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

Combined healthy lifestyles and risk of depressive symptoms: A baseline survey in China

BACKGROUND

Little evidence exists about whether a combination of healthy lifestyle factors is associated with a lower risk of depressive symptoms among Chinese population. We aimed to investigate the association between combined healthy lifestyle factors and risk of depressive symptoms.

METHODS

We conducted a baseline survey from July 2021 to December 2023, including 53,642 Chinese adults from general population. A healthy lifestyle score was constructed based on six lifestyle factors (physical activity, smoking status, alcohol consumption, diet, sleep duration, and body mass index). Logistic regression models were used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) adjusted for confounding variables.

RESULTS

Each additional healthy lifestyle score was associated with a 20 % lower risk of having depressive symptoms (OR (95 % CI): 0.80 (0.78-0.81)). Compared with individuals with ≤2 healthy lifestyle factors, individuals with all the six healthy lifestyle factors had a 58 % reduced risk of having depressive symptoms (0.42 (0.37-0.47)). After stratification by gender, education and urbanization, the significant inverse association with healthy lifestyle score was stronger in women, individuals with high education, and urban residents. Besides, the significant negative association between healthy lifestyle score and depressive symptoms remained for different severity of depressive symptoms.

LIMITATIONS

Given the cross-sectional nature of data, we cannot make causal inferences.

CONCLUSIONS

Our study indicated that adherence to healthy lifestyle factors was associated with a reduced risk of having depressive symptoms among Chinese adults. The observed associations were modified by gender, education and urbanization. These findings warrant further verification in interventional studies.

Socioeconomic disparities in alcohol-related depression: a national cohort study of low-income medical aid beneficiaries and national health insurance beneficiaries in Korea

OBJECTIVE

To examine the association between patterns of alcohol consumption in the past and the risk of depression among medical aid beneficiaries and National Health Insurance beneficiaries in Korea.

METHODS

We used data from the National Health Information Database (NHID) of 1,292,618 participants who underwent health checkups in 2015-16 and 2017-18. We categorized alcohol consumption into four groups: continuous high, increased, decreased, and non-consumers. We followed the participants from 2019 to 2021 and identified new episodes of depression. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for depression by alcohol consumption groups and socioeconomic status.

RESULTS

Medical aid beneficiaries had higher risks of depression than National Health Insurance beneficiaries across all alcohol consumption groups. The highest risk was observed among continuous high consumers (aOR, 2.31; 95% CI, 1.36-3.93), followed by increased (aOR, 1.51; 95% CI, 1.17-1.94), decreased (aOR, 1.48; 95% CI, 1.18-1.84), and non-consumers (aOR, 1.37; 95% CI, 1.22-1.54).

CONCLUSIONS

Socioeconomic status and patterns of alcohol consumption in the past are associated with the risk of depression. Public health interventions should consider both factors to reduce alcohol-related depression and health inequalities.

Long-term effects of alcohol consumption on anxiety in adults: A systematic review

OBJECTIVE

Despite the high prevalence and comorbidity of alcohol consumption and anxiety, it is unclear whether alcohol consumption influences long-term anxiety. This study aimed to systematically review the literature on the long-term longitudinal effects of alcohol consumption on anxiety in adults.

METHODS

EMBASE, PsychInfo, Medline, and Web of Science databases were systematically searched from inception to April 12th, 2024. Articles analysing the relationship between alcohol consumption and anxiety symptoms or anxiety disorder diagnosis at least three-months later in adults were eligible. Articles were screened and extracted by two independent reviewers with study quality assessed using the Mixed Methods Appraisal Tool.

RESULTS

From 884 records, eight studies of mixed quality met inclusion criteria. One study using a sample representative of the USA population found low volume consumption was associated with lower long-term anxiety. All other studies used a convenience sample or a specific medical population sample. The significance and direction of the relationship between alcohol consumption and long-term anxiety in these studies varied, likely due to differences in alcohol consumption thresholds used and populations studied.

CONCLUSIONS

A paucity of research on the longitudinal effects of alcohol consumption on anxiety was found, highlighting a significant gap in the research literature. Furthermore, existing research, primarily focussed on clinical subpopulations, has yielded mixed results. Further research is needed to explore the longitudinal dose dependent impact of alcohol consumption on anxiety using samples representative of national populations.

Association of nature of work and work-related characteristics with cognitive functioning, life satisfaction and depression among Indian ageing adults

BACKGROUND

Most individuals spend a significant amount of their time at work, and the dynamics at work can potentially influence their overall life, especially health and mental health. The present study tried to understand the association of the nature of work categorized as physically demanding, psychologically demanding, and environmentally hazardous on life satisfaction, cognitive functioning, and depressive symptoms among working middle-aged and older adults in India.

METHOD

We used data from the Longitudinal Ageing Study in India (LASI), Wave 1, collected between 2017 and 2018. The study sample consists of 28,653 working adults aged between 45 and 70. The study measures were assessed using standard tools. Linear regression analysis was employed.

RESULTS

The results indicate that individuals working in less physically demanding (β = 0.06, 99% CI = 0.02-0.09) and not hazardous environments (β = 0.15, 99% CI = 0.09-0.20) had better life satisfaction. Also, not being involved in hazardous work environments increased the likelihood of good cognitive functioning and reduced depressive symptoms (β= -0.17, 99% CI= -0.20- -0.15). However, samples involved in works requiring less psychological demand had an increased likelihood of reduced life satisfaction and increased depressive symptoms.

CONCLUSION

This study's results highlight the importance of creating a conducive working environment for the ageing adults.

Risk of major depressive increases with increasing frequency of alcohol drinking: a bidirectional two-sample Mendelian randomization analysis

Introduction

A growing body of evidence suggests that alcohol use disorders coexist with depression. However, the causal relationship between alcohol consumption and depression remains a topic of controversy.

Methods

We conducted a two-sample two-way Mendelian randomization analysis using genetic variants associated with alcohol use and major depressive disorder from a genome-wide association study.

Results

Our research indicates that drinking alcohol can reduce the risk of major depression (odds ratio: 0.71, 95% confidence interval: 0.54~0.93, p = 0.01), while increasing the frequency of drinking can increase the risk of major depression (odds ratio: 1.09, 95% confidence interval: 1.00~1.18, p = 0.04). Furthermore, our multivariate MR analysis demonstrated that even after accounting for different types of drinking, the promoting effect of drinking frequency on the likelihood of developing major depression still persists (odds ratio: 1.13, 95% confidence interval: 1.04~1.23, p = 0.005). Additionally, mediation analysis using a two-step MR approach revealed that this effect is partially mediated by the adiposity index, with a mediated proportion of 37.5% (95% confidence interval: 0.22 to 0.38).

Discussion

In this study, we found that alcohol consumption can alleviate major depression, while alcohol intake frequency can aggravate it.These findings have important implications for the development of prevention and intervention strategies targeting alcohol-related depression.

Alcohol use disorder as a moderator of the relationship between posttraumatic stress disorder and suicidality among military personnel

BACKGROUND

Alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and suicide are substantial public health concerns among military service members, yet the nature of their relationships is not well understood. Here, we tested the hypothesis that AUD moderates the relationship between PTSD symptom severity and suicidal ideation.

METHODS

This secondary analysis uses data collected at baseline for a randomized clinical trial. The sample consists of 160 active-duty service members from three service branches (Army, Air Force, and Navy). All participants met diagnostic criteria for PTSD and were not engaged in evidence-based PTSD treatment at the time of enrollment. Zero-inflated Poisson generalized linear regression models were used to test the associations of PTSD and AUD symptom severity with the presence and severity of suicidal ideation.

RESULTS

Findings suggest that AUD symptom severity moderates (i.e., amplifies) the relationship between PTSD symptoms and severity of suicidal ideation among military personnel with untreated PTSD. Among service members with mild or absent AUD, we found no significant association between PTSD symptoms and the severity of suicidal ideation. However, when AUD severity was average (i.e., sample mean) or high (mean + 1SD), PTSD symptoms were significantly positively associated with the severity of suicidal ideation.

CONCLUSIONS

This study highlights the importance of assessing AUD and PTSD as a part of suicide risk evaluations of veterans. The results also provide strong support for the maintenance and further development in the military health system of treatment programs that simultaneously address AUD and PTSD comorbidity.

The Association of Central Sensitisation with Depression, Anxiety, and Somatic Symptoms: A Cross-Sectional Study of a Mental Health Outpatient Clinic in Japan

For patients with chronic pain and persistent physical symptoms, understanding the mechanism of central sensitisation may help in understanding how symptoms persist. This cross-sectional study investigated the association of central sensitisation with depression, anxiety, and somatic symptoms. Four hundred and fifteen adults attending an outpatient psychosomatic clinic were evaluated. Participants completed the Hospital Anxiety and Depression Scale, Somatic Symptom Scale 8, and the Central Sensitisation Inventory. The relationships between these factors were examined using descriptive statistics and multiple logistic regression analyses. The mean age was 42.3 years, and 59% were female. The disorders included adjustment disorders (n = 70), anxiety disorders (n = 63), depressive disorders (n = 103), feeding and eating disorders (n = 30), sleep-wake disorders (n = 37), somatic symptoms and related disorders (n = 84), and others (n = 28). In multiple logistic regression analyses, higher central sensitisation was associated with more severe anxiety, depression, and somatic symptoms after controlling for potential confounders. In the disease-specific analysis, somatic symptoms correlated more positively with central sensitisation than with depression or anxiety. Central sensitisation and depression, anxiety, and somatic symptoms were associated with patients attending an outpatient clinic. These findings highlight the importance of evaluating depression, anxiety, and somatic symptoms when assessing central sensitisation.

Is low-level alcohol consumption really health-protective? A critical review of approaches to promote causal inference and recent applications

Heavy and disordered alcohol consumption is a known risk factor for several health conditions and is associated with considerable disease burden. However, at low-to-moderate levels, evidence suggests that drinking is associated with reduced risk for certain health outcomes. Whether these findings represent genuine protective effects or mere methodological artifacts remains unclear, but has substantial consequences for policy and practice. This critical review introduces methodological advances capable of enhancing causal inference from observational research, focusing on the 'G-methods' and Mendelian Randomization. We also present and evaluate recent research applying these methods and compare findings to the existing evidence base. Future directions are proposed for improving our causal understanding of the relationships between alcohol and long-term health outcomes.

Healthy lifestyle and the risk of depression recurrence requiring hospitalisation and mortality among adults with pre-existing depression: a prospective cohort study

BACKGROUND

Although lifestyle-based treatment approaches are recommended as important aspects of depression care, the quantitative influence of aggregated healthy lifestyles on depression recurrence and mortality remains unknown.

OBJECTIVE

To investigate the association between healthy lifestyle and the risks of first-time hospitalisation for recurrent depression and mortality.

METHODS

26 164 adults with depression (mean (SD) age, 56.0 (7.9) years) were included from UK Biobank between 2006 and 2010 and followed up until 2022. Depression was defined as a physician's diagnosis in hospital admissions or the use of prescribed antidepressant medication. A weighted healthy lifestyle score (HLS) was calculated based on smoking, alcohol consumption, diet, sleep pattern, physical activity, social health, employment status and greenspace interaction.

FINDINGS

Over a 13.3-year follow-up, 9740 cases of first-time hospitalisation due to depression recurrence and 1527 deaths were documented. Compared with the lowest HLS tertile, the highest tertile was associated with a 27% lower risk (HR=0.73, 95% CI 0.69 to 0.77) of first-time hospitalisation for depression recurrence and a 22% (HR=0.78, 95% CI 0.68 to 0.91) lower risk of mortality among adults with depression. Lower risks of first-time hospitalisation for depression recurrence were observed among those who smoked less, drank more alcohol, followed healthier diets and sleep patterns, spent more time employed in current job or had greater exposure to greenspace.

CONCLUSION AND IMPLICATIONS

Greater adherence to healthy lifestyle was associated with a lower risk of hospitalisation and mortality among adults with pre-existing depression. Incorporating behaviour modification as an essential part of clinical practice for depressed patients could complement medication-based therapies.

The Relationship between Age at Initiation of Regular Drinking of Alcohol and Viral Suppression Status, and Depression Symptoms Among People Living with HIV in South-Western Uganda

Alcohol use is an important factor in achieving and maintaining viral suppression and optimal mental health among persons with HIV (PWH), however, the effect of age at first regular drinking on viral suppression and depression remains poorly understood. Here, using secondary data from the Alcohol Drinkers' Exposure to Preventive Therapy for Tuberculosis (ADEPT-T) study, we used logistic regression analyses to explore whether there is an association between age at first regular drinking and viral suppression (< 40 copies/ml), or presence of depressive symptoms (Center for Epidemiologic Studies Depression, CES-D ≥ 16) among 262 PWH. The median age at first regular drinking was 20.5 years (IQR: 10), with high proportions starting under age 12 (12.2%) and as teens (13.4%). The majority had an undetectable viral load (91.7%) and 11% had symptoms of probable depression. We found no significant association between age at first regular drinking and viral suppression (i.e., child (aOR = 0.76 95%CI: 0.18, 3.26), adolescent (aOR = 0.74 95%CI: 0.18, 2.97) and young adult (aOR = 1.27 95%CI: 0.40, 3.97)) nor with depressive symptoms (i.e., child (aOR = 0.72 95%CI: 0.19, 2.83), adolescent (aOR = 0.59 95%CI: 0.14, 2.50) and young adult (aOR = 0.57 95%CI: 0.22, 1.53)). Age at first regular drinking among PWH did not appear to be associated with either viral suppression or the presence of depressive symptoms, suggesting interventions may best be focused on the harmful effects of current alcohol use.

Factors associated with psychological distress of workers in the Finnish Evangelical Lutheran Church

BACKGROUND

The work of church employees contains many elements causing symptoms of stress and anxiety. They can lead into psychological distress and possibly indicate the beginning of a more serious psychological state. Women seem to be more disposed to psychological stress than men. We investigated factors contributing to psychological distress among women and men in four professions of the Evangelical Lutheran Church of Finland (ELCF).

METHODS

A link to an electronic survey was sent to the members of respective trade unions of four professions of the ELCF, and we got responses from pastors (n = 241), church musicians (n = 92), diaconal workers (n = 85) and youth workers (n = 56). Psychological distress was assessed using the Mental Health Inventory-5 (MHI-5; cut-off value ≤ 52 indicating severe distress). We used logistic regression to examine sociodemographic, health-related, and work-related factors that could potentially be associated with psychological distress.

RESULTS

We found severe psychological distress in all profession groups. Gender differences were scarce. Loneliness was the most important factor associated with psychological distress in both men and women (OR 14.01; 95% CI 2.68-73.25 and OR 7.84; 3.44-17.88, respectively), and among pastors and church musicians (OR 8.10; 2.83-23.16 and OR 24.36; 2.78-213.72, respectively). High mental strain of work was associated with distress in women (OR 2.45; 1.01-5.97). Good work satisfaction was a protective factor for men and women (OR 0.06; 95% CI 0.01-0.40 and OR 0.61; 0.18-0.40, respectively) and for pastors and church musicians (OR 0.22; 0.08-0.73 and OR 0.06; 0.01-0.43, respectively). For women, additional protective factors were being a pastor (OR 0.26; 0.07-0.95), or youth worker (OR 0.08; 0.01-0.48), and good self-reported health (OR 0.38; 0.18-0.82).

CONCLUSION

Even though we found some protective factors, the share of workers with severe distress was higher in all profession groups of the ELCF than in the general population. Loneliness was the strongest stressor among both genders and high mental strain among women. The result may reflect unconscious mental strain or subordination to the prevailing working conditions. More attention should be paid to the mental wellbeing and work conditions of church employees.

Construction of a depression risk prediction model for type 2 diabetes mellitus patients based on NHANES 2007-2014

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent global health issue that has been linked to an increased risk of depression. The objective of this study was to construct a nomogram model for predicting depression in T2DM patients.

METHODS

A total of 4280 patients with T2DM were included in this study from the 2007-2014 NHANES. The entire dataset was split randomly into training set comprising 70 % of the data and a validation set comprising 30 % of the data. LASSO and multivariate logistic regression analyses identified predictors significantly associated with depression, and the nomogram was constructed with these predictors. The model was assessed by C-index, calibration curve, the hosmer-lemeshow test and decision curve analysis (DCA).

RESULTS

The nomogram model comprised of 9 predictors, namely age, gender, PIR, BMI, education attainment, smoking status, LDL-C, sleep duration and sleep disorder. The C-index of the training set was 0.780, while that of the validation set was 0.752, indicating favorable discrimination for the model. The model exhibited excellent clinical applicability and calibration in both the training and validation datasets. Moreover, the cut-off value of the nomogram is 223.

LIMITATIONS

This study has shortcomings in data collection, lack of external validation, and results non-extrapolation.

CONCLUSIONS

Our nomogram exhibits high clinical predictability, enabling clinicians to utilize this tool in identifying high-risk depressed patients with T2DM. It has the potential to decrease the incidence of depression and significantly improve the prognosis of patients with T2DM.

Bidirectional associations between alcohol drinking and depressive symptom scores among US older adults

BACKGROUND

This study examines the bidirectional associations between alcohol drinking and depression in which low to moderate alcohol drinking may reduce the risk of depression, while the occurrence of depression may increase the amount of alcohol drinking as a coping strategy.

METHOD

Data for the community-dwelling older adults from the Medicare Current Beneficiary Survey (MCBS) 2016 to 2019 were analyzed using random intercept cross-lagged panel models to explore the within-individual causal associations for males and females separately. Socioeconomic status (SES), smoking and comorbidities were adjusted in the models.

RESULTS

Among 3388 older adults with three measures for the number of alcohol drinks and Patient Health Questionnaire (PHQ) depression scores, a prior increase in the number of drinks was related to a moderate non-significant decrease in PHQ scores in the follow-up, but a previous increase in the PHQ scores was significantly associated with a decrease in the number of drinks at the follow-up visit in the adjusted models (regression coefficient = -0.144, p = 0.017 for males; and coefficient = -0.11, p < 0.001 for females).

CONCLUSION

Prior depression may lead to reduced drinking in the follow up visits, but no bidirectional association was found among US older adults.

Socioeconomic position indicators and risk of alcohol-related medical conditions: A national cohort study from Sweden

BACKGROUND

Alcohol consumption contributes to excess morbidity and mortality in part through the development of alcohol-related medical conditions (AMCs, including alcoholic cardiomyopathy, hepatitis, cirrhosis, etc.). The current study aimed to clarify the extent to which risk for these outcomes differs as a function of socioeconomic position (SEP), as discrepancies could lead to exacerbated health disparities.

METHODS AND FINDINGS

We used longitudinal Swedish national registries to estimate the individual and joint associations between 2 SEP indicators, educational attainment and income level, and risk of AMC based on International Classification of Diseases codes, while controlling for other sociodemographic covariates and psychiatric illness. We conducted Cox proportional hazards models in sex-stratified analyses (N = 1,162,679 females and N = 1,196,659 males), beginning observation at age 40 with follow-up through December 2018, death, or emigration. By the end of follow-up, 4,253 (0.37%) females and 11,183 (0.93%) males had received an AMC registration, corresponding to overall AMC incidence rates among females and males of 2.01 and 5.20, respectively. In sex-stratified models adjusted for birth year, marital status, region of origin, internalizing and externalizing disorder registrations, and alcohol use disorder (AUD) registration, lower educational attainment was associated with higher risk of AMC in both females (hazard ratios [HRs] = 1.40 to 2.46 for low- and mid-level educational attainment across 0 to 15 years of observation) and males (HRs = 1.13 to 1.48). Likewise, risk of AMC was increased for those with lower income levels (females: HRs = 1.10 to 5.86; males: HRs = 1.07 to 6.41). In secondary analyses, we further adjusted for aggregate familial risk of AUD by including family genetic risk scores for AUD (FGRSAUD), estimated using medical, pharmacy, and criminal registries in extended families, as covariates. While FGRSAUD were associated with risk of AMC in adjusted models (HR = 1.17 for females and HR = 1.21 for males), estimates for education and income level remained largely unchanged. Furthermore, FGRSAUD interacted with income level, but not education level, such that those at higher familial liability to AUD were more susceptible to the adverse effect of low income. Limitations of these analyses include the possibility of false negatives for psychiatric illness registrations, changes in income after age 40 that were not accounted for due to modeling restrictions, restriction to residents of a high-income country, and the inability to account for individual-level alcohol consumption using registry data.

CONCLUSIONS

Using comprehensive national registry data, these analyses demonstrate that individuals with lower levels of education and/or income are at higher risk of developing AMC. These associations persist even when accounting for a range of sociodemographic, psychiatric, and familial risk factors. Differences in risk could contribute to further health disparities, potentially warranting increased screening and prevention efforts in clinical and public health settings.

Affective and cognitive Theory of Mind in patients with alcohol use disorder: Associations with symptoms of depression, anxiety, and somatization

INTRODUCTION

Theory of Mind (ToM) is the ability to ascribe thoughts (cognitive ToM) and feelings (affective ToM) to others. Ample evidence exists for impairments of affective and cognitive ToM in individuals with alcohol use disorder (AUD); however, evidence regarding changes of these impairments during AUD treatment and their possible relationship to comorbid symptoms is ambiguous. The current study analyzed changes in ToM during treatment and tested associations with comorbid symptoms of depression, anxiety, somatization, and social functioning.

METHODS

We analyzed data from 175 individuals with AUD. The study assessed ToM and comorbid symptoms of depression, anxiety, somatization, and social functioning at the time of admission and at the time of discharge from an approximately 60 days long abstinence-oriented inpatient treatment. We assessed affective and cognitive ToM using the Movie for the Assessment of Social Cognition, a measure with high ecological validity.

RESULTS

All symptoms, total and cognitive ToM improved following treatment; however, affective ToM did not improve. Moreover, cognitive ToM at the beginning of treatment was associated with improved symptoms of depression and somatization, while affective ToM was not.

CONCLUSIONS

Our study shows improvements in total and cognitive ToM as well as symptoms of depression, anxiety, somatization, and social functioning following long-term treatment. Furthermore, cognitive ToM was related to improvements in comorbid symptoms. This finding suggests that ToM may be an important treatment target in patients with AUD.

Sex differences in the association between smoking and central sensitization: A cross-sectional study

INTRODUCTION

Despite the acknowledged interconnection between smoking and pain, research on the relationship between smoking and central sensitization (CS) is scarce; this pain mechanism has attracted recent research attention. Considering potential sex differences, this cross-sectional study aimed to investigate the association between smoking and CS.

METHODS

Overall, 415 adult participants from an outpatient clinic underwent evaluation. The analysis focused on determining the relationship between smoking status and CS by differentiating between sexes. Data were collected on smoking presence or absence (independent variable) and CS (dependent variable) for each sex, with age, education level, drinking history, depression, and anxiety as covariates. CS was evaluated using the Central Sensitization Inventory. Following a descriptive analysis of the study population's characteristics, logistic regression analysis was employed to assess the relationships.

RESULTS

The average participant age was 42.3 years, with 59% being women. Among women, a significant association was found between smoking status and higher CS severity (AOR=3.21; 95% CI 1.29-7.99, p<0.01), after accounting for confounding variables. Conversely, no significant association was observed for men (AOR=1.50; 95% CI 0.63-3.60, p=0.36). Interaction by sex on the relationship between smoking and CS was not statistically significant (p=0.23).

CONCLUSIONS

This study suggests a potential association between smoking and CS in women, whereas no conclusive relationship was observed among men. These findings indicate the necessity of considering CS when examining the relationship between smoking and pain.

Stability of clustering of lifestyle risk factors in the Dutch adult population and the association with mental health

BACKGROUND

Lifestyle factors often co-occur in clusters. This study examines whether clusters of lifestyle risk factors, such as smoking, alcohol use, physical inactivity, poor diet, sexual risk behaviour, cannabis and other drug use, change over time in a representative sample of Dutch adults. Additionally, the association between mental health and self-reported depression of lifestyle clusters was examined.

METHODS

Each year cross-sectional data of approximately 7500 individuals of 18 years and older from the annual Dutch Health Survey of 2014-2019 were used. Clusters were determined by a two-step cluster analysis. Furthermore, regression analyses determined the association between clusters of lifestyle risk factors and mental health.

RESULTS

Results show six clusters composed of one, multiple or no lifestyle risk factors. The clusters remained relatively stable over time: in some clusters, the number of people slightly changed between 2014 and 2019. More specifically, clusters that increased in size were the cluster with no lifestyle risk factors and the cluster with multiple lifestyle risk factors. Furthermore, results show that clusters with none to a few lifestyle risk factors were associated with better mental health and a lower prevalence of self-reported depression compared with clusters with multiple lifestyle risk factors.

CONCLUSIONS

The clustering of lifestyle risk factors remained stable over time. People with multiple lifestyle risk factors had poorer mental health than those without risk factors. These findings may emphasize the need for intervention strategies targeting this subgroup with multiple lifestyle risk factors.

Machine learning using multimodal clinical, electroencephalographic, and magnetic resonance imaging data can predict incident depression in adults with epilepsy: A pilot study

OBJECTIVE

This study was undertaken to develop a multimodal machine learning (ML) approach for predicting incident depression in adults with epilepsy.

METHODS

We randomly selected 200 patients from the Calgary Comprehensive Epilepsy Program registry and linked their registry-based clinical data to their first-available clinical electroencephalogram (EEG) and magnetic resonance imaging (MRI) study. We excluded patients with a clinical or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)-based diagnosis of major depression at baseline. The NDDI-E was used to detect incident depression over a median of 2.4 years of follow-up (interquartile range [IQR] = 1.5-3.3 years). A ReliefF algorithm was applied to clinical as well as quantitative EEG and MRI parameters for feature selection. Six ML algorithms were trained and tested using stratified threefold cross-validation. Multiple metrics were used to assess model performances.

RESULTS

Of 200 patients, 150 had EEG and MRI data of sufficient quality for ML, of whom 59 were excluded due to prevalent depression. Therefore, 91 patients (41 women) were included, with a median age of 29 (IQR = 22-44) years. A total of 42 features were selected by ReliefF, none of which was a quantitative MRI or EEG variable. All models had a sensitivity > 80%, and five of six had an F1 score ≥ .72. A multilayer perceptron model had the highest F1 score (median = .74, IQR = .71-.78) and sensitivity (84.3%). Median area under the receiver operating characteristic curve and normalized Matthews correlation coefficient were .70 (IQR = .64-.78) and .57 (IQR = .50-.65), respectively.

SIGNIFICANCE

Multimodal ML using baseline features can predict incident depression in this population. Our pilot models demonstrated high accuracy for depression prediction. However, overall performance and calibration can be improved. This model has promise for identifying those at risk for incident depression during follow-up, although efforts to refine it in larger populations along with external validation are required.

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.

Association between weekly working hours and risky alcohol use: A 12-year longitudinal, nationwide study from South Korea

We aimed to investigate the association between long working hours and onset of risky alcohol use. We included a nationally representative sample comprising 11,226 workers in South Korea (57,887 observations). The Alcohol Use Disorders Identification Test was used to assess risky alcohol use. Fixed effect regressions were employed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Adjusted ORs (95% CIs) of risky alcohol use were 1.08 (0.95-1.22) for 41-48 h/week, 1.12 (0.96-1.31) for 49-54 h/week, and 1.40 (1.21-1.63) for ≥55 h/week, compared with standard working hours (35-40 h/week). ORs (95% CIs) of the association between working ≥55 h/week and risky alcohol use was 1.39 (1.17-1.65) for men and 1.34 (0.98-1.82) for women. Yearly cumulative exposure to long working hours (>40 h/week) is positively associated with risky alcohol use in a dose-dependent manner. For instance, exposure to long working hours for ≥3 years was associated with an increased likelihood of risky alcohol use (OR [95% CI]: 2.20 [1.78-2.72]). Sex-stratified analyses showed that long work hours are associated with risky alcohol use in both male and female workers. Appropriate work-hour policy is needed to prevent workers from risky alcohol use.

Weighing psychosocial factors in relatives for the risk of psychopathology: a study of patients with depressive and anxiety disorders and their siblings

PURPOSE

Siblings of probands with depressive and anxiety disorders are at increased risk for psychopathology, but little is known about how risk factors operate within families to increase psychopathology for siblings. We examined the additional impact of psychosocial risk factors in probands-on top of or in combination with those in siblings-on depressive/anxious psychopathology in siblings.

METHODS

The sample included 636 participants (Mage = 49.7; 62.4% female) from 256 families, each including a proband with lifetime depressive and/or anxiety disorders and their sibling(s) (N = 380 proband-sibling pairs). Sixteen psychosocial risk factors were tested. In siblings, depressive and anxiety disorders were determined with standardized psychiatric interviews; symptom severity was measured using self-report questionnaires. Analyses were performed with mixed-effects models accounting for familial structure.

RESULTS

In siblings, various psychosocial risk factors (female gender, low income, childhood trauma, poor parental bonding, being single, smoking, hazardous alcohol use) were associated with higher symptomatology and likelihood of disorder. The presence of the same risk factor in probands was independently associated (low income, being single) with higher symptomatology in siblings or moderated (low education, childhood trauma, hazardous alcohol use)-by reducing its strength-the association between the risk factor and symptomatology in siblings. There was no additional impact of risk factors in probands on likelihood of disorder in siblings.

CONCLUSION

Our findings demonstrate the importance of weighing psychosocial risk factors within a family context, as it may provide relevant information on the risk of affective psychopathology for individuals.

The association of alcohol dependence and consumption during adolescence with depression in young adulthood, in England: a prospective cohort study

BACKGROUND

The role of alcohol use in the development of depression is unclear. We aimed to investigate whether alcohol dependence, but not high frequency or quantity of consumption, during adolescence increased the risk of depression in young adulthood.

METHODS

In this prospective cohort study, we included adolescents who were born to women recruited to the Avon Longitudinal Study of Parents and Children in Avon, UK, with delivery dates between April 1, 1991, and Dec 31, 1992. Alcohol dependence and consumption were measured at about age 16 years, 18 years, 19 years, 21 years, and 23 years using the self-reported Alcohol Use Disorders Identification Test, and at about age 18 years, 21 years, and 23 years using items corresponding to DSM-IV symptoms. The primary outcome was depression at age 24 years, assessed using the Clinical Interview Schedule Revised. Analyses were probit regressions between growth factors for alcohol dependence and consumption and depression, before and after adjustments for confounders: sex, housing tenure, maternal education, maternal depressive symptoms, parents' alcohol use, conduct problems at age 4 years, being bullied from age 12-16 years, and frequency of smoking cigarettes or cannabis. Adolescents were included in analyses if they had data from at least one timepoint for alcohol use and confounders.

FINDINGS

We included 3902 adolescents (2264 [58·0%] female; 1638 [42·0%] male) in our analysis, and 3727 (96·7%) of 3853 participants with data on ethnicity were White. After adjustments, we found a positive association between alcohol dependence at 18 years of age (latent intercept) and depression at 24 years of age (probit coefficient 0·13 [95% CI 0·02 to 0·25]; p=0·019), but no association between rate of change (linear slope) and depression (0·10 [-0·82 to 1·01]; p=0·84). There was no evidence of an association between alcohol consumption and depression (latent intercept probit coefficient -0·01 [-0·06 to 0·03]; p=0·60; linear slope 0·01 [-0·40 to 0·42]; p=0·96) after adjustments.

INTERPRETATION

Psychosocial or behavioural interventions that reduce the risk of alcohol dependence during adolescence could contribute to preventing depression in young adulthood.

FUNDING

UK Medical Research Council and Alcohol Research UK (grant number MR/L022206/1).

Are health behaviors associated with mental health among tertiary education students? A systematic review of cohort studies

OBJECTIVE

To evaluate the association between health behaviors with mental health among tertiary education students.

METHODS

Six databases were searched until September 2021 for prospective cohort studies evaluating the association between health behavior(s) (dietary intake, physical activity, sedentary behavior, alcohol intake, sleep, smoking or illicit drug use) and mental health. Two independent reviewers screened records for inclusion, extracted data and completed risk of bias assessments.

RESULTS

33 studies were included (14 assessed sleep, 14 alcohol intake, 13 physical activity, 8 smoking, 6 sedentary behavior, 4 diet, 1 illicit drug use). A consistent association between poor sleep, and physical inactivity with increased risk of poor psychological wellbeing, and between poor sleep and increased mental ill-health related outcomes was demonstrated.

CONCLUSION

Findings suggest interventions to address poor sleep and physical inactivity among students may positively impact mental health. Further research of other health behaviors, and their association with mental health, is required.

Psychological Distress in the Republic of Serbia, the Association of Social Characteristics and Substance Use on a National Representative Sample of Serbia

This study examined the association between social characteristics, substance use, and psychological distress in a national representative sample of adults in Serbia. It was a secondary analysis of the National Survey on Lifestyles in Serbia: Substance Abuse and Gambling 2018. The study included a total of 2000 participants aged 18 to 65 from the general population in Serbia. Psychological distress was examined using the Kessler 6 questionnaire. There were a total of 945 male participants (47.3%) and 1055 (52.8%) female participants. The average age was 37.83 ± 13.61 years. The prevalence of a high risk of psychological distress was 5.2% (103/2000), while the prevalence of moderate risk of psychological distress was 15.2% (303/2000). Multivariate logistic regression analysis showed that being male, having poor self-rated health, having poor subjective financial status, binge drinking in the past year, and lifetime use of any illicit drug were associated with a higher likelihood of having a high risk of psychological distress. One in six adults in Serbia has a high risk of psychological distress, while one in twenty has a moderate risk. The findings of this study urge targeted actions to protect and improve the health of people in psychological distress and drug and alcohol users.

Purchasing Under the Influence of Alcohol: The Impact of Hazardous and Harmful Patterns of Alcohol Consumption, Impulsivity, and Compulsive Buying

The current research examined how hazardous and harmful patterns of alcohol consumption, problematic online shopping when drinking alcohol, impulsivity, and compulsive buying were associated with and predicted the frequency of making purchases while under the influence of alcohol. A sample of American adults between the ages of 25 and 64 who reported having at least one drink per week over the past 6 months were surveyed. Regression-based path modeling revealed for those who made online purchases while moderately intoxicated, hazardous and harmful patterns of drinking alcohol and, problematic online shopping when drinking alcohol, predicted the frequency of making purchases while intoxicated. For those who made online purchases while heavily intoxicated, hazardous and harmful patterns of drinking alcohol, impulsivity, problematic online shopping when drinking alcohol, and compulsive buying predicted the frequency of making purchases while intoxicated. We explain our findings by suggesting individuals engage in frequent drunk purchases because they are motivated to alleviate their negative mood states.

Moderate Alcohol Consumption and Depression: A Marginal Structural Model Approach Promoting Causal Inference

OBJECTIVE

Moderate alcohol consumption is associated with decreased risk for depression, but it remains unclear whether this is a causal relationship or a methodological artifact. To compare the effects of consistent abstinence and occasional, moderate, and above-guideline alcohol consumption throughout early to middle adulthood on depression at age 50, the authors conducted a secondary analysis of the National Longitudinal Survey of Youth 1979 cohort and employed a marginal structural model (MSM) approach.

METHODS

Baseline was set at 1994, when individuals were ages 29-37. The MSM incorporated measurements of alcohol consumption in 1994, 2002, and 2006, baseline and time-varying covariates, and repeated measurements with the Center for Epidemiologic Studies Depression Scale-Short Form (CES-D-SF). A total of 5,667 eligible participants provided valid data at baseline, 3,593 of whom provided valid outcome data. The authors used all observed data to predict CES-D-SF means and rates of probable depression for hypothetical trajectories of consistent alcohol consumption.

RESULTS

The results approximated J-curve relationships. Specifically, both consistent occasional and consistent moderate drinkers were predicted to have reduced CES-D-SF scores and rates of probable depression at age 50 compared with consistent abstainers (CES-D-SF scores: b=-0.84, 95% CI=-1.47, -0.11; probable depression: odds ratio=0.58, 95% CI=0.36, 0.88 for consistent occasional drinkers vs. abstainers; CES-D-SF scores: b=-1.08, 95% CI=-1.88, -0.20; probable depression: odds ratio=0.59, 95% CI=0.26, 1.13 for consistent moderate drinkers vs. consistent abstainers). Consistent above-guideline drinkers were predicted to have slightly increased risk compared with consistent abstainers, but this was not significant. In sex-stratified analyses, results were similar for females and males.

CONCLUSIONS

This study contributes preliminary evidence that associations between moderate alcohol consumption and reduced risk for depression may reflect genuine causal effects. Further research using diverse methodologies that promote causal inference is required.

Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study

AIMS

There are indications that problematic alcohol use may negatively impact the course of major depressive disorder (MDD). However, most studies on alcohol use and adverse MDD outcomes are conducted amongst MDD populations with (severe) alcohol use disorder in psychiatric treatment settings. Therefore, it remains unclear whether these results can be generalised to the general population. In light of this, we examined the longitudinal relationship between alcohol use and MDD persistence after a 3-year follow-up amongst people with MDD from the general population.

METHODS

Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric epidemiological prospective study comprising four waves amongst the adult Dutch general population (n = 6.646). The study sample (n = 642) consisted of those with 12-month MDD who participated at the follow-up wave. The outcome was 12-month MDD persistence after the 3-year follow-up, which was assessed via the Composite International Diagnostic Interview version 3.0. Weekly alcohol consumption was operationalised as non-drinking (0 drinks), low-risk drinking (⩽7 drinks; reference), at-risk drinking (women 8-13 drinks, men 8-20 drinks) and high-risk drinking (women ⩾14, men ⩾21 drinks). We performed univariate and multiple logistic regression analyses, which were adjusted for various socio-demographic and health-related factors.

RESULTS

The majority (67.4%) of the MDD sample were female, while the mean age was 47.1 years. Amongst these, 23.8% were non-drinkers, 52.0% were low-risk drinkers and 14.3% and 9.4% were at-risk and high-risk drinkers, respectively. Around one-quarter of the sample (23.6%) met the criteria for a persistent MDD after 3-year follow-up. No statistically significant association was found between alcohol use and MDD persistence, either for the crude model or the adjusted models. In comparison to low-risk drinking, the full adjusted model showed no statistically significant associations between MDD persistence and non-drinking (odds ratio (OR) = 1.15, p = 0.620), at-risk drinking (OR = 1.25, p = 0.423), or high-risk drinking (OR = 0.74, p = 0.501).

CONCLUSIONS

Contrary to our expectations, our findings showed that alcohol use was not a predictor of MDD persistence after 3-year follow-up amongst people with MDD from the general population.

The Relationship between Selected Factors (Temperament, Bipolar Traits, Sleep Quality, Severity of Addiction) and Depressive Symptoms in Alcohol-Dependent Men

Clinical and epidemiological studies have demonstrated a relationship between alcohol addiction and mood disorders. Alcohol-dependent patients with depression tend to demonstrate clinically more severe manic symptoms, which complicates the process of diagnosis and therapy. However, the predictors indicating the risk of mood disorders in addicted patients remain unclear. The aim of the study was to examine the relationship between personal dispositions, bipolar traits, depth of addiction, quality of sleep, and depressive symptoms in alcohol-dependent men. The study group comprised 70 men (age M = 46.06, SD = 11.29) diagnosed with alcohol addiction. The participants completed a battery of questionnaires: BDI, HCL-32, PSQI, EPQ-R and MAST. The results were tested using Pearson's correlation quotient and general linear model. The findings indicate that some of the studied patients are likely to have mood disorders of clinically significant severity. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in alcohol-dependent patients. Among the components of sleep quality, problems with falling asleep and waking up at night appear to be most strongly associated with depressive symptoms. The intensity of depressive symptoms may relate to the intensity of certain bipolar features, such as risk-taking activity and irritability. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in the studied group.

Update on Pharmacological Treatment for Comorbid Major Depressive and Alcohol Use Disorders: The Role of Extended-release Trazodone

BACKGROUND

Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) are major public health concerns because of their high prevalence and clinical and functional severity. MDD and AUD commonly co-occur, but effective therapeutic approaches for comorbidity are still scarce. Available evidence on selective serotonin reuptake inhibitors and tricyclic antidepressants held mixed results, and further pharmacological categories have been less investigated. Trazodone is an approved antidepressant drug for adults and has shown efficacy on symptoms like anxiety and insomnia observed in AUD patients as well. Thus, this study aims to evaluate the effect of extended-release trazodone on clinical and functional features in MDD + AUD subjects.

METHODS

One hundred MDD + AUD outpatients were retrospectively evaluated at 1, 3, and 6 months of treatment with extended-release trazodone (150-300 mg/day, flexibly dosed). Improvement in depressive symptoms was the primary outcome measure. Changes in anxiety, sleep, functioning, quality of life, clinical global severity, and alcohol craving were also investigated.

RESULTS

Trazodone reduced depressive symptoms (p < 0.001) with 54.5% remission at the endpoint. Similar improvements were observed in all secondary outcomes, including anxiety, sleep alterations, and craving (p < 0.001). Only mild side effects were reported and disappeared over time.

CONCLUSION

Extended-release trazodone displayed good antidepressant properties in MDD + AUD patients, ameliorating overall symptomatology, functioning, and quality of life, with a good safety/ tolerability profile. Further, it significantly improved sleep disturbances and craving symptoms, which are associated with drinking relapse and worse outcomes. Therefore, trazodone might represent a promising pharmacological option for MDD + AUD patients.

Probable depression and its correlates among undergraduate students in Johannesburg, South Africa

BACKGROUND

Depression is associated with high rates of morbidity and mortality. Globally, depression is higher among university students than the general population-making it a significant public health problem. Despite this, there is limited data on the prevalence in university students in the Gauteng province, South Africa. This study determined the prevalence of screening positive for probable depression and its correlates among undergraduate students at the university of the Witwatersrand, Johannesburg, South Africa.

METHODS

A cross-sectional study, using an online survey was conducted among undergraduate students at the University of the Witwatersrand in 2021. Patient Health Questionnaire (PHQ-2) was used to assess the prevalence of probable depression. Descriptive statistics was computed and conducted bivariate and multivariable logistic regression to identify factors associated with probable depression. Age, marital status, substance use (alcohol use, cannabis use, tobacco use, and other substance use) were included in the multivariable model apriori determined confounders and other factors were only added if they had a p-value <0.20 in the bivariate analysis. A p-value of 0.05 was considered statistically significant.

RESULTS

The response rate was 8.4% (1046/12404). The prevalence of screening positive for probable depression was 48% (439/910). Race, substance use, and socio-economic status were associated with odds of screening positive for probable depression. Specifically reporting white race (adjusted OR (aOR) = 0.64, 95% CI: 0.42, 0.96), no cannabis use (aOR = 0.71, 95% CI: 0.44-0.99), higher spending power in the form of having the most important things but few luxury goods (aOR = 0.50, 95% CI: 0.31, 0.80) and having enough money for luxury goods and extra things (aOR = 0.44, 95% CI: 0.26-0.76) were associated with lower odds of screening positive for probable depression.

DISCUSSION

In this study, screening positive for probable depression was common among undergraduate students at the University of the Witwatersrand, Johannesburg, South Africa and associated with sociodemographic and selected behavioral factors. These findings call for strengthening the awareness and use of counselling services among undergraduate students.

Prevalence of self-reported lifetime medical diagnosis of depression in Brazil: analysis of data from the 2019 Brazilian National Health Survey

OBJECTIVES

To assess the prevalence of and factors associated with the lifetime medical diagnosis of depression in Brazil.

DESIGN

Population-based, cross-sectional study.

SETTING

Analysis of data from the 2019 Brazilian National Health Survey.

PARTICIPANTS

90 846 individuals aged ≥15 years were included.

OUTCOME MEASURE

The self-reported medical diagnosis of depression at some point in one's life was the main outcome. Prevalence ratios (PRs) with 95% CIs were calculated by Poisson regression with robust variance. The independent variables included the geographical area of residence, sociodemographic characteristics, current smoking status, alcohol abuse, daily screen time, and the presence of physical disorders and mental health comorbidities.

RESULTS

The self-reported lifetime prevalence of medical diagnosis of depression was 9.9% (95% CI 9.5% to 10.2%). The probability of having received a medical diagnosis of depression was higher among urban residents (PR 1.23; 95% CI 1.12 to 1.35); females (2.75; 2.52 to 2.99); those aged 20-29 years (1.17; 0.91 to 1.51), 30-39 years (1.73; 1.36 to 2.19), 40-49 years (2.30; 1.81 to 2.91), 50-59 years (2.32; 1.84 to 2.93) and 60-69 years (2.27; 1.78 to 2.90) compared with those under 20 years; white-skinned people (0.69 (0.61 to 0.78) for black-skinned people and 0.74 (0.69 to 0.80) for indigenous, yellow and brown-skinned people compared with white-skinned people); those with fewer years of education (1.33(1.12 to 1.58) among those with 9-11 years, 1.14 (0.96 to 1.34) among those with 1-8 years and 1.29 (1.11 to 1.50) among those with 0 years compared with those with ≥12 years of education); those who were separated/divorced (1.43; 1.29 to 1.59), widowed (1.06; 0.95 to 1.19) and single (1.01; 0.93 to 1.10) compared with married people; smokers (1.26; 1.14 to 1.38); heavy screen users (1.31; 1.16 to 1.48) compared with those whose usage was <6 hours/day; those with a medical diagnosis of a physical disorder (1.80; 1.67 to 1.97); and individuals with a medical diagnosis of a mental health comorbidity (5.05; 4.68 to 5.46).

CONCLUSION

This nationwide population-based study of self-reported lifetime medical diagnosis of depression in Brazil showed that the prevalence was almost 10%. Considering the current Brazilian population, this prevalence corresponds to more than 2 million people who have been diagnosed with depression at some point in their lives.

The relationships between use of alcohol, tobacco and coffee in adolescence and mood disorders in adulthood

INTRODUCTION

Alcohol, tobacco and coffee are commonly used substances and use in adolescence has previously been linked to mood disorders. However, few large prospective studies have investigated adolescent use in relation to mental health outcomes in adulthood. The main aim of this study was to examine the prospective associations between alcohol use, cigarette smoking and coffee consumption at age 16 and subsequent mood disorders up to 33 years of age.

METHODS

Data from The Northern Finland Birth Cohort 1986 Study were used and a total of 7660 participants (49.9% male) were included. Associations between alcohol use, cigarette smoking and coffee consumption at age 16 and later diagnoses of major depression and bipolar disorder were examined using multinomial logistic regression analyses.

RESULTS

Mean number of cigarettes/day (OR, 1.23 [95% CI 1.01-1.50]) and mean volume of alcohol consumption (OR, 1.22 [95% CI 1.01-1.47]), but not frequency of excessive drinking, in adolescence were associated with increased risk for subsequent bipolar disorder after adjustment for sex, parental psychiatric disorders, family structure, illicit substance use, and emotional and behavioral problems at age 16. An association between cigarette smoking and major depression attenuated to statistically non-significant when adjusted for emotional and behavioral problems. No associations were observed between adolescent coffee consumption and subsequent mood disorders.

CONCLUSIONS

This is the first study to report an association of adolescent cigarette smoking and subsequent bipolar disorder diagnosis providing grounds for further research and pointing to a place for preventive measures among adolescents.

Factors Affecting the Occurrence of Mental Health Problems in Female Cancer Survivors: A Nationwide Cohort Study

The purpose of this study is to determine the effect of cancer survivorship stage and health-related behaviors on the risk of developing mental health problems (depressive and anxiety disorders) in women who have experienced cancers that affect women (breast cancer, cervical cancer, ovarian cancer, endometrial cancer). Using the healthcare utilization and medical checkup data from 2010 to 2020 provided by the National Health Insurance Service, the occurrence of mental health problems since 2020 was tracked for 36,801 women diagnosed with cancer. The occurrence of mental health problems was defined as the cases in which the disease code was assigned to anxiety disorders (F40~F44, F48) and depressive disorders (F32~34, F41.2, F92) as presented in ICD-10. To evaluate the effect of cancer survivorship stage and health-related behaviors on the development of mental health problems, the hazard ratio (HR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazard model. During the follow-up period of 5.6 years, anxiety disorder occurred in 14,698 (39.9%), and by cancer type, breast cancer survivors accounted for the most at 1.02 per 1000 person-years. The risk of anxiety disorders increased in those who experienced cervical cancer (AHR, 1.08, 95% CI, 1.03-1.13) and those in the acute survivorship stage (AHR, 1.38, 95% CI, 1.22-1.55). In terms of health-related behaviors, the risk of developing anxiety disorder was shown to be reduced in drinkers (AHR, 0.91, 95% CI, 0.87-0.96), former smokers (AHR, 0.86, 95% CI, 0.77-0.97), and current smokers (AHR, 0.80, 95% CI, 0.71-0.90). During the follow-up period of 5.6 years, depressive disorder occurred in 6168(16.8%), and by cancer type, ovarian cancer survivors accounted for the most at 1.30 per 1000 person-years. The risk of developing depressive disorders was highest in those who experienced ovarian cancer (AHR, 1.40, 95% CI, 1.27-1.53) and those in the acute survivorship stage (AHR, 2.99, 95% CI, 2.60-3.42). For health-related behaviors, the risk of developing depressive disorders was increased in former smokers (AHR, 1.32, 95% CI, 1.14-1.54), current smokers (AHR, 1.21, 95% CI, 1.04-1.41), and those with insufficient physical activity (AHR, 1.09, 95% CI, 1.02-1.15). It has been confirmed that cancer type, cancer survivorship stage, and health-related behaviors, such as smoking, drinking, and physical activity, are significantly related to the risk of mental health problems. Thus, it is necessary to develop strategies to cope with mental health problems at the individual and national levels and to develop interventions to promote a more active lifestyle.

Comorbidity between mood and substance-related disorders: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Evidence indicates that mood disorders often co-occur with substance-related disorders. However, pooling comorbidity estimates can be challenging due to heterogeneity in diagnostic criteria and in the overall study design. The aim of this study was to systematically review and, where appropriate, meta-analyse estimates related to the pairwise comorbidity between mood disorders and substance-related disorders, after sorting these estimates by various study designs.

METHODS

We searched PubMed (MEDLINE), Embase, CINAHL and Web of Science for publications between 1980 and 2017 regardless of geographical location and language. We meta-analysed estimates from original articles in 4 broadly defined mood and 35 substance-related disorders.

RESULTS

After multiple eligibility steps, we included 120 studies for quantitative analysis. In general, regardless of variations in diagnosis type, temporal order or use of adjustments, there was substantial comorbidity between mood and substance-related disorders. We found a sixfold elevated risk between broadly defined mood disorder and drug dependence (odds ratio = 5.7) and fivefold risk between depression and cannabis dependence (odds ratio = 4.9) while the highest pooled estimate, based on period prevalence risk, was found between broadly defined dysthymic disorder and drug dependence (odds ratio = 11.3). Based on 56 separate meta-analyses, all pooled odds ratios were above 1, and 46 were significantly greater than 1 (i.e. the 95% confidence intervals did not include 1).

CONCLUSION

This review found robust and consistent evidence of an increased risk of comorbidity between many combinations of mood and substance-related disorders. We also identified a number of under-researched mood and substance-related disorders, suitable for future scrutiny. This review reinforces the need for clinicians to remain vigilant in order to promptly identify and treat these common types of comorbidity.

Risk factors for depression in the elderly: An umbrella review of published meta-analyses and systematic reviews

BACKGROUND

Depression has been identified as one of the leading causes of the disease burden worldwide. Identification of the potential factors that increased or decreased the risk of depression could be important to provide prevention strategies. We aimed to conduct an umbrella review of risk factors for depression in the elderly and assessed the credibility of evidence of the association between each factor and depression.

METHODS

We searched PubMed and Web of Science from 1990 to April 11, 2021 for articles investigating associations between potential factors and depression. For each association, we recalculated the summary effect size and 95% confidence intervals using random effects models. The 95% prediction interval and between-heterogeneity were also reported. For publication bias, small-study effect and excess of significance bias were assessed.

RESULTS

Twenty-five publications met the inclusion criteria, including twenty-two meta-analyses and three qualitative systematic reviews. Approximately 1,199,927 participants and 82 unique factors were reported. Two factors were rated as convincing evidence and four factors showed highly suggestive evidence. These risk factors were aspirin use, individuals aged 80 years and above, sleep disturbances and persistent sleep disturbances, hearing problem, poor vision, and cardiac disease.

LIMITATIONS

Most studies that we included were of low quality.

CONCLUSIONS

We found several risk factors for depression with different levels of evidence, in which aspirin use and individuals aged 80 years and above presented the strongest evidence. Further research is warranted to support other findings from this umbrella review using a large, well-designed cohort study.

Alcohol Intake Influences the Occurrence and Progression of Periodontitis Differently According to Sex and Country Sociodemographic Development: A Two-Stage Systematic Review

AIMS

To conduct an overview and systematic evaluation of prospective cohort studies on whether alcohol intake is associated with the incidence and progression of periodontitis.

METHODS

Nine databases were searched by two independent reviewers up to November 2021 according to prespecified eligibility criteria. Risk of Bias in Systematic Reviews and Risk of Bias in Non-Randomized Studies of Interventions were used for risk of bias assessment and certainty of evidence was assessed using the GRADE approach. Random-effects pair-wise meta-analyses were performed with data from cohort studies on the effects of higher levels of alcohol intake compared with current non-drinking to determine risk ratios (RR) and confidence intervals of periodontitis.

RESULTS

The four systematic reviews were at high risk of bias and concluded that alcohol intake is associated with periodontitis regardless of the study design. Five reports from seven cohort studies contributed to the meta-analyses and no statistically significant differences were found for higher levels of consumption regarding the risk of periodontitis, except for men from countries with low- and high-middle socio-demographic index (RR = 1.30, 95% CI: 1.13-1.46), with low certainty evidence.

CONCLUSION

Higher levels of alcohol consumption seem to be part of the causal mechanism of periodontitis when cooccurring with male sex in underdeveloped countries. No conclusion can be drawn regarding alcohol use disorders or patterns of consumption.

Schoolteachers with voice handicap are twice as likely to report depressive symptoms

This study aimed to examine the association between voice disorder and depressive symptoms in schoolteachers. A cross-sectional survey was conducted with elementary and secondary schoolteachers. Voice disorders and depressive symptoms were assessed with the Voice Handicap Index-10 and the Beck Depression Inventory-II, respectively. Logistic and linear regressions models were adjusted for confounding variables. In the 389 schoolteachers studied, the prevalence of voice handicap and depressive symptoms was 18.8 and 38.8%, respectively. Voice handicap was associated with depressive symptoms on all models tested. The logistic regression showed an odds ratio of 2.21 (95% confidence interval: 1.19, 4.08; p value < 0.05), while in the linear regression each point increase on the voice disorder scale increased the Beck Depression Inventory-II score by 0.39 points (95% confidence interval: 0.26, 0.54; p value < 0.05). This study showed that teachers of public schools with voice handicap are twice as likely to report depressive symptoms.

Longitudinal reciprocal associations between depression, anxiety, and substance use disorders over three decades of life

BACKGROUND AND OBJECTIVE

Studies exploring longitudinal reciprocal associations between depressive, anxiety, and substance use disorders (DD, AD and SUD, respectively) over long periods of time are mainly lacking. Therefore, the aim of the present study is to test longitudinal associations (i.e. temporal dynamics) between DD, AD and SUD from young adulthood to middle adulthood.

METHODS

A stratified community sample of 591 participants from the canton of Zurich, Switzerland, was interviewed with the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology over seven interview waves from ages 20/21 to 49/50. Diagnostic and Statistical Manual of Mental Disorders criteria were used to evaluate the presence of DD, AD and SUD. We fitted an auto-regressive cross-lagged path analysis within a Bayesian structural equation model to test longitudinal associations.

RESULTS

Regarding autoregressive effects, AD (except during young adulthood) and SUD predicted themselves over the entire time period, while DD recurrently predicted itself not consistently over time. Regarding cross-lagged effects, DD predicted SUD at different time points, and vice versa. DD predicted subsequent AD in adulthood, whereas the reverse did not happen. Female gender was associated with DD and AD at all ages while male gender was associated with SUD only in young adulthood.

CONCLUSIONS

Reciprocal longitudinal associations were found between DD and SUD and DD usually preceded AD. Our results further confirm an increased risk of DD and AD in women and a higher risk of SUD in young men. Early treatment and broad psychosocial interventions should be provided in order to prevent chronicity and further maladjustment as well as interrupting the cycle of mutual reinforcement between DD and SUD.

Socioeconomic status, alcohol use disorders, and depression: A population-based study

BACKGROUND

Depressive disorders (DD) and alcohol use disorders (AUD) frequently co-occur. They are key to understanding the current increases in "deaths of despair" among individuals with lower socioeconomic status (SES). The aim of this study was to assess the prospective bidirectional associations between AUD and DD, as well as the effect of SES on these two conditions.

METHODS

The National Epidemiologic Survey on Alcohol and Related Conditions is a cohort study representative of the US adult population, which began in 2001-2002, with follow-up interviews conducted 3 years later. SES was primarily operationalized as educational attainment. AUD, DD, and their levels of severity were defined according to the DSM-5 criteria.

RESULTS

The risk of developing an incident DD increased gradually with the recency and the severity of AUD at baseline, but the converse was not observed. Lower SES was an independent risk for incident AUD or DD. SES did not modify the prospective association between AUD and DD.

LIMITATIONS

The absence of interaction between SES and moderate or severe AUD for the incident DD must be considered with caution due to the limited number of DD cases reported in these AUD categories.

CONCLUSIONS

This result is consistent with a causal relationship between AUD and DD, and suggests that therapeutic interventions for AUD may also have beneficial effects to lower DD rates. The independent effects of a lower SES and AUD on DD may result in a vulnerable population cumulating disorders with heavy consequences on health and social well-being.

Are there non-linear relationships between alcohol consumption and long-term health?: a systematic review of observational studies employing approaches to improve causal inference

Background

Research has long found ‘J-shaped’ relationships between alcohol consumption and certain health outcomes, indicating a protective effect of moderate consumption. However, methodological limitations in most studies hinder causal inference. This review aimed to identify all observational studies employing improved approaches to mitigate confounding in characterizing alcohol–long-term health relationships, and to qualitatively synthesize their findings.

Methods

Eligible studies met the above description, were longitudinal (with pre-defined exceptions), discretized alcohol consumption, and were conducted with human populations. MEDLINE, PsycINFO, Embase and SCOPUS were searched in May 2020, yielding 16 published manuscripts reporting on cancer, diabetes, dementia, mental health, cardiovascular health, mortality, HIV seroconversion, and musculoskeletal health. Risk of bias of cohort studies was evaluated using the Newcastle-Ottawa Scale, and a recently developed tool was used for Mendelian Randomization studies.

Results

A variety of functional forms were found, including reverse J/J-shaped relationships for prostate cancer and related mortality, dementia risk, mental health, and certain lipids. However, most outcomes were only evaluated by a single study, and few studies provided information on the role of alcohol consumption pattern.

Conclusions

More research employing enhanced causal inference methods is urgently required to accurately characterize alcohol–long-term health relationships. Those studies that have been conducted find a variety of linear and non-linear functional forms, with results tending to be discrepant even within specific health outcomes.

Trial registration

PROSPERO registration number CRD42020185861.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01486-5.

Alcohol and other substance use during the COVID-19 pandemic: A systematic review

BACKGROUND

Although evidence suggests substance and alcohol use may change during the Covid-19 pandemic there has been no full review of the evidence around this.

METHODS

A systematic review of all available evidence was carried out to document and interpret the frequency and severity of alcohol and other substance use during the Covid-19 pandemic and their relationship to demographic and mental health variables that may suggest further clinical implications. Peer reviewed articles in MEDLINE, Embase, PsycINFO, CINAHL complete and Sociological Abstracts were searched from December 2019 until November 2020.

RESULTS

The search and screening identified 45 articles from 513 deduplicated records. The evidence suggests a mixed picture for alcohol use. Overall, there was a trend towards increased alcohol consumption. The proportion of people consuming alcohol during the pandemic ranged from 21.7% to 72.9% in general population samples. Unlike alcohol use, there was a clear trend towards increased use of other substances use during the COVID-19 pandemic. The proportion of people consuming other substances during the pandemic ranged from 3.6% to 17.5% in the general population. Mental health factors were the most common correlates or triggers for increased use of both alcohol and other substances.

CONCLUSION

There is an increased need for treatment for alcohol and other substance use related problems during the pandemic. Increased targeting and evidence-based interventions will also be important in the period which follows this pandemic, to improve the quality of life for individuals and families, but also to prevent additional costs to society and health systems.

Symptoms of major depressive disorder during the COVID-19 pandemic: results from a representative sample of the Canadian population

INTRODUCTION

Since the outbreak of COVID-19, numerous studies from around the world have reported declines in mental health. However, most of these studies were of low-to-moderate quality and many were based on convenience samples or used mental health measures with low validity, or both. Consequently, it has been difficult to draw conclusions.

METHODS

Both the 2020 Survey on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015-2019) used the Patient Health Questionnaire-9 to screen for major depressive disorder (MDD) in adults aged 18 or older. The prevalence of MDD was compared between the SCMH and the CCHS. Risk and protective factors for MDD in the SCMH were examined using bivariate and logistic regression analyses.

RESULTS

Based on SCMH data, 15.2% (95% CI: 14.2-16.2) of Canadians screened positive for MDD. The prevalence of MDD was more than two times higher in the SCMH (during COVID-19) than in the CCHS (predating COVID-19). In bivariate analysis, Canadians reporting five or more COVID-19-related risk factors were close to 30 times more likely to have MDD than those reporting no risk factors. Mastery and a sense of community belonging were protective factors for MDD.

CONCLUSION

After remaining stable for two decades, the prevalence of depression among Canadians increased substantially with the onset of COVID-19. Ongoing monitoring of this common condition associated with major morbidity is vital to determine if elevated levels of MDD persist as we progress through and beyond future waves of COVID-19.

Cannabis and binge alcohol use among older individuals with major depressive episode

BACKGROUND

Research shows significant associations of major depression with cannabis and binge alcohol use. However, despite increasing cannabis and binge alcohol use rates among the 50+ age group, research on this age group is scant. Methods: We used the 2015-2019 National Survey on Drug Use and Health data (n = 44,007 age 50+) and multinomial logistic regression models to examine associations of a major depressive episode (MDE) with cannabis and binge alcohol use and co-use and associations of binge alcohol use with nonmedical and medical cannabis use. Results: Of individuals age 50+, 89.6% had no history of MDE, 5.7% had prior-to-past-year MDE, and 4.7% had past-year MDE. The rates of past-month cannabis use were 4.3%, 7.7%, and 11.6% and binge alcohol use were 17.3%, 18.7%, and 19.9% among those with no MDE history, prior-to-past-year MDE, and past-year MDE, respectively. Compared to no MDE history, prior-to-past-year MDE (RRR = 1.70, 95% CI = 1.30-2.23) and past-year MDE (RRR = 1.80, 95% CI = 1.27-2.55) were significantly associated with past-month cannabis use (with or without binge alcohol use). However, MDE status was not associated with past-month binge alcohol use. Among cannabis users, binge alcohol use was significantly associated with nonmedical cannabis use only (RRR = 2.50, 95% CI = 1.95-3.21). Users of cannabis and/or binge alcohol also had a higher likelihood of using tobacco products and illicit drugs. Conclusions: Healthcare professionals treating individuals age 50+ with depression should screen for substance use, provide education on the potential adverse effects of polysubstance use, and help them access treatment for co-occurring depression and substance use problems.

The Association Between Alcohol Use and Suicidal Ideation Among Employees

OBJECTIVE

The risk of suicide is assessed by identifying the relationship between alcohol-use patterns and suicidal ideation in Korean employees.

METHODS

The study involved 13,858 employees who underwent workplace mental health screening at the Workplace Mental Health Institute of Kangbuk Samsung Hospital over a 6-year period between 2014 and 2019. Analysis was performed separately for Alcohol Use Disorders Identification Test-Korea (AUDIT-K) items related to the frequency/volume of alcohol consumption (items 1 to 3, AUDIT-C) and those regarding alcohol dependence/related problems (items 4 to 10, AUDIT-D/P). Subjects were then classified into three groups on the basis of the presence or absence of clinical depression and suicidal ideation. The groups' sociodemographic factors and clinical features of depression, anxiety, and alcohol-use patterns were analyzed with a chi-square test as well as one-way analysis of variance, followed by a post hoc test using the Bonferroni correction.

RESULTS

AUDIT-K and AUDIT-D/P scores were significantly associated with the presence or absence of clinical depression as well as the presence or absence of suicidal ideation (p<0.05). However, no significant differences were found among the three groups with regard to the AUDIT-C score (p=0.054).

CONCLUSION

Identifying or treating alcohol dependence/related problems can help lower the occurrence of mental health problems, and suicidal ideation in particular, in employees and reduce social costs.

Alcohol drinking, especially light drinking, and depressive symptoms in adolescents

BACKGROUND

The association of depressive symptoms with moderate and heavy drinking in adolescents have been reported in many studies, but that with light drinking is unclear.

METHODS

In a 2012-13 school-based survey, 20,951 secondary school students (aged 11-20 years, 51.3 % boys) from 44 schools in Hong Kong reported their sociodemographic information, depressive symptoms, drinking patterns and other lifestyle factors. The associations of depressive symptoms with drinking status, drinking frequency and quantity, and the usual type of alcohol beverage consumed were examined using robust Poisson regression accounting for school clustering and covariates.

RESULTS

The prevalence of current drinking and depressive symptoms was 13.6 % and 19.0 %, respectively. Depressive symptoms were associated with former drinking (adjusted prevalence ratio 1.48, 95 % confidence interval 1.30-1.68) and measures of light drinking: experimental drinking (1.29, 1.19-1.39), less-than-monthly drinking (1.40, 1.18-1.67) and consuming half a drink or less (1.33, 1.12-1.58), and such associations were stronger in younger adolescents. Associations were also observed for light drinking patterns of 1-2 drinks less than monthly (1.72, 1.40-2.11) and half a drink monthly (1.51, 1.21-1.88). Consuming fruit wine (1.51, 1.27-1.79) and beer (1.63, 1.42-1.88) with relatively low alcohol contents was also associated with depressive symptoms.

CONCLUSIONS

Our study provided first evidence that even light drinking in terms of the amount, frequency and type of alcohol beverages or light drinking patterns such as consuming 1-2 drinks less than monthly and half a drink monthly were associated with depressive symptoms in adolescents. Our results support total alcohol abstinence in adolescents.

Role of dietary factors in the prevention and treatment for depression: an umbrella review of meta-analyses of prospective studies

The role of diet in depression is becoming increasingly acknowledged. This umbrella review aimed to summarize comprehensively the current evidence reporting the effects of dietary factors on the prevention and treatment of depression. PubMed, Embase, and the Cochrane Library were searched up to June 2021 to identify relevant meta-analyses of prospective studies. Twenty-eight meta-analyses, with 40 summary estimates on dietary patterns (n = 8), food and beverages (n = 19), and nutrients (n = 13) were eligible. The methodological quality of most meta-analyses was low (50.0%) or very low (25.0%). Quality of evidence was moderate for inverse associations for depression incidence with healthy diet [risk ratio (RR): 0.74, 95% confidential interval (CI), 0.48-0.99, I² = 89.8%], fish (RR: 0.88, 95% CI, 0.79-0.97, I²= 0.0%), coffee (RR: 0.89, 95% CI, 0.84-0.94, I²= 32.9%), dietary zinc (RR: 0.66, 95% CI 0.50-0.82, I²= 13.9%), light to moderate alcohol (<40 g/day, RR: 0.77, 95% CI, 0.74-0.83, I²= 20.5%), as well as for positive association with sugar-sweetened beverages (RR: 1.05, 95% CI, 1.01-1.09, I²= 0.0%). For depression treatment, moderate-quality evidence was identified for the effects of probiotic [standardized mean difference (SMD): -0.31, 95% CI, -0.56 to -0.07, I²= 48.2%], omega-3 polyunsaturated fatty acid (SMD: -0.28, 95% CI, -0.47 to -0.09, I² = 75.0%) and acetyl-L-carnitine (SMD: -1.10, 95% CI, -1.65 to -0.56, I² = 86.0%) supplementations. Overall, the associations between dietary factors and depression had been extensively evaluated, but none of them were rated as high quality of evidence, suggesting further studies are likely to change the summary estimates. Thus, more well-designed research investigating more detailed dietary factors in association with depression is warranted.

Racial discrimination, depressive symptoms, ethnic-racial identity, and alcohol use among Black American college students

BACKGROUND

Racial discrimination is prevalent among Black Americans, and may increase risk for alcohol use and related problems. Understanding the mediating and moderating factors in the pathways linking racial discrimination to alcohol use outcomes is important for prevention and intervention efforts. We tested depressive symptoms as a mediator and ethnic-racial identity as a moderator in the relation between racial discrimination and alcohol use outcomes among Black American young adults.

METHODS

We used data from 2 independent samples of Black American young adults recruited from different regions in the United States. The first sample included 383 Black American young adults (Mage = 20.65, SD = 2.28; 81% female), and the second sample included 165 Black American young adults (Mage = 21.56, SD = 4.92; 75% female).

RESULTS

Racial discrimination was associated with alcohol consumption and problems indirectly via depressive symptoms across the 2 independent samples. Moderation was evident for one sample such that high private regard levels buffered the association between racial discrimination and alcohol consumption, whereas high public regard levels exacerbated the association between racial discrimination and depressive symptoms.

CONCLUSIONS

Racial discrimination experiences put Black American young adults at risk for alcohol use and related problems through increased depressive symptoms. Ethnic-racial identity may buffer or exacerbate these associations depending on the specific dimension. The findings imply the need to target depressive symptoms and alcohol use simultaneously to promote health and well-being among Black Americans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impulsivity Scale-12 and its utilization in alcohol use disorder

INTRODUCTION

One of the core symptoms of alcohol use disorder (AUD) is impulsivity. The recently published study on the Impulsivity Scale 12 (IS-12) offers a promising tool to use in clinics working with clients with AUD due to its simplicity. IS-12 includes subscales related tocognitive impulsivity and behavioral impulsivity, which are related to different aspects of AUD symptomatology. The aim of the study was to adapt IS-12 to polish and test its utility in a sample of patients diagnosed with AUD.

METHODS

Using a Confirmatory Factor Analysis, we compared the two-factor model of the Polish adaptation of the BIS-11 and the IS-12 on a sample of 615 patients diagnosed with AUD. Additionally, we explored the association between the IS-12's cognitive impulsivity and behavioral impulsivity subscales and depressive symptoms, AUD severity, and suicidal ideation using Structural Equation Modeling on a subsample of 450 patients with AUD.

RESULTS

The IS-12 demonstrated a better model fit and good reliability compared to the BIS-11. Moreover, cognitive impulsivity predicted suicidal ideation, but not AUD severity, while behavioral impulsivity predicted AUD severity, but not suicidal ideation. Both subscales of IS-12 predicted depressive symptoms.

CONCLUSION

Consistent with prior work, findings indicate that the second-order factor model of the BIS-11 had reliability issues and evidenced poor model fit. In contrast, the IS-12 demonstrated a satisfactory model fit and was predictive of clinical symptomatology. Thus, utilizing an easy tool, such as IS-12, might be beneficial for researchers and clinicians working with patients with AUD.