Patterns of alcohol consumption and related behaviour in Great Britain: a latent class analysis of the alcohol use disorder identification test (AUDIT)

An empirically based typology of temporary alcohol abstinence challenge participants using latent class analysis

INTRODUCTION

Identifying subgroups of Temporary (alcohol) Abstinence Challenge (TAC) participants may offer opportunities to enhance intervention effectiveness. However, knowledge about such subgroups is missing. This study aimed to (i) describe a TAC population; (ii) identify subgroups of participants based on determinants of changes in drinking behaviour; and (iii) characterise subgroups in terms of sociodemographic and other characteristics.

METHODS

Data from 3803 Dutch TAC participants were analysed to identify subgroups using three-step Latent Class Analysis. Classes were based on determinants of changes in drinking behaviour (i.e., drinking refusal self-efficacy, craving and behavioural automaticity) and were characterised by sociodemographic characteristics, drinking behaviour, previous participation in TACs, self-reported health and life satisfaction.

RESULTS

The majority of TAC participants were female, highly educated, employed, 53 years old on average, participated in previous TACs and reported relatively high alcohol use. Four classes of participants were identified: (i) 'ordinary drinkers' (49.0%); (ii) 'drinkers in control' (21.4%); (iii) 'habitual drinkers with perceived control to refuse' (18.4%); and (iv) 'drinkers not in control' (11.2%). Class 2 drank least often and non-excessive volumes, while other classes typically drank 4 or more days per week and 3 to 4 glasses per drinking day, with the highest alcohol use found in class 4.

DISCUSSION AND CONCLUSIONS

Different configurations of determinants in this study's four subgroups may require different intervention approaches and might inform personalised support. Future research is needed to examine the predictive value of these subgroups on post-challenge drinking behaviour to assess support needs and participation value.

Binge drinking alcohol and circadian misalignment in night shift nurses is associated with decreased resiliency to COVID-19 infection

BACKGROUND

Nurses and other first responders are at high risk of exposure to the SARS-CoV2 virus, and many have developed severe COVID-19 infection. A better understanding of the factors that increase the risk of infection after exposure to the virus could help to address this. Although several risk factors such as obesity, diabetes, and hypertension have been associated with an increased risk of infection, many first responders develop severe COVID-19 without established risk factors. As inflammation and cytokine storm are the primary mechanisms in severe COVID-19, other factors that promote an inflammatory state could increase the risk of COVID-19 in exposed individuals. Alcohol misuse and shift work with subsequent misaligned circadian rhythms are known to promote a pro-inflammatory state and thus could increase susceptibility to COVID-19. To test this hypothesis, we conducted a prospective, cross-sectional observational survey-based study in nurses using the American Nursing Association network.

METHOD

We used validated structured questionnaires to assess alcohol consumption (the Alcohol Use Disorders Identification Test) and circadian typology or chronotype (the Munich Chronotype Questionnaire Shift -MCTQ-Shift).

RESULTS

By latent class analysis (LCA), high-risk features of alcohol misuse were associated with a later chronotype, and binge drinking was greater in night shift workers. The night shift was associated with more than double the odds of COVID-19 infection of the standard shift (OR 2.67, 95% CI: 1.18 to 6.07). Binge drinkers had twice the odds of COVID-19 infection of those with low-risk features by LCA (OR: 2.08, 95% CI: 0.75 to 5.79).

CONCLUSION

Working night shifts or binge drinking may be risk factors for COVID-19 infection among nurses. Understanding the mechanisms underlying these risk factors could help to mitigate the impact of COVID-19 on our at-risk healthcare workforce.

Relationships between adolescent smartphone usage patterns, achievement goals, and academic achievement

As smartphones are emerging as a common device for adolescent, prior studies have provided theoretical and empirical evidence for the factors affecting adolescent smartphone use. However, mainstream research has tended to focus on the negative effects of smartphone. Even though smartphone use can have adverse outcomes, it may also allow students to engage in flexible mobile learning, gain access to important information about their possible future careers and achieve their personal goals. To fill this gap in adolescent smartphone usage, this study explored the smartphone usage patterns of adolescent subpopulations and the associations with their self-control, achievement goals, and academic achievements. Data were collected from 2341 s-year high school students as part of a larger longitudinal panel study. Three distinct smartphone usage profiles were identified in the latent profile analysis: learning, recreational use, and minimal use. Respondents with high perseverance were assigned to the learning group, and respondents with lower compliance and perseverance were assigned to the recreational group. The achievement goal score was found to be the highest in the learning group and lowest in the recreational group. Academic achievement was found to be higher in both the learning and minimal use groups than the recreational use group. Based on these findings, the implications of this study for research and practice are discussed.

Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt

BACKGROUND

Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take 'one-size-fits-all' approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks.

METHODS

We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis.

RESULTS

Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62-3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53-0.81, p < 0.001).

CONCLUSIONS

The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.

Latent alcohol use patterns and their link to depressive symptomatology in medical care patients

AIMS

To investigate latent patterns of alcohol use and bingeing by gender and their association with depressive symptom severity and individual depressive symptoms.

DESIGN

Cross-sectional data were collected from January 2017 to March 2018 as part of a joint screening recruiting for different intervention studies.

SETTING

Ambulatory practices and general hospitals from three sites in Germany.

PARTICIPANTS

A total of 5208 male and 5469 female proactively recruited alcohol users aged 18-64 years.

MEASUREMENTS

Frequency and typical quantity of alcohol use, frequency of bingeing, alcohol-related problems (assessed by the Alcohol Use Disorder Identification Test); depressive symptom severity, individual depressive symptoms (assessed with the Patient Health Questionnaire-8); and socio-demographics and health-related variables.

FINDINGS

Latent categorical analysis identified six patterns of alcohol use, with the majority of patients engaging in 'light use plus no or occasional bingeing' (males: 41.85%; females: 64.04%), followed by 'regular use plus occasional bingeing' (males: 34.03%; females: 16.17%). Multinomial logistic regression analyses (three-step approach with correction for classification uncertainty, as implemented in the Mplus R3STEP command) controlling for socio-demographics and health-related variables revealed that severity of depressive symptoms was positively associated with 'frequent use plus frequent bingeing' when compared with 'light use plus no or occasional bingeing' [relative risk ratio (RRR)_male  = 1.07, 95% confidence interval (CI) = 1.03-1.11; RRR_female  = 1.09, 95% CI = 1.04-1.14]. Severity of depressive symptoms was negatively associated with 'regular use plus occasional bingeing' for males (RRR_male  = 0.98, 95% CI = 0.95-1.00) and positively with 'occasional use plus occasional bingeing' for females (RRR_female  = 1.03, 95% CI = 1.01-1.05) when compared with 'light use plus no or occasional bingeing'. Individual depressive symptoms were differentially associated with alcohol use patterns, with depressed mood, poor appetite or overeating, feelings of worthlessness or guilt and psychomotor agitation or retardation, being especially pronounced in the 'frequent use plus frequent bingeing' class (RRRs_male  = 1.72-2.36; RRRs_female  = 1.99-2.17).

CONCLUSIONS

Patterns of 'frequent alcohol use plus frequent bingeing' and 'occasional alcohol use plus occasional bingeing' appear to have positive associations with depression when compared with 'light alcohol use plus no or occasional bingeing'.

The Alcohol Use Disorders Identification Test (AUDIT) in Adolescents: Using a Model-Based Approach to Identify Patterns of Alcohol Misuse

To explore the latent structure of the Alcohol Use Disorders Identification Test (AUDIT) among adolescents of different school grades (age strata). Methods: Data derived from two simultaneous run cohort studies from the "Adolescent Nutritional Assessment Longitudinal Study-ELANA" conducted in private and public schools of Rio de Janeiro/Brazil. Participants comprised 564 seventh-graders and 419 ninth-graders, respectively sampled in 2011 and 2013 from cohort 1, and 730 eleventh-graders sampled in 2011 from cohort 2. Latent class factor analytical (LCFA) models were applied to the AUDIT items to identify internally homogeneous latent groups of individuals representing distinct patterns of alcohol use, and optimal group-separating cutoffs. The classification agreement was also evaluated. Results: Three and two groups (classes) were found for the eleventh and the earlier grades, respectively. These best-fitting models held a very high degree of class separation (entropy >0.9). By contrasting the AUDIT's raw scores (0-10) with the model-based latent classes, the cutoff separating the base (milder) category was found between scores 0 and 1 in all grades. The eleventh-graders differed from the others by showing a third and more intense category of alcohol use (cutoff between 4 and 5). The classification agreement was almost perfect in eleventh-graders (98.6%) and perfect in the earlier grades (100%). Conclusions: Findings show that the AUDIT may be adequately used in adolescents of different ages and school grades, although the number of homogeneous categories may differ accordingly. Besides, raw scores may be pragmatically used to identify groups with confidence by applying specific optimal cutoffs.

Dynamic Features of Problematic Drinking: Alcohol Use Disorder Latent Classes Across Ages 18-64

Aims

Alcohol use disorders (AUDs) are linked with numerous severe detrimental outcomes. Evidence suggests that there is a typology of individuals with an AUD based on the symptoms they report. Scant research has identified how these groups may vary in prevalence by age, which could highlight aspects of problematic drinking behavior that are particularly salient at different ages. Our study aimed to (a) identify latent classes of drinkers with AUD that differ based on symptoms of AUD and (b) examine prevalences of latent classes by age.

Short summary

Our findings advocate for personalized treatment approaches for AUD and highlight the need for carefully considering the role of age in prevention and intervention efforts.

Methods

We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Current drinkers aged 18-64 who met criteria for a past-year AUD were included (n = 5402).

Results

Latent class analysis (LCA) based on 11 AUD criteria revealed 5 classes: 'Alcohol-Induced Injury' (25%), 'Highly Problematic, Low Perceived Life Interference' (21%), 'Adverse Effects Only' (34%), 'Difficulty Cutting Back' (13%) and 'Highly Problematic' (7%). Using time-varying effect modeling (TVEM), each class was found to vary in prevalence across age. The Adverse Effects Only and Highly Problematic, Low Perceived Life Interference classes were particularly prevalent among younger adults, and the Difficulty Cutting Back and Alcohol-Induced Injury classes were more prevalent as age increased.

Conclusions

Findings suggest that experience of AUD is not only heterogeneous in nature but also that the prevalence of these subgroups vary across age.

Stressful life events influence transitions among latent classes of alcohol use

Stressful life events (SLEs) have been associated with an increased risk of heavy drinking, suggesting individuals may use alcohol to cope with negative life events. However, little research has explored the extent to which SLEs have different effects on later alcohol use based on one's current alcohol use pattern. We replicated prototypical patterns of alcohol use via latent class analysis at Waves 2, 3, and 4 of the National Longitudinal Study of Adolescent to Adult Health (n = 4,569). Latent transition analysis was then used to examine the extent to which SLEs influenced the likelihood of stability or change in class membership from adolescence to early adulthood. Results suggested that adolescents were more likely to transition into different patterns of alcohol use as they entered early adulthood but were more likely to retain the same drinking pattern once in early adulthood. Among those who typically abstained, experiencing SLEs was associated with greater odds of transitioning to heavier drinking or problematic patterns of alcohol use. However, among those who had heavy or problematic alcohol use patterns, SLEs were associated with greater odds of decreasing alcohol use to either heavy or abstaining levels. Results suggest those who previously abstained may begin to use alcohol as a coping mechanism following stressful events, whereas those who drank heavily may decrease or abstain from alcohol use following life stress as a means of enacting positive life changes. The results encourage further study into factors that differentiate changes in alcohol use among light drinkers following SLEs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Heterogeneity in Drinking Practices in England and Wales and Its Association With Violent Behavior: A Latent Class Analysis

BACKGROUND

Crude single-item consumption metrics, such as "binge drinking" measures, mask the complexity and heterogeneity in young people's drinking; thus limiting our understanding of young people's drinking patterns as well as how alcohol drinking is associated with violent outcomes.

OBJECTIVES

The current study employed a range of consumption and contextual indicators to explore heterogeneity in young people's (16-29 years) drinking practices, giving due consideration to their social nature. It also assessed to what extent heterogeneity in drinking practices was associated with violent outcomes.

METHODS

Employing data from the 2006 Offending Crime and Justice Survey, three measures of alcohol consumption and nine drinking context indicators were utilized within latent class analysis to create typologies of drinking practices among current drinkers in England and Wales (n = 2711) and examine their association with violent outcomes. The validity of the typologies was also assessed on age, sex, and socio-economic status.

RESULTS

Three discernible drinking profiles were identified: "regular social drinkers" (48%), "regular pub binge drinkers" (32%), and "moderate drinkers" (20%). The "regular pub binge drinkers" were found to be more than twice as likely to commit an assault offence (odds ratio = 2.8 95% CI [1.3, 6.2]) when compared to "moderate drinkers" and "regular social drinkers" (odds ratio = 2.2 95% CI [1.4, 3.4]).

CONCLUSIONS

Interventions aimed at reducing alcohol-related violence ought to give due consideration to the social context of drinking as well as levels of consumption.

Latent classes of alcohol problems in Mauritian men: Results from the Joint Child Health Project

INTRODUCTION AND AIMS

The purpose of this study was to identify latent classes of alcohol problems and their sociodemographic correlates in the east African nation of Mauritius.

DESIGN AND METHODS

Participants were from the Joint Child Health Project, a longitudinal study of a 1969-1970 birth cohort of 1795 individuals. In mid-adulthood (M = 37 years), all available participants (n = 1206; 67% of the original cohort) were assessed for demographic characteristics, and lifetime drinkers were assessed for alcohol-related problems. Given the low endorsement of problems by women, only male lifetime drinkers (n = 520) were included in the latent class analyses.

RESULTS

Analyses indicated the best-fitting model contained four classes of drinkers: Non-problematic (66%), Moderate (16%), Hazardous (11%) and Severe (6%). Lower education and occupation were associated with Moderate and Severe problem classes, whereas higher education and occupation were associated with the Hazardous class. Being Hindu, Tamil and Creole were differentially predictive of class membership, but being Muslim was not.

DISCUSSION AND CONCLUSIONS

Our findings provide evidence of a distinct Hazardous drinking class that has unique demographic correlates and may represent a cluster of problems that is more bound by cultural factors. We also found problem classes on a severity continuum from none to moderate to severe problems. This study highlights the importance of examining societal, subgroup and person-level factors to produce a more nuanced understanding of distinct classes of alcohol-related problems. [Luczak SE, Prescott CA, Venables PH. Latent classes of alcohol problems in Mauritian men: Results from the Joint Child Health Project.

Mapping risk factors for substance use: Introducing the YouthMap12

BACKGROUND

In adolescence, psychological problems and regular use of alcohol, cigarettes, cannabis and other drugs (AOD) tend to cluster together, strongly indicating that certain groups of young people are at elevated risk of developing a problematic use of AOD.

OBJECTIVE

The aim of the present study was to develop an easy-to-implement screening instrument to identify subgroups of young people with different psychological problems at risk of problem use of AOD.

METHOD

3589 randomly selected young Danes between 15 and 25years of age, from a national survey (n=2702) and a municipality survey (n=887), answered a 12-item questionnaire (YouthMap12) with 6 items identifying externalizing problems (EP6) and 6 items identifying internalizing problems (IP6). Latent class analysis (LCA) was used to characterize groups at risk, and associations were estimated between EP6 and IP6 and regular use of AOD, and between latent class membership and regular use of AOD.

RESULTS

LCA identified 6 classes with varying degrees of externalizing and internalizing problems: 70% of youth were in the low problem score class, and the remaining 30% were at various levels of risk. Regular use of cigarettes, cannabis and alcohol was strongly associated with classes characterized by externalizing problems, while over-the-counter and prescription medicine was strongly associated with classes characterized by internalizing problems.

CONCLUSIONS

Youth at risk of problem use of AOD can be identified using a simple and easily administered instrument.

Sex differences in the latent class structure of alcohol use disorder: Does (dis)aggregation of indicators matter?

Many researchers have argued for a differential presentation of alcohol use disorder (AUD) between men and women. Latent class analysis is the most commonly used analytic technique for modeling AUD subcategories, and latent class analyses have supported a variety of class structures of AUD. This article examines whether these differential results are, in part, an artifact of whether researchers have (a) analyzed men and women in the same analysis and (b) aggregated item-level symptoms into AUD diagnostic criteria prior to analysis. These related methodological issues are examined using Wave 2 data from the National Epidemiologic Survey of Alcohol and Related Conditions (N = 22,177). Direct comparison of results when the sexes are modeled separately or together shows that women are classified differently depending on whether men are included in the analysis. A comparison of disaggregated item-level symptoms and aggregated AUD criteria suggests that aggregating data remove a subgroup, individuals who exhibit tolerance but are normative on all other AUD symptoms, which is of theoretical and clinical interest. Consequently, basic methodological issues that are rarely systematically studied appear to be important determinants of studies seeking to determine whether male and female alcoholism are structurally isomorphic.

Drinking pattern, abstention and problem drinking as risk factors for depressive symptoms: evidence from three urban Eastern European populations

Purpose

To examine whether the frequency and amount of alcohol consumed in binge drinking sessions, total annual volume of alcohol consumed, problem drinking and abstaining from alcohol are associated with depressive symptoms in Eastern Europe.

Subjects and Methods

Cross-sectional data from a total of 24,381 participants from general population samples of the Czech Republic (N = 7,601), Russia (N = 6,908) and Poland (N = 9,872) aged 45–69 years in 2002–2005. Depressive symptoms were defined as ≥16 points on the Centre for Epidemiological Studies – Depression (CES-D) scale. Several alcohol related measures were derived using responses from the graduated frequency questionnaire. Binge drinking was defined at several sex-specific thresholds (ranging from 60+ to 140+ g of ethanol) and two frequencies (at least monthly or weekly). Total annual alcohol intake in grams was also extracted. Problem drinking was defined as ≥2 positive answers on the CAGE questionnaire.

Results

Problem drinking was consistently associated with approximately a 2-fold increase in odds of depressive symptoms across all countries and in both sexes. Abstaining from alcohol was typically associated with increased odds of depressive symptoms. Analyses separating lifelong abstainers and former drinkers in the Russian cohort revealed that this increased odds was driven by former drinkers. Amongst men, heavy frequent binge drinking was associated with increased odds of depressive symptoms in the Czech Republic and Poland. In women, heavy infrequent binge drinking was associated with increased odds of depressive symptoms in Russia and Poland. Only in Polish men was higher annual volume of alcohol intake associated with increased odds of depressive symptoms.

Conclusion

Abstaining from alcohol and problem drinking were associated with increased odds of depressive symptoms in these Eastern European populations. Annual volume of alcohol intake as well as frequency and amount of alcohol consumed in a binge drinking session were less consistently associated with depressive symptoms.

An exploration of the dynamic longitudinal relationship between mental health and alcohol consumption: a prospective cohort study

BACKGROUND

Despite intense investigation, the temporal sequence between alcohol consumption and mental health remains unclear. This study explored the relationship between alcohol consumption and mental health over multiple occasions, and compared a series of competing theoretical models to determine which best reflected the association between the two.

METHODS

Data from phases 5 (1997 to 1999), 7 (2002 to 2004), and 9 (2007 to 2009) of the Whitehall II prospective cohort study were used, providing approximately 10 years of follow-up for 6,330 participants (73% men; mean ± SD age 55.8 ± 6.0 years). Mental health was assessed using the Short Form (SF)-36 mental health component score. Alcohol consumption was defined as the number of UK units of alcohol drunk per week. Four dynamic latent change score models were compared: 1) a baseline model in which alcohol consumption and mental health trajectories did not influence each other, 2) and model in which alcohol consumption influenced changes in mental health but mental health exerted no effect on changes in drinking and 3) vice versa, and (4) a reciprocal model in which both variables influenced changes in each other.

RESULTS

The third model, in which mental health influenced changes in alcohol consumption but not vice versa, was the best fit. In this model, the effect of previous mental health on upcoming change in alcohol consumption was negative (γ = -0.31, 95% CI -0.52 to -0.10), meaning that those with better mental health tended to make greater reductions (or shallower increases) in their drinking between occasions.

CONCLUSIONS

Mental health appears to be the leading indicator of change in the dynamic longitudinal relationship between mental health and weekly alcohol consumption in this sample of middle-aged adults. In addition to fuelling increases in alcohol consumption among low-level consumers, poor mental health may also be a maintaining factor for heavy alcohol consumption. Future work should seek to examine whether there are critical levels of alcohol intake at which different dynamic relationships begin to emerge between alcohol-related measures and mental health.

Predictors of drinking patterns in adolescence: a latent class analysis

BACKGROUND

Uni-dimensional measures of alcohol consumption may be unable to fully capture the complexity of adolescent drinking and experience of alcohol-related harms. Latent class analysis provides an empirical method to understand different adolescent drinking patterns.

METHODS

Latent class analysis was used to create typologies of drinking among the 5018 current drinkers in the national Youth '07 survey. Determinants of drinking patterns were identified using multinomial logistic regression.

RESULTS

Four latent classes were identified, demonstrating an overall increase in risk of alcohol-related outcomes from increasing consumption. One class strongly deviated from this pattern, having moderate consumption patterns but disproportionately high levels of alcohol-related problems. Multinomial logistic regression found that the strongest predictors of belonging to high-risk drinking typologies were having a positive attitude to regular alcohol use, buying own alcohol, peers using alcohol, and obtaining alcohol from friends and/or other adults. Other significant predictors included being male, having a strong connection to friends, having parents with a low level of knowledge of their daily activities and poor connection to school. Class membership also varied by ethnicity.

CONCLUSION

The latent class approach demonstrated variability in alcohol-related harms across groups of students with different drinking patterns. Longitudinal studies are necessary to determine the causes of this variability in order to inform the development of targeted policy and preventative interventions. Legislative controls, such as increasing the legal purchase age and reducing the commercial availability of alcohol, will continue to be important strategies for reducing harm in young people.

Self-regulation and alcohol use involvement: a latent class analysis

Although alcohol use can be problematic, research suggests considerable heterogeneity in problems across various drinking classes; particularly among the heaviest drinking groups. Differences in self-regulation may differentiate drinking classes. The current study evaluated differences in emotional and behavioral self-regulation across four empirically derived drinking classes. Participants (n=1895 college students) completed online measures of demographics, alcohol involvement, and self-regulation. Using latent class analysis (LCA), four drinking classes were empirically derived. Moderate drinkers were the largest class (38.1%) followed by light drinkers (37.4%), heavy drinkers (17.8%), and problem drinkers (6.8%). Each class was predicted by self-regulation indicators in the LCA. With the exception of urgency, behavioral self-regulation distinguished primarily between light drinkers and the other three classes. Emotional self-regulation and urgency were not associated with use, but did distinguish among the most problematic class. Specifically, emotional instability and urgency were higher in the problem use class than all other classes. Overall, the findings suggest important differences in behavioral and emotional self-regulation across drinking classes that differentially contribute to use and consequences. Further, the results highlight the importance of examining homogenous subpopulations of drinkers that may differ on indices other than consumption.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Task-values across subject domains: A gender comparison using a person-centered approach

This study examined what kinds of groups can be identified according to students’ task-values across four subject domains (languages, math and science, social sciences, practical subjects) and the related gender differences using a person-centered approach. Latent class analysis was applied to classify 638 students (mean age = 15) into four task-value groups, namely, all-subjects (55%), practical-subjects (5.7%), high-math-and-science (20.2%) and low-math-and-science (19.1%) groups. Significant gender differences were found: boys dominated the high-math-and-science group (boys = 98%), while girls dominated the low-math-and-science group (girls = 82%). Compared to the low-math-and-science group, the high-math-and-science group reported a stronger tendency in furthering their studies immediately after the completion of compulsory education.

Subtypes of sleep disturbance: associations among symptoms, comorbidities, treatment, and medical costs

Medical claims and survey data were used to evaluate patients with sleep disturbance lasting 1 year or more, and to identify subtypes of sleep disturbance using latent class analysis. Four subtypes were identified from the 1,374 patients. Subtypes differed on the number of sleep disturbance symptoms, presence of non-restorative sleep and comorbidities, degree of daytime impairment, and insomnia severity. The results from this study suggest that patient-reported symptoms of sleep disturbance, the frequency of symptoms, functional impairment, and comorbid conditions are important elements in distinguishing among groups of patients with varying degrees of sleep problems. These data provide evidence that the Insomnia Severity Index (ISI) varies accordingly with the frequency and resulting impairment of symptoms captured in the 4 clusters.

Life course social mobility and risk of upper aerodigestive tract cancer in men

The aim of this study was to explore associations between social mobility and tumours of the upper aero-digestive tract (UADT), focussing on life-course transitions in social prestige (SP) based on occupational history. 1,796 cases diagnosed between 1993 and 2005 in ten European countries were compared with 1585 controls. SP was classified by the Standard International Occupational Prestige Scale (SIOPS) based on job histories. SIOPS was categorised in high (H), medium (M) and low (L). Time weighted average achieved and transitions between SP with nine trajectories: H --> H, H --> M, H --> L, M --> H, M --> M, M --> L, L --> H, L --> M and L --> L were analysed. Odds ratios (ORs) and 95%-confidence intervals [95%-CIs] were estimated with logistic regression models including age, consumption of fruits/vegetables, study centre, smoking and alcohol consumption. The adjusted OR for the lowest versus the highest of three categories (time weighted average of SP) was 1.28 [1.04-1.56]. The distance of SP widened between cases and controls during working life. The downward trajectory H --> L gave an OR of 1.71 [0.75-3.87] as compared to H --> H. Subjects with M --> M and L --> L trajectories ORs were also elevated relative to subjects with H --> H trajectories. The association between SP and UADT is not fully explained by confounding factors. Downward social trajectory during the life course may be an independent risk factor for UADT cancers.

Mental health symptoms in relation to socio-economic conditions and lifestyle factors--a population-based study in Sweden

BACKGROUND

Poor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990 s. There is a need for a better understanding of the area for planning preventive activities and health care.

METHODS

The study is based on a postal survey questionnaire sent to a random sample of men and women aged 18-84 years in 2004. The overall response rate was 64%. The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden. The study population includes 42,448 respondents. Mental health was measured with self-reported symptoms of anxiety/depression (EQ-5D, 5th question). The association between socio-economic conditions, lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models.

RESULTS

About 40% of women and 30% of men reported that they were moderately or extremely anxious or depressed. Younger subjects reported poorer mental health than older subjects, the best mental health was found at ages 65-74 years. Factors that were strongly and independently related to mental health symptoms were poor social support, experiences of being belittled, employment status (receiving a disability pension and unemployment), economic hardship, critical life events, and functional disability. A strong association was also found between how burdensome domestic work was experienced and anxiety/depression. This was true for both men and women. Educational level was not associated with mental health symptoms. Of lifestyle factors, physical inactivity, underweight and risk consumption of alcohol were independently associated with mental health symptoms.

CONCLUSION

Our results support the notion that a ground for good mental health includes balance in social relations, in domestic work and in employment as well as in personal economy both among men and women. In addition, physical inactivity, underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors.