Changes in prevalence and correlates of alcohol-use disorders in Finland in an 11-year follow-up

Associations of broad eating disorder symptoms with later alcohol problems in Finnish adult twins: A nationwide 10-year follow-up

OBJECTIVE

Eating disorders are associated with subsequent alcohol problems, but it is not known whether this association also extends to broader eating disorder symptoms not captured by clinical diagnoses. We assessed the longitudinal association of broad eating disorder symptoms with alcohol problems in a nationwide twin sample (FinnTwin16).

METHODS

Finnish women (N = 1905) and men (N = 1449) self-reported their eating disorder symptoms using the Eating Disorder Inventory-2 Bulimia, Drive for Thinness, and Body Dissatisfaction subscales at the mean age of 24.4 years in 2000-2003. A subsample of participants also completed items on drive for muscularity, height dissatisfaction, and muscle-enhancing supplement use. Alcohol problems were assessed 10 years later at the age of 34.1 in 2010-2012 with the Rutgers Alcohol Problem Index.

RESULTS

Eating disorder symptoms were associated with later alcohol problems (odds ratio per point increase 1.02-1.18). Bulimia showed stronger associations among men than women (p for interaction .012). Drive for muscularity and height dissatisfaction were also associated with later alcohol problems, but supplement use was not. When accounting for baseline alcohol problems, only Bulimia (among women and men) and Drive for Thinness (among men) were significantly associated with later alcohol problems. Bulimia was also significantly associated with later alcohol problems in within-twin-pair analyses among dizygotic twins, but not among monozygotic twins.

DISCUSSION

In a longitudinal setting, eating disorder symptoms were associated with later alcohol problems. Bulimic symptoms were a stronger risk factor for men than women. These associations may be attributable to baseline alcohol problems, childhood environment and genetic liability.

PUBLIC SIGNIFICANCE

This study found that both young adult women and men with broad eating disorder symptoms are at a higher risk of alcohol-related problems than those without such symptoms. Men with bulimic symptoms were at a particularly high risk. These findings emphasize the need for better prevention and treatment of disordered eating, body image concerns and alcohol problems for both young adult women and men.

Relationship between sensation seeking, alcohol problems and bulimic symptoms: a community-based, longitudinal study

PURPOSE

The association of bulimic symptoms with sensation seeking is uncertain; however, both behaviors have been linked to alcohol problems. We assessed in a longitudinal, community-based setting whether sensation seeking in adolescence is associated with bulimic symptoms in early adulthood, also accounting for alcohol problems.

METHODS

Finnish men (N = 2000) and women (N = 2467) born between 1974-1979 completed Zuckerman's sensation seeking scale (SSS) at age 18. Alcohol problems (Malmö-modified Michigan alcoholism screening test (Mm-MAST) and bulimic symptoms [eating disorder inventory-2, bulimia subscale (EDI-Bulimia), population and clinical scoring systems] were defined at age 22-27. We examined relationships between SSS, Mm-MAST, and EDI-Bulimia using Pearson's correlation coefficient (r) and linear regression.

RESULTS

Alcohol problems were moderately correlated with sensation seeking and bulimic symptoms (population scoring) among women and men (r = 0.21-0.31). The correlation between sensation seeking and bulimic symptoms (population scoring) was weak among men (r = 0.06, p = 0.006) and even weaker and non-significant among women (r = 0.03, p = 0.214). Adjustment for alcohol problems removed the association between sensation seeking and bulimic symptoms among men. Furthermore, there were no significant correlations between sensation seeking and bulimic symptoms when assessing EDI-Bulimia clinical scoring.

CONCLUSION

Sensation seeking and bulimic symptoms were not associated among women. The association between sensation seeking and bulimic symptoms among men was entirely attributable to increased alcohol problems among those with higher sensation seeking. While this association may be important on the population level, its clinical significance may be minor.

LEVEL OF EVIDENCE

Level III, well-designed cohort study.

Occupational health care personnel tackling alcohol overuse - an observational study of work processes and patient characteristics

Background

Overuse of alcohol is a significant risk factor for early retirement. This observational study investigated patient characteristics and work processes in occupational health care (OHC) affecting practices in tackling alcohol overuse.

Methods

The data were from 3089 patient contacts gathered for quality improvement purposes in fifteen OHC units during the years 2013–2019 in Finland. A two-proportion z-test was performed to find associations between reason for contact, and 17 other factors, and the probability of alcohol use being checked and overuse tackled.

Results

OHC personnel checked alcohol use twice as often with male patients as with female patients. Employees at risk of needing sick leave were checked for alcohol use more often (55.4, 95% confidence interval 49.2–61.6%) than those on > 30-day sick leave or working with permanent work disability (p < 0.01). Alcohol use was checked in 64.1% (59.5–68.7%) of patients while making an individual health promotion plan compared to 36.9% of those without a plan (33.1–40.6%, p < 0.0001). Patients with depression were actively checked for alcohol use, especially in cases of major depression (72.7%, 64.0–81.0%). Work processes in which OHC should have been more active in checking and tackling alcohol use included assessing the need for rehabilitation (36.5%, 32.0–41.0%) and health check-ups (HCUs) for mental reasons (43.8%, 38.1–49.4%). HCUs where alcohol overuse was detected led to brief interventions to tackle the overuse in 58.1% (43.4–72.9%) of cases.

Conclusions

The study showed factors that increased OHC personnel’s practices in checking and tackling alcohol use and work processes where the activity should be improved. Discussions about alcohol use took place more often with working-aged men than women, the younger the more. OHC personnel checked actively alcohol use with patients in danger of sick leave, patients treated for depression, while making an individual health promotion plan, and in planned HCUs with a confirmed protocol. More improvement is needed to conduct brief interventions in disability prevention processes, and especially when overuse is detected.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12473-2.

Comorbid alcohol use disorder in psychiatric MDD patients: A five-year prospective study

BACKGROUND

Comorbid alcohol use disorder (AUD) is common among patients with major depressive disorder (MDD), and often complicates presentation and treatment. However, there is a scarcity of clinical studies investigating the characteristics and outcome of psychiatric MDD patients with AUD.

METHODS

In the Vantaa Depression Study (VDS), a five-year prospective study of psychiatric out- and inpatients (N = 269) with MDD, we investigated the clinical features of MDD, comorbid Axis I and II disorders, psychosocial factors, and long-term outcome of patients with or without AUD.

RESULTS

Depressed patients with comorbid AUD at baseline (n = 66/269, 24.5%) were more often male (OR=3.57, [95% CI 1.72 - 7.41], p = 0.001), had more suicidal ideation (OR=1.06 [1.02 - 1.11], p = 0.008), comorbid panic disorders (OR=3.44 [1.47 - 8.06], p = 0.004), symptoms of any personality disorder (OR=1.04 [1.00 - 1.08], p = 0.038), and more often smoked daily (OR=2.79 [1.32 - 5.88], p = 0.007) than those without. At five years, 13.9% (25/180) still had AUD. More specifically, alcohol abuse was associated with suicide attempts, and dependence with suicidal ideation, and Cluster B personality disorder. Patients with AUD spent more time depressed and had more suicide attempts during follow-up.

LIMITATIONS

We did not investigate other substance use disorders. The AUD diagnoses were based on DSM-IV criteria.

CONCLUSIONS

Psychiatric MDD patients with comorbid alcohol use disorders have characteristics consistent with the epidemiology of AUDs in the general population. They are more often males and smoke, and have more comorbid mental disorders and suicidal behavior. Prospectively they spend more time depressed, thus having worse outcomes than patients without AUDs.

Alcohol habits in Sweden during 1997-2018: a repeated cross-sectional study

Aims: This study describes changes in alcohol habits in age and gender strata among the Swedish general population during the 21-year period following the Swedish EU membership in 1995. Methods: The Alcohol Use Disorders Identification Test (AUDIT) was distributed as a postal questionnaire to randomly selected cross-sectional samples every fourth year, starting in 1997. Results: Six samples were included in this study. A comparison between 2014 and 2018 showed a tendency to decreasing average total AUDIT scores, particularly among men and in the youngest age group (Cohen's d = 0.28). Conclusion: The results should be understood in the context of declining response rates in this type of survey.