid with depressive symptoms. Cohort studies on the association between AUD and subsequent depressive symptoms have produced inconsistent results. Moreover, regarding alcohol intake, the risk of developing depressive symptoms might vary with alcohol intake level. We aimed to investigate the association between AUD, alcohol intake and subsequent depressive symptoms.

DESIGN AND SETTING

We conducted a systematic search in PubMed, Embase and PsycINFO for cohort studies on the association between AUD or alcohol intake and subsequent depressive symptoms.

PARTICIPANTS

We included 338 426 participants from 42 studies. Six and four studies analyzed only females and males, respectively.

MEASUREMENTS

We combined risk estimates for developing depressive symptoms using a random-effects model. We divided alcohol intake into abstinence, light (0-84 g/week), moderate (85-168 g/week) and heavy drinking (> 168 g/week or > 48 g/day at least weekly). We conducted a categorical analysis to compare the risk of depressive symptoms between abstinence and different intake categories. Further, we conducted a dose-response analysis to investigate the alcohol-depression association.

FINDINGS

We analyzed 42 studies (follow-up time: 1-40 years). AUD was associated with significantly increased risk of subsequent depressive symptoms [relative risk (RR) = 1.57, 95% confidence interval (CI) = 1.41-1.76]. Regarding alcohol intake, heavy drinking had an increased risk of depressive symptoms; however, the association was only significant when controls were limited to non-heavy drinkers (RR = 1.13, 95% CI = 1.05-1.22). Taking into consideration the possibility of publication bias and confounding factors made the association non-significant. We observed J-shaped associations in both categorical and dose-response analyses where light-moderate drinking had a significantly decreased risk of depression, while heavy drinking did not show a significant association with depressive symptoms compared with non-drinkers.

CONCLUSION

Alcohol use disorders are associated with increased the risk of subsequent depressive symptoms. Heavy drinking does not significantly predict occurrence of depressive symptoms after adjusting for potential confounders.

Harmful drinking is associated with mental health conditions and other risk behaviours in Australian young people

OBJECTIVE

To investigate factors associated with alcohol use in adolescents, with the focus on analysing the comorbidities between single-occasion harmful-drinking episodes with mental health issues and risk behaviours.

METHODS

This study used data from the Young Minds Matter survey, designed to inform on the prevalence of the seven most common mental health disorders of children and adolescents. Logistic regression modelling was used to assess the odds of harmful drinking behaviour in young people aged 13-17 years in Australia.

RESULTS

We found a strong association between single-occasion harmful drinking and mental health issues, which hold after controlling for sociodemographic characteristics. Young people with severe mental health issues within the past year were four times more likely to have been drinking at harmful levels in the past 30 days.

CONCLUSIONS

Alcohol use can have adverse health effects among children and adolescents. Research has found a bidirectional association between alcohol use and mental health conditions where the presence of one issue almost doubles the risk of having the other issue. Implications for public health: The comorbidity between these issues suggests the need for strategies to integrate policies addressing mental health and alcohol use disorders in young people.

Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990-2019: Systematic review and meta-analysis

BACKGROUND

Comorbidity between Substance Use Disorders (SUDs) and major depression is highly prevalent. This systematic review and meta-analysis aimed to estimate the prevalence of SUDs in subjects diagnosed with a major depressive disorder (MDD) in community, inpatient and outpatient settings.

METHODS

A comprehensive literature search of Medline, EMBASE, PsycINFO and CINAHL databases was conducted from 1990 to 2019. Prevalence of co-morbid SUDs and MDD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis.

RESULTS

There were 48 articles identified by electronic searches with a total sample size of 348,550 subjects that yielded 14 unique epidemiological studies, 2 national case registry studies, 7 large cohort studies and 20 clinical studies using in- or out-patients. The prevalence of any SUD in individuals with MDD was 0.250. Maximum prevalence was found with alcohol use disorder (0.208), followed by illicit drug use disorder (0.118) and cannabis use disorder (0.117). Meta-analysis showed the pooled variance of any AUD in men with MDD was 36%, which was significantly higher than that for females with MDD (19%, OR 2.628 95% CI 2.502, 2.760).

CONCLUSIONS

Few studies were published over the last decade so current prevalence rates of SUD in MDD are needed. Meta-analysis revealed that SUDs in MDD are highly prevalent and rates have not changed over time. The persistently high prevalence suggests there is an urgent need for more informative studies to help develop better prevention and treatment options for reducing prevalence of SUDs in persons with major depression and co-morbid disorders.

Associations between major depressive symptoms and drinking onset: Do sex and age matter?

BACKGROUND

There has been mixed evidence about whether major depression predicts drinking onset. Empirical evidence about whether the heterogeneity of major depressive symptoms differentially predicts drinking onset is scarce, and potential sex- and age-variations have not been fully studied. In this study, we estimate sex- and age-specific relationships linking (a) depressed mood and/or anhedonia with drinking onset among all 'at-risk' individuals and (b) three latent depressive constructs, manifested by 13 clinical features, with drinking onset among individuals with depressed mood and/or anhedonia.

METHODS

Study population was non-institutionalized civilian residents 12 years of age and older living in the United States. Major depressive symptoms and drinking onset were assessed via audio-computer-assisted self-interviews. Logistic regressions and structural equation modeling were used for analysis.

RESULTS

Among all 'at risk' individuals, depressed mood or anhedonia strongly predicted early-adolescent drinking onset, whereas they did not predict at-age drinking onset. Among individuals with depressed mood or anhedonia, a 3-factor model provided a good fit to the data for all sex- and age-subgroups. With the exception of early-adolescent boys, neurovegetative symptoms and suicide-related symptoms tended to positively predict underage drinking onset, whereas Low mood or energy tended to inversely predict underage drinking onset; limited evidence was found for at-age and post-21 drinking onset.

LIMITATIONS

The observational nature precludes causal inference. Few people initiated alcohol drinking later than 21 years of age, which resulted in less precise estimates.

CONCLUSIONS

Strengths and directions of major depressive symptoms predicting drinking onset vary across age, sex, and depressive symptoms.

Anxiety sensitivity in relation to cigarette smoking and other substance use in African American smokers

Anxiety sensitivity (AS)-fearfulness of anxiety symptoms-has been implicated in the etiology of emotional disorders (e.g., depressive and anxiety disorders) and linked to cigarette smoking and other substance use (SU). However, studies examining AS in relation to SU primarily have been conducted with racially/ethnically heterogeneous or mostly European American samples. Hence, this cross-sectional study involving secondary analysis of baseline data focused on investigating associations of AS with cigarette smoking and other SU in a sample of 630 non-treatment-seeking African American smokers (37.3% female; M age = 49.6 years; M cigarettes smoked per day = 15.4). After screening out individuals with non-nicotine substance dependence, participants reported their demographics, AS, dysphoria symptoms (i.e., depression and anxiety symptoms), and SU. In regression analyses controlling for dysphoria symptoms, age, education level, income level, and years of regular smoking, AS was positively associated with tobacco withdrawal severity (β = .12, p = .007), overall smoking motives (β = .17, p < .001), alcohol use problems (β = .12, p = .005), and other (non-nicotine, nonalcohol) SU problems (β = .16, p < .001). Though lacking the passage of time between assessments needed to provide strong evidence of mediation, unplanned analyses further revealed indirect associations of AS with several SU variables through dysphoria symptoms. Current findings are consistent with those found in prior samples and suggest that AS is similarly related to SU in African Americans, who may benefit from interventions that have been helpful in improving AS, dysphoria symptoms, and SU in other groups. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Affective Risk for Problem Drinking: Reciprocal Influences Among Negative Urgency, Affective Lability, and Rumination

BACKGROUND

Affective disturbances have long been implicated in the onset and maintenance of problematic alcohol use. Affective risk theory for problem drinking has moved beyond early documentation that negative affect broadly confers risk to models specifying specific affectbased risk processes.

OBJECTIVE

This paper provides a theory-driven review of recent literature on the role of affect-based factors in the etiology of problematic alcohol use. First, we review recent advances in the understanding of affect-based risk for problem drinking. Second, we highlight the importance of three specific affect-based risk factors: urgency, affective lability, and rumination. Third, we offer hypotheses regarding the reciprocal relationships between specific risk factors and drinking problems. Finally, we suggest possible avenues for future research.

CONCLUSION

Recent advances in the understanding of reciprocal prediction between affect-based risk factors and problem drinking have set the stage for important new avenues of investigation into the risk process. Affect-based risk processes appear to influence each otherover time, and they influence and are influenced by problem drinking. Further understanding of these processes will pave the way for a new generation of intervention strategies.

Alcohol consumption predicts incidence of depressive episodes across 10 years among older adults in 19 countries

Alcohol consumption is increasing in many countries, and excessive alcohol consumption is particularly increasing among older adults. Excessive alcohol consumption causes morbidity and mortality, especially among older adults, including an increased risk of depressive episodes. We review the mechanisms through which alcohol consumption may affect depression, and argue that the effects of alcohol consumption on depressive episodes among older adults are understudied. We harmonized data among older adults (≥50 years) on alcohol consumption, depressive episodes, and an array of risk factors across 10 years and 19 countries (N=57,276). Alcohol consumption was categorized as current or long-term abstainer, occasional, moderate and heavy drinking at an average of 2.3 follow-up time points. Depressive episodes were measured through the CES-D or EURO-D. Multi-level Cox proportional frailty models in which the random effect has a multiplicative relationship to hazard were estimated with controls for co-occurring medical conditions, health behaviors, and demographics. Long-term alcohol abstainers had a higher hazard of depressive episodes (HR=1.14, 95% C.I. 1.08-1.21), as did those reporting occasional (HR=1.16, 95% C.I. 1.10-1.21) and heavy drinking (HR=1.22, 95% C.I. 1.13-1.30), compared with moderate drinking. Hazard ratios were attenuated in frailty models; heavy drinking, however, remained robustly associated in a random-effects model with a frailty component (HR=1.16, 95% C.I. 1.11-1.21). Interactions were observed by gender and smoking status: long-term abstainers, women's, and smokers' (HR for interaction, 1.04, 95% C.I. 1.00-1.07) hazards of depressive episodes increased more than what would be expected based on their multiplicative effects, when compared to moderate drinking, non-smoking men. Excessive alcohol consumption among older adults is a concern not only for physical, but also for mental health. Physician efforts to screen older adults for excessive alcohol use is critical for mental health to remain strong in aging populations.

Genetics of Alcoholism

PURPOSE OF REVIEW

We review the search for genetic variants that affect the risk for alcohol dependence and alcohol consumption.

RECENT FINDINGS

Variations in genes affecting alcohol metabolism (ADH1B, ALDH2) are protective against both alcohol dependence and excessive consumption, but different variants are found in different populations. There are different patterns of risk variants for alcohol dependence vs. consumption. Variants for alcohol dependence, but not consumption, are associated with risk for other psychiatric illnesses. ADH1B and ALDH2 strongly affect both consumption and dependence. Variations in many other genes affect both consumption and dependence-or one or the other of these traits-but individual effect sizes are small. Evidence for other specific genes that affect dependence is not yet strong. Most current knowledge derives from studies of European-ancestry populations, and large studies of carefully phenotyped subjects from different populations are needed to understand the genetic contributions to alcohol consumption and alcohol use disorders.

Positive and negative effects of internalizing on alcohol use problems from childhood to young adulthood: The mediating and suppressing role of externalizing

A longstanding hypothesis is that some alcohol use problems (AUP) develop and are maintained through the "self-medication" of internalizing (INT; depression and anxiety) problems. However, their high rate of co-occurrence with one another and with externalizing (EXT; antisocial behavior and impulse control) problems obscures any causal association because EXT may account for the INT-AUP link. Using a large community sample, we estimated prospective effects of INT and EXT on AUP via latent cross-lagged mediation panel spanning 14 years from childhood (ages 9-11) to young adulthood (ages 21-23). After adjusting for the cross-lagged, concurrent, and stability effects across factors, INT decreased AUP risk through its direct and indirect effects and increased AUP risk through shared variance with EXT. Between childhood and young adulthood, unique aspects of INT reduced risk for AUP while aspects of INT shared with EXT increased risk for AUP. (PsycINFO Database Record

Alcohol Use Disorder and Depressive Disorders

Alcohol use disorder (AUD) and depressive disorders are among the most prevalent psychiatric disorders and co-occur more often than expected by chance. The aim of this review is to characterize the prevalence, course, and treatment of co-occurring AUD and depressive disorders. Studies have indicated that the co-occurrence of AUD and depressive disorders is associated with greater severity and worse prognosis for both disorders. Both pharmacologic and behavioral treatments have demonstrated efficacy for this population. However, treatment response is somewhat modest, particularly for drinking outcomes, highlighting the importance of further research on the etiology and treatment of co-occurring AUD and depressive disorders. Key future directions include studies to understand the heterogeneity of both AUD and depressive disorders, research on novel treatment approaches to enhance outcomes, and better understanding of sex and gender differences.

Vital exhaustion and risk of alcohol use disorders: A prospective cohort study

OBJECTIVE

Vital exhaustion is an emotional state characterized by fatigue and depressive symptoms. We examined the prospective association between vital exhaustion and risk of alcohol use disorders (AUD). Furthermore, we investigated whether cohabitation status modifies the effect of this potential association.

METHODS

Vital exhaustion was assessed by a condensed, 17 item, version of the Maastricht Questionnaire as part of the Copenhagen City Heart Study in 1991-93. The study population consisted of 8956 individuals aged 21-93 years, who were followed for a first-time diagnosis of AUD in national registers until 2016. The mean length of follow-up was 16.6 years.

RESULTS

During follow-up, AUD was diagnosed in 146 men and 103 women. For both sexes, the risk of AUD increased dose-dependently with increasing vital exhaustion. Individuals who reported high vital exhaustion had a 2- to 3-fold higher risk of AUD in both men (HR = 2.46, 95% CI: 1.40-4.29) and women (HR = 3.34, 95% CI: 1.62-6.85). A potential modifying effect of cohabitation status on the relation between vital exhaustion and AUD was found for men.

CONCLUSION

The results showed that vital exhaustion is significantly associated with a higher risk of AUD in both men and women and that living with a cohabitee may have a protective effect among men.

The Temporal Relationship between Selected Mental Disorders and Substance-Related Disorders: A Nationwide Population-Based Cohort Study

Introduction. Previous studies have examined the association between specific mental disorders, particularly mood and anxiety disorders, and substance-related disorders; but the temporal link between them remains unclear. This study aimed to examine whether individuals with specific mental disorders, including affective psychoses, neurotic disorders, schizophrenia, personality disorders, and adjustment reaction, have higher risks for subsequently developing substance-related disorders compared to those without. Methods. A large-scale study with longitudinal data was conducted using the Taiwan National Health Insurance Research Database (NHIRD) consisting of 2,000,118 patients' medical records from 2000 to 2009. A total of 124,423 people diagnosed with selected mental disorders and the same number of people without the diagnoses of the selected disorders were identified between January 1, 2001, and December 31, 2006, and followed up for the diagnoses of substance-related disorders till the end of 2009. We estimated the risk for subsequently developing substance-related disorders among patients with the selected mental disorders compared to those without by using Cox proportional hazard models. The cumulative incidence of substance-related disorders was calculated using the Kaplan-Meier method. Results. The risk for developing substance-related disorders in patients with selected mental disorders is about 5 times (HR=5.09, 95% CI: 4.74-5.48) higher than those without after adjusting for potential confounding variables. From the multivariate analyses of subsamples stratified by age, sex, and urban and income levels, we found all adjusted hazard ratios were significantly higher than 1.0, ranging from 2.12 (95% CI: 1.72-2.62) to 14.55 (95% CI: 7.89-26.83). For children and adolescents aged 10-19 years, those with specific mental disorders had 14.55-fold higher risk for developing substance-related disorders in later life compared to their counterparts. Furthermore, patients with personality disorders had the highest risk (HR=25.05). Conclusions. The earlier onset of the selected mental disorders is a potential risk for developing substance-related disorders in later life, particularly for personality disorders. Health professionals should pay more attention to this at-risk population, especially to adolescents with mental disorders.

Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature

BACKGROUND

The comorbidity of mood and anxiety disorders (MD and AD) with substance use disorders (SUD) is common. One explanation for this comorbidity is the self-medication hypothesis, which posits that individuals with MD or AD use substances to cope with the difficult symptoms associated with the disorder. Over time, self-medication (SM) can develop into an independent SUD. This narrative review will present the prevalence and correlates of SM with alcohol and/or drugs for MD and AD and the relationship between SM and subsequent SUD using both cross-sectional and longitudinal epidemiological data.

METHODS

Scopus and PsycINFO were searched from January 1997 to April 2018 to identify original research articles that examined the prevalence and correlates of SM and the temporal relationship between MD/AD and SUD in the general population (n = 22).

RESULTS

The prevalence of SM with alcohol and/or drugs among those with MD or AD ranged from 21.9% to 24.1%. Male sex, younger age, being separated, divorced or widowed, and being Caucasian were characteristics associated with higher proportions of respondents endorsing SM with alcohol/drugs for MD and AD. Longitudinal data supports the temporal onset of primary MD/AD and secondary SUD among those who self-report SM.

CONCLUSION

Providing and promoting alternate coping strategies for those with MD/AD may reduce SM, the development of SUD, and the comorbidity of MD/AD with SUD. The concurrent treatment of MD/AD and substance use is the current "gold standard" model of care, and the results of this review support its use.

Alvanzo AA, Mojtabai R, Pacek LR, Cullen BA, Reboussin BA. Transitions through stages of alcohol involvement: The potential role of mood disorders

INTRODUCTION

Although prior clinical and population-based studies have demonstrated comorbidity between mood and alcohol use disorders (AUD), there is a paucity of research assessing whether mood disorders predict transition across stages of alcohol involvement.

METHOD

Hypothesizing that mood disorders predict transition across sex-specific alcohol involvement stages, we used prospective data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of US adults, which included male (n = 14,564) and female (n = 20,089) participants surveyed in 2001-2 and re-interviewed in 2004-5. Latent class (LCA) and latent transition analyses (LTA) were used to assess patterns of alcohol involvement in the US and the association of lifetime mood disorders at baseline with transition across stages of alcohol involvement during follow-up.

RESULTS

A three-class model of AUD criteria was identified (No problems, Moderate problems and Severe problems) for both sexes. Positive cross-sectional associations between mood disorder and problem classes of alcohol involvement were found among both sexes, as were positive longitudinal associations. Propensity score adjustment mitigated the associations of baseline mood disorder with progressive transition for both sexes. However, among females, baseline mood disorder was consistently associated with reduction in remission from Severe to Moderate alcohol problems (aOR = 0.30, CI = 0.09-0.99, p = .048) over time.

DISCUSSION

Our study provides evidence that mood disorders impact transition through stages of alcohol involvement and are most strongly associated with hindering remission among females. Findings advance our understanding of these comorbid relationships and have clinical implications for ongoing assessment of drinking patterns among individuals with mood disorders.

Childhood Adversity and Hazardous Drinking: The Mediating Role of Attachment Insecurity

BACKGROUND

Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol use and may be a target for modification or used to personalize interventions.

OBJECTIVES

This study aims to (a) identify the association between attachment insecurity and harmful drinking, (b) determine if attachment insecurity may mediate between childhood adversity and harmful drinking, and (c) test sex as a moderator between attachment insecurity and harmful drinking in the mediation relationship.

METHODS

Adult primary care patients (N = 348, 60% women) completed a cross-sectional survey study using validated measures in 2012. Statistical analyses were performed using Hayes's PROCESS macro in SPSS.

RESULTS

Childhood adversity was reported by 61% of the cohort and 18% endorsed harmful drinking. Attachment anxiety was associated with harmful drinking (p >.001), but attachment avoidance was not (p =.11). Attachment anxiety may mediate between childhood adversity and harmful drinking (95% CI:.03-.14). Sex did not moderate the relationships between attachment anxiety and harmful drinking in the mediation relationship (women: 95% CI:.031-.179; men: 95% CI:.003.-.182). Conclusions/Importance: Attachment anxiety may mediate between childhood adversity and harmful drinking in both men and women. Attachment anxiety may be a potential therapeutic target for people with a history of childhood adversity.

Anxiety sensitivity components in relation to alcohol and cannabis use, motives, and problems in treatment-seeking cigarette smokers

Anxiety sensitivity (AS)- fear of anxiety symptoms and their potential negative consequences-has been implicated in the development of substance use problems and motivation to use substances for coping with distress, though the AS components (physical, cognitive, and social concerns) have not been studied extensively in relation to alcohol- and cannabis-related variables. In a cross-sectional design, self-report measures of AS and alcohol and cannabis use, motives, and problems were administered to 364 treatment-seeking cigarette smokers with a history of alcohol and cannabis use. In both adjusted and unadjusted analyses, linear regression models indicated that AS cognitive concerns are related to cannabis-use conformity motives, alcohol-use coping motives, and alcohol problems; AS physical and cognitive concerns are related to greater cannabis problems specifically in males; and AS social concerns are associated with greater social, coping, enhancement, and conformity drinking motives. AS cognitive and physical concerns were also related to greater alcohol and cannabis problems, respectively, in subsamples limited to 214 current alcohol users and 170 current cannabis users. Together with prior work, current findings suggest that it may be beneficial to focus more on addressing AS cognitive concerns in individuals with tobacco-alcohol problem comorbidity, whereas it may be beneficial to focus on addressing both AS physical and cognitive concerns in males with tobacco-cannabis problem comorbidity. In addition, cigarette smokers high in AS social concerns may benefit from relaxation training to lessen their social anxiety as well as behavioral activation to enhance their positive affect.

Testing bidirectional relationships between alcohol use and depressive symptoms: What is the role of the serotonin transporter gene?

Alcohol abuse often co-exists with a major depressive disorder. In order to understand the development of this comorbidity, it is important to concentrate on the preceding process. It has been suggested that the link between alcohol use and depressive symptoms is a result of an interaction with genetic factors. The aim of this study was to longitudinally examine the effect of the 5-HTTLPR genotype on the association between depressive symptoms and alcohol use in a Dutch community sample. Following a stepwise approach, bivariate correlations, longitudinal regression analyses, and latent growth curve analyses were separately conducted for 316 males and 321 females. A positive correlation between depressive symptoms and alcohol use was shown in female carriers of the 5-HTTLPR short allele. In addition, latent growth curve analyses showed a positive association between alcohol use and the intercept of depressive symptoms (but not the slope), but only in female carriers of the 5-HTTLPR short allele. These findings show that alcohol use may be positively related, at least cross-sectionally, to depressive symptoms in female carriers of the 5-HTTLPR S allele, and indicate that moderators such as SLC6A4 genotype and sex need to be taken into account when examining associations between depressive symptoms and drinking behavior. In order to gain insight into the longitudinal association between alcohol use and depressive symptoms, studies should concentrate on earlier stages and focus on more fine-grained research designs that allow day-to-day changes in both alcohol use and depressive symptoms.

Is Major Depression Linked to Alcohol-Impaired Driving?

BACKGROUND

Alcohol-impaired driving causes a substantial proportion of motor vehicle accidents. Depression is a prevalent psychiatric disorder among drinker-drivers. Few previous studies have investigated the relationship between major depression and alcohol-impaired driving.

OBJECTIVES

We investigated whether depression has a positive relationship with the probability of alcohol-impaired driving after controlling for the co-occurrence of binge drinking and alcohol dependence.

METHODS

Our data consisted of drinkers aged 21-64 years from two waves of the National Epidemiologic Survey of Alcohol and Related Conditions. Cross-sectional analysis investigated whether depression is an independent risk factor for drinking-driving. Longitudinal analysis distinguished the relationship of depression onset, continuance, and recovery with changes in drinking-driving behaviors between the waves. These dual approaches allowed comparisons with previous studies.

RESULTS

Major depression was a small but statistically significant predictor of changes in alcohol-impaired driving behaviors among males but not females. Binge drinking and alcohol dependence were comparatively stronger predictors. Conclusions/Importance: There is limited empirical support that treating depression reduces drinking and driving in males who do not exhibit symptoms of alcohol use disorders. For persons with co-occurring depression and alcohol use disorders, depression treatment should be part of a strategy for treating alcohol use disorders which are highly related to drinking and driving.

Hazardous alcohol use among patients with schizophrenia and depression

AIMS

The current study aimed to 1) report the prevalence of hazardous alcohol use in an outpatient population among those with schizophrenia and depressive disorders, 2) assess the sociodemographic and clinical correlates of hazardous alcohol use, 3) examine the association of hazardous alcohol use with severity of depression, anxiety and smoking, and 4) assess the association of hazardous alcohol use with quality of life.

METHODS

Three hundred ten outpatients seeking treatment at a tertiary psychiatric institute with a diagnosis of either schizophrenia spectrum disorder or depressive disorder were included in the study. Patients were assessed for hazardous alcohol use using the Alcohol Use Disorders Identification Test. Information on sociodemographic correlates, clinical history, severity of symptoms of depression and anxiety, as well as quality of life (QOL) was collected.

RESULTS

The overall prevalence of hazardous alcohol use among the sample was 12.6%. The prevalence of hazardous alcohol use among patients with depression and schizophrenia was 18.8% and 6.4%, respectively. Compared to those who were students, patients who were gainfully employed or unemployed were more likely to engage in hazardous alcohol use (Odds Ratio (OR) = 5.5 and 7.7, respectively). Patients with depression compared to those with schizophrenia (OR = 11.1) and those who were current smokers compared to those who had never smoked (OR = 14.5) were more likely to engage in hazardous alcohol use. Hazardous alcohol use was associated with lower QOL in the physical health domain (p = 0.002).

CONCLUSION

Given the significant prevalence of hazardous alcohol use in this population, routine screening for hazardous alcohol use and brief interventions could be an effective way of managing this comorbidity. There is a need to develop and evaluate culturally appropriate brief interventions based on patient preference in this setting.

Genetic Risk Variants Associated With Comorbid Alcohol Dependence and Major Depression

Importance

Alcohol dependence (AD) and major depression (MD) are leading causes of disability that often co-occur. Genetic epidemiologic data have shown that AD and MD share a common possible genetic cause. The molecular nature of this shared genetic basis is poorly understood.

Objectives

To detect genetic risk variants for comorbid AD and MD and to determine whether polygenic risk alleles are shared with neuropsychiatric traits or subcortical brain volumes.

Design, Setting, and Participants

This genome-wide association study analyzed criterion counts of comorbid AD and MD in African American and European American data sets collected as part of the Yale-Penn study of the genetics of drug and alcohol dependence from February 14, 1999, to January 13, 2015. After excluding participants never exposed to alcohol or with missing information for any diagnostic criterion, genome-wide association studies were performed on 2 samples (the Yale-Penn 1 and Yale-Penn 2 samples) totaling 4653 African American participants and 3169 European American participants (analyzed separately). Tests were performed to determine whether polygenic risk scores derived from potentially related traits in European American participants could be used to estimate comorbid AD and MD.

Main Outcomes and Measures

Comorbid criterion counts (ranging from 0 to 14) for AD (7 criteria) and MD (9 criteria, scaled to 7) as defined by the DSM-IV.

Results

Of the 7822 participants (3342 women and 4480 men; mean [SD] age, 40.1 [10.7] years), the median comorbid criterion count was 6.2 (interquartile range, 2.3-10.9). Under the linear regression model, rs139438618 at the semaphorin 3A (SEMA3A [OMIM 603961]) locus was significantly associated with AD and MD comorbidity in African American participants in the Yale-Penn 1 sample (β = 0.89; 95% CI, 0.57-1.20; P = 2.76 × 10-8). In the independent Yale-Penn 2 sample, the association was also significant (β = 0.83; 95% CI, 0.39-1.28; P = 2.06 × 10-4). Meta-analysis of the 2 samples yielded a more robust association (β = 0.87; 95% CI, 0.61-1.12; P = 2.41 × 10-11). There was no significant association identified in European American participants. Analyses of polygenic risk scores showed that individuals with a higher risk of neuroticism (β = 1.01; 95% CI, 0.50-1.52) or depressive symptoms (β = 0.87; 95% CI, 0.32-1.42) and a lower level of subjective well-being (β = -0.94; 95% CI, -1.46 to -0.42) and educational attainment (β = -1.00, 95% CI, -1.57 to -0.44) had a higher level of AD and MD comorbidity, while larger intracranial (β = 1.07; 95% CI, 0.50 to 1.64) and smaller putamen volumes (β = -1.16; 95% CI, -1.86 to -0.46) were associated with higher risks of AD and MD comorbidity.

Conclusions and Relevance

SEMA3A variation is significantly and replicably associated with comorbid AD and MD in African American participants. Analyses of polygenic risk scores identified pleiotropy with neuropsychiatric traits and brain volumes. Further studies are warranted to understand the biological and genetic mechanisms of this comorbidity, which could facilitate development of medications and other treatments for comorbid AD and MD.

The Causal Role of Alcohol Use in Adolescent Externalizing and Internalizing Problems: A Mendelian Randomization Study

BACKGROUND

The co-occurrence of alcohol use and externalizing/internalizing problems threatens adolescents' mental health. Research on whether alcohol use and these problems are causal and the direction of the potential causal relationships is needed to understand the mechanisms of the co-occurrence.

METHODS

A Mendelian randomization analysis was conducted in which the aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism was used as an instrumental variable for alcohol use phenotypes. In total, 1,608 Chinese adolescents (mean age 14.11 ± 1.83 years) were genotyped for the ALDH2 rs671 polymorphism. Three externalizing problems (aggression, delinquency, and attention problems) were measured with the Youth Self-Report inventory, and 2 internalizing problems (depression and anxiety) were measured with the self-reported Children's Depression Inventory and the Trait subscale of the State-Trait Anxiety Inventory.

RESULTS

Alcohol use was positively associated with all 3 externalizing and 2 internalizing problems, and the ALDH2 polymorphism had a significant effect on alcohol use. Aggression and attention problems were also significantly affected by the ALDH2 polymorphism, whereas no significant association was observed between the ALDH2 polymorphism and delinquency, anxiety, or depression.

CONCLUSIONS

The results suggest that alcohol use is a cause of adolescent aggression and attention problems but not adolescent delinquency, anxiety, or depression.

A Systematic Review on Harmful Alcohol Use Among Civilian Populations Affected by Armed Conflict in Low- and Middle-Income Countries

BACKGROUND

There are currently over 55 million refugees and internally displaced persons due to armed conflict. In addition, there are around 150 million more conflict-affected residents who remain in their home communities. Armed conflict poses a number of potential risks for harmful alcohol use.

OBJECTIVE

The objective of the study was to systematically examine evidence on harmful alcohol use among conflict-affected populations in low- and middle-income countries.

METHODS

A systematic review methodology was used following PRISMA guidelines. Quantitative studies were selected with outcomes relating to harmful alcohol use among conflict-affected populations in low- and middle-income countries. Seven bibliographic databases and a range of gray literature sources were searched. Descriptive analysis was applied and a quality assessment conducted using the Newcastle-Ottawa Quality Assessment Scale.

RESULTS

The search yielded 10,037 references of which 22 studies met inclusion criteria. Twenty-one of the studies used a cross-sectional design, and 1 used a case series design. Evidence on risk factors for harmful alcohol use was weak overall. Factors associated with harmful alcohol use were male gender, older age, cumulative trauma event exposure, and depression. There were no studies on the effectiveness of interventions for harmful alcohol use. The strength of evidence was also limited by the generally moderate quality of the studies.

CONCLUSIONS

Substantially more evidence is required to understand the scale of conflict-associated harmful alcohol use, key risk factors, association of alcohol use with physical and mental disorders, and effectiveness of interventions to address harmful alcohol use in conflict-affected populations.

Stability and change in etiological factors for alcohol use disorder and major depression

Alcohol use disorder (AUD) and major depressive disorder (MDD) are often comorbid. It is not understood how genetic risk factors for these disorders relate to each other over time and to what degree they are stable. Age-dependent characteristics of the disorders indicate that different genetic factors could be relevant at different stages of life, and MDD may become increasingly correlated with AUD over time. DSM-IV diagnoses of AUD and MDD were assessed by interviews of 2,801 young adult twins between 1999 and 2004 (T1) and 2,284 of the same twins between 2010 and 2011 (T2). Stability, change, and covariation were investigated in longitudinal biometric models. New genetic factors explained 56.4% of the genetic variance in AUD at T2. For MDD, there was full overlap between genetic influences at T1 and T2. Genetic risk factors for MDD were related to AUD, but their association with AUD did not increase over time. Thus, genetic risk factors for AUD, but not MDD, vary with age, suggesting that AUD has age-dependent heritable etiologies. Molecular genetic studies of AUD may therefore benefit from stratifying by age. The new genetic factors in AUD were not related to MDD. Environmental influences on the 2 disorders were correlated in middle, but not in young adulthood. The environmental components for AUD correlated over time (r = .27), but not for MDD. Environmental influences on AUD can have long-lasting effects, and the effects of preventive efforts may be enduring. Environment influences seem to be largely transient. (PsycINFO Database Record

Review: Genetic research on alcohol use outcomes in African American populations: A review of the literature, associated challenges, and implications

BACKGROUND AND OBJECTIVES

There have been remarkable advances in understanding genetic influences on complex traits; however, individuals of African descent have been underrepresented in genetic research.

METHODS

We review the limitations of existing genetic research on alcohol phenotypes in African Americans (AA) including both twin and gene identification studies, possible reasons for underrepresentation of AAs in genetic research, the implications of the lack of racially diverse samples, and special considerations regarding conducting genetic research in AA populations.

RESULTS

There is a marked absence of large-scale AA twin studies so little is known about the genetic epidemiology of alcohol use and problems among AAs. Individuals of African descent have also been underrepresented in gene identification efforts; however, there have been recent efforts to enhance representation. It remains unknown the extent to which genetic variants associated with alcohol use outcomes in individuals of European and African descent will be shared. Efforts to increase representation must be accompanied by careful attention to the ethical, legal, and social implications of genetic research. This is particularly true for AAs due to the history of abuse by the biomedical community and the persistent racial discrimination targeting this population.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Lack of representation in genetic studies limits our understanding of the etiological factors that contribute to substance use and psychiatric outcomes in populations of African descent and has the potential to further perpetuate health disparities. Involving individuals of diverse ancestry in discussions about genetic research will be critical to ensure that all populations benefit equally from genetic advances. (Am J Addict 2017;26:486-493).

Temporal sequencing of nicotine dependence and major depressive disorder: A U.S. national study

Major Depressive Disorder (MDD) and Nicotine dependence (ND) often co-occur. However, little attention has been given to the temporal order between the two disorders. We compared the sociodemographic and clinical characteristics of individuals whose onset of ND preceded (ND-prior) or followed the onset of MDD (MDD-prior). Binary logistic regression models were computed to compare ND-prior (n=546) and MDD-prior (n=801) individuals from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n=43,093). We found that MDD-prior were more likely to have a history of suicide attempts and a family history of both depression and antisocial behavior, to have had psychiatric hospitalization, and to have an earlier age of onset of the first depressive episode; but a later age of onset for both daily smoking and ND. On average, MDD-prior individuals showed a significantly longer transition time from daily smoking to ND (15.6±0.6 vs. 6.9±0.4 years, P<0.001). In contrast, ND-prior subjects had a significantly greater proportion of withdrawal symptoms, and of lifetime alcohol use or alcohol use disorder. We conclude that the phenomenology and course of ND and MDD vary significantly, depending on which disorder had earlier onset.

Pattern and risk of developing alcohol use disorders, illegal substance use and psychiatric disorders after early onset of alcohol use: Results of the Thai National Mental Health Survey 2013

INTRODUCTION

Although underage drinking is a global concern, little is known about the relationship between age at first drink and development of various psychiatric comorbidities.

METHODS

A secondary data analysis was done among 2928 lifetime drinkers from the Thai National Mental Health Survey 2013. Age at first drink, and onset of related psychiatric outcomes were inquired. Survival analysis using Cox regression was performed to estimate the risk over time for psychiatric problems across age ranges at first drink.

RESULTS

Two-thirds of male and one-third of female drinkers were considered underage at drinking onset. Substance use and abuse developed earlier (<5 years) than alcohol use disorders (AUDs) and other outcomes (mostly >10 years). Those who started drinking before age 15 years were more likely to develop use of cannabis (HR=4.75; 95% CI 2.73, 8.24), club drugs (HR=2.88; 95% CI 1.46, 5.71) and inhalants (HR=6.46; 95% CI% 1.64, 25.37), compared to those who were 20 years or older at drinking onset. Using age as an alternative time-scale, those aged <15years at drinking onset were significantly more likely to experience AUDs, psychotic symptoms, intermittent explosive disorder and panic disorder. However, the early onset drinkers were less likely to develop depression compared to those who started at age 20 years and over.

CONCLUSION

Premature alcohol consumption tends to be a gateway to various serious consequences. Efforts of such drinking age policy and interventions are needed to address vulnerable young populations.

The role of hazardous drinking reductions in predicting depression and anxiety symptom improvement among psychiatry patients: A longitudinal study

BACKGROUND

Co-occurrence of depression, anxiety, and hazardous drinking is high in clinical samples. Hazardous drinking can worsen depression and anxiety symptoms (and vice versa), yet less is known about whether reductions in hazardous drinking improve symptom outcomes.

METHODS

Three hundred and seven psychiatry outpatients were interviewed (baseline, 3-, 6-months) for hazardous drinking (drinking over recommended daily limits), depression (PHQ-9), and anxiety (GAD-7) as part of a hazardous drinking intervention trial. Longitudinal growth models tested associations between hazardous drinking and symptoms (and reciprocal effects between symptoms and hazardous drinking), adjusting for treatment effects.

RESULTS

At baseline, participants had moderate anxiety (M=10.81; SD=10.82) and depressive symptoms (M=13.91; SD=5.58); 60.0% consumed alcohol at hazardous drinking levels. Over 6-months, participants' anxiety (B=-3.03, p<.001) and depressive symptoms (B=-5.39, p<.001) improved. Continued hazardous drinking led to slower anxiety (B=0.09, p=.005) and depressive symptom (B=0.10, p=.004) improvement; reductions in hazardous drinking led to faster anxiety (B=-0.09, p=.010) and depressive (B=-0.10, p=.015) symptom improvement. Neither anxiety (B=0.07, p=.066) nor depressive (B=0.05, p=.071) symptoms were associated with hazardous drinking outcomes.

LIMITATIONS

Participants were psychiatry outpatients, limiting generalizability.

CONCLUSIONS

Reducing hazardous drinking can improve depression and anxiety symptoms but continued hazardous use slows recovery for psychiatry patients. Hazardous drinking-focused interventions may be helpful in promoting symptom improvement in clinical populations.

Alcohol Misuse and Co-Occurring Mental Disorders Among New Soldiers in the U.S. Army

BACKGROUND

Problem drinking that predates enlistment into military service may contribute to the overall burden of alcohol misuse in the Armed Forces; however, evidence bearing on this issue is limited. This study examines prevalence and correlates of alcohol misuse among new U.S. Army soldiers.

METHODS

Cross-sectional survey data were collected from soldiers reporting for basic combat training. The survey retrospectively assessed lifetime alcohol consumption and substance abuse/dependence, enabling estimation of the prevalence of lifetime binge drinking and heavy drinking in a sample of 30,583 soldiers and of probable alcohol use disorder (AUD) among 26,754 soldiers with no/minimal lifetime use of other drugs. Co-occurrence of mental disorders and other adverse outcomes with binge drinking, heavy drinking, and AUD was examined. Discrete-time survival analysis, with person-year the unit of analysis and a logistic link function, was used to estimate associations of AUD with subsequent onset of mental disorders and vice versa.

RESULTS

Weighted prevalence of lifetime binge drinking was 27.2% (SE = 0.4) among males and 18.9% (SE = 0.7) among females; respective estimates for heavy drinking were 13.9% (SE = 0.3) and 9.4% (SE = 0.4). Among soldiers with no/minimal drug use, 9.5% (SE = 0.2) of males and 7.2% (SE = 0.5) of females had lifetime AUD. Relative to no alcohol misuse, binge drinking, heavy drinking, and AUD were associated with increased odds of all mental disorders and other adverse outcomes under consideration (adjusted odds ratios [AORs] = 1.5 to 4.6; ps < 0.001). Prior mental disorders and suicidal ideation were associated with onset of AUD (AORs = 2.3 to 2.8; ps < 0.001), and prior AUD was associated with onset of mental disorders and suicidal ideation (AORs = 2.0 to 3.2, ps < 0.005).

CONCLUSIONS

Strong bidirectional associations between alcohol misuse and mental disorders were observed in a cohort of soldiers beginning Army service. Conjoint recognition of alcohol misuse and mental disorders upon enlistment may provide opportunities for risk mitigation early in a soldier's career.

The natural history of substance use disorders

PURPOSE OF REVIEW

Illicit drugs, alcohol, and tobacco use disorders contribute substantially to the global burden of disease. Knowledge about the major elements of the natural history of substance use disorders (incidence, remission, persistence, and relapse) is crucial to a broader understanding of the course and outcomes of substance use disorders.

RECENT FINDINGS

Prospective cohort studies in nonclinical samples indicate that externalizing psychopathology in earlier life, including early disordered substance use, delinquency, and personality disorders, are related to substance use disorders later in life and chronic course. Externalizing psychopathology may be initiated by early adverse experiences, for example, childhood maltreatment and stressful life events. After controlling for confounders, 'age at first use' as a causal factor for alcohol use disorder later in life and the 'drug substitution' hypothesis are not supported in general population data.

SUMMARY

Future research should focus on elaborating the causal framework that leads to the development and persistence of severe substance use disorders, with an emphasis on identifying modifiable factors for intervention by policy makers or health professionals. More research is needed on the natural history of substance use disorders in low-income and middle-income countries.

Integrating affect and impulsivity: The role of positive and negative urgency in substance use risk

BACKGROUND

The personality traits of positive and negative urgency refer to the tendencies to act rashly when experiencing unusually positive or negative emotions, respectively.

METHODS

The authors review recent empirical work testing urgency theory (Cyders and Smith, 2008a) and consider advances in theory related to these traits.

RESULTS

Empirical findings indicate that (a) the urgency traits are particularly important predictors of the onset of, and increases in, substance use in both children and young adults; (b) they appear to operate in part by biasing psychosocial learning; (c) pubertal onset is associated with increases in negative urgency, which in turn predict increases in adolescent drinking behavior; (d) variation in negative urgency trait levels are associated with variations in the functioning of an identified brain system; and (e) variations in the serotonin transporter gene, known to influence the relevant brain system, relate to variations in the urgency traits.

CONCLUSION

A recent model (Carver et al., 2008) proposes the urgency traits to be markers of a tendency to respond reflexively to emotion, whether through impulsive action or ill-advised inaction (the latter leading to depressive symptoms); this model has received empirical support. The authors discuss new directions for research on the urgency traits.

Prospective relationship of depressive symptoms, drinking, and tobacco smoking among middle-aged and elderly community-dwelling adults: Results from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Previous studies in Western countries have consistently documented positive associations of smoking and heavy drinking with depressive symptoms but a prospective analysis of these relationships among middle-aged and elderly community members in China have not previously been reported.

METHODS

Using data from the China Health and Retirement Longitudinal Study, a two-wave nationally representative survey conducted in 15,628 adults 45 years of age and older, we estimated the prospective association between depressive symptoms and an array of smoking and drinking behaviors. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) short form.

RESULTS

Inverse associations were the dominant pattern of association. For the population as a whole, individuals with baseline depressive symptoms were less likely to start drinking (OR=0.7, 95% CI=0.5, 0.9) or smoking (OR=0.6, 95% CI=0.4, 0.8). Similarly, baseline drinkers and smokers were less likely to develop depressive symptoms (ORdrinkers=0.6, 95% CI=0.5, 0.7; ORsmokers=0.7, 95% CJ=0.6, 0.9). No evidence was found for an increased incidence or persistence of depressive symptoms among high-frequency drinkers or heavy smokers or vice versa. Males who had never smoked prior to the onset of depressive symptoms tended to have more rapid onset of tobacco dependence compared to those without such symptoms. Males and females had different association patterns.

LIMITATIONS

The study is observational in nature and provides limited evidence for causality.

DISCUSSION

The results are inconsistent with previous findings in Western countries, throwing into question the presumed universality of the association between alcohol drinking or tobacco use and depression among middle-aged and elderly adults.

Does Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) Predict Levels of Depressive Symptoms during Emerging Adulthood?

Little is known about the development and course of depressive symptoms through emerging adulthood among individuals with a childhood history of attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to examine if a history of ADHD in childhood significantly predicted depressive symptoms during emerging adulthood (i.e., ages 18-25 years), including the initial level of depressive symptoms, continued levels of depressive symptoms at each age year, and the rate of change in depressive symptoms over time. 394 participants (205 with ADHD and 189 without ADHD; 348 males and 46 females) drawn from the Pittsburgh ADHD Longitudinal Study (PALS) completed annual self-ratings of depressive symptoms between the ages of 18 and 25 years. Childhood history of ADHD significantly predicted a higher initial level of depressive symptoms at age 18, and higher levels of depressive symptoms at every age year during emerging adulthood. ADHD did not significantly predict the rate of change in depressive symptoms from age 18 to age 25. Childhood history of ADHD remained a significant predictor of initial level of depressive symptoms at age 18 after controlling for comorbid psychiatric diagnoses, but not after controlling for concurrent ADHD symptoms and psychosocial impairment. Participants with childhood histories of ADHD experienced significantly higher levels of depressive symptoms than non-ADHD comparison participants by age 18 and continued to experience higher, although not increasing, levels of depressive symptoms through emerging adulthood. Clinical implications and directions for future research are discussed.

Racial Differences in the Transactional Relationship Between Depression and Alcohol Use From Elementary School to Middle School

OBJECTIVE

The aim of this investigation was to test hypothesized reverse prospective relationships between alcohol consumption and depressive symptomatology as a function of race among youth.

METHOD

In a two-wave prospective study, 328 European American, 328 African American, and 144 Hispanic American youth were studied at the end of fifth grade (last year of elementary school) and the end of sixth grade (first year of middle school).

RESULTS

A positive correlation was observed between alcohol consumption and depressive symptoms among all youth. However, the predictive relationship differed based on race. For European American and Hispanic American youth, depressive symptom levels at the end of elementary school predicted alcohol consumption at the end of the first year of middle school, but the converse relationship was not observed. For African American youth, the opposite pattern was found. Alcohol consumption at the end of elementary school predicted depressive symptom levels at the end of the first year of middle school, and the converse relationship was not observed.

CONCLUSIONS

These findings suggest the possibility that etiological relationships between depression and alcohol use vary by race, thus highlighting the importance of considering race when studying the risk process.