Prevalence and correlates of major depression among Nepalese patients in treatment for alcohol-use disorders

Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking

AIMS

To disaggregate associations with alcohol use disorder relative to those with early alcohol use stages in an adult population. We estimated prevalence rates and socio-demographic correlates for the opportunity to drink and transitions into life-time alcohol use, regular use and alcohol use disorder.

DESIGN

A retrospective, cross-sectional population survey within a family panel study.

SETTING

Chitwan in Nepal, an ethnically diverse setting with heterogeneous ethnic restrictions regarding alcohol.

PARTICIPANTS

A total of 10 714 individuals aged 15-59 years (response rate = 93%).

MEASUREMENTS

The Nepal-specific Composite International Diagnostic Interview assessed life-time alcohol use opportunity, any use, regular use, disorder and socio-demographic characteristics.

FINDINGS

Seventy per cent [95% confidence interval (CI) = 69.08-70.82%] of the population had the opportunity to drink, 38.06% (95% CI = 37.14-38.99%) had life-time alcohol use, 32.37% (95% CI = 31.48-33.27%) had regular alcohol use and 6.04% (95% CI = 5.60-6.50%) developed an alcohol use disorder. Compared with high-caste Hindus, all other ethnicities had greater odds of early stage transitions [odds ratios (OR) ranged from 1.31, 95% CI = 1.16-1.47 to 1.98, 95% CI = 1.81-2.18)], but not of development of disorder. Male sex was associated with greater odds of all transitions, from opportunity (OR = 5.71, 95% CI = 5.41-6.03) to development of disorder (OR = 1.95, 95% CI = 1.35-2.81). The youngest cohort had higher odds of all transitions, from opportunity (OR = 4.86, 95% CI = 4.47-5.29) to development of disorder (OR = 9.34, 95% CI = 6.88-12.70). Higher education was associated with lower odds of all transitions except opportunity [from use (OR = 0.77, 95% CI = 0.71-0.83) to the development of disorder (OR = 0.73, 95% CI = 0.59-0.89)].

CONCLUSIONS

The prevalence of life-time alcohol use among adults in Nepal appears to be low, but the overall prevalence of disorder is similar to other countries. Socio-demographic correlates of early alcohol use transitions differ from those associated with later transitions; while sex and age cohort were associated with all transitions, ethnicity was associated with early transitions (opportunity, life-time use, regular use), but not later transitions (use and regular use to disorder).

The role of alcohol-induced blackouts in symptoms of depression among young adults

OBJECTIVE

Blackouts are associated with other alcohol-related consequences and depression among young adults, but the mechanisms underlying these associations are unclear. Using two separate samples, we tested the hypothesis that blackouts would be linked to symptoms of depression due in part to their association with other alcohol-related consequences.

METHOD

Young adults who use alcohol completed assessments at baseline in Sample 1 (N₁ = 381, 58% female) and baseline, 3 months, and 6 months in Sample 2 (N₂ = 603, 53 % female). Bootstrapped confidence intervals were used to examine the direct and indirect effects of blackouts on depressive symptoms, using cross-sectional mediation analysis in Sample 1 and a counterfactual approach with longitudinal data in Sample 2.

RESULTS

In both samples, alcohol-induced blackouts were associated with alcohol-related consequences, which in turn were associated with symptoms of depression. In Sample 1, blackouts had both direct and indirect (mediated) effects on depressive symptoms. In Sample 2, blackouts measured at baseline only had an indirect effect on depressive symptoms six months later through other alcohol-related consequences at three months.

CONCLUSIONS

Among heavy-drinking college students, the majority of whom reported minimal symptoms of depression, blackouts were associated with increases in other alcohol-related consequences, which in turn were associated with increases in symptoms of depression. These findings suggest that prevention and intervention efforts targeting blackouts may help reduce other alcohol-related consequences among young adults.

Comorbid post-traumatic stress disorder in alcohol use disorder: relationships to demography, drinking and neuroimmune profile

BACKGROUND

This study examined how alcohol use disorder (AUD) patients with post-traumatic stress disorder (PTSD) differed from those without PTSD in terms of demography, drinking patterns and C-reactive protein, inflammatory cytokines, tryptophan metabolism parameters, and brain-derived neurotrophic factor (BDNF).

METHODS

A consecutive sample (N = 187) of treatment-receiving AUD individuals were recruited from Nepalese facilities. They underwent fully structured psychiatric interviews. Serum levels of inflammatory cytokines [interleukin (IL)-6, IL-1 Receptor antagonist (IL-1Ra), IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ)] were determined by a multiplex assay, kynurenine and tryptophan levels by high-performance liquid chromatography, and BDNF by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The prevalence of exposure to severe trauma and PTSD was 74% and 17%, respectively. PTSD comorbidity was not associated with age, gender, or socioeconomic status, but with co-occurring major depression, history of attempted suicide, earlier peak of drinking problems, higher drinking quantity and withdrawal symptoms, experiencing alcoholic blackouts, and drinking problems among parents. None of the assessed neuroimmune parameters was related to comorbid PTSD.

CONCLUSIONS

The findings support routine trauma screening in AUD treatment samples and screening for risky drinking in trauma populations to help guide interventions. The expected aberrations in neuroimmune functioning may not be found when examined in a sample with multiple psychiatric morbidities.

Prevalence and correlates of psychological distress symptoms among patients with substance use disorders in drug rehabilitation centers in urban Nepal: a cross-sectional study

BACKGROUND

The burden of substance misuse in developing countries is large and increasing, with negative consequences for physical and psychological health. Substance use disorders and psychological distress commonly co-exist, however few studies have examined this relationship in developing countries, including Nepal. Our aim was to investigate the prevalence of psychological distress symptoms and associated factors among patients with substance use disorders attending drug rehabilitation centers in Nepal.

METHODS

We conducted a cross-sectional study including 180 patients attending drug rehabilitation centers in the Kathmandu Valley region of Nepal. We used the 6-item Kessler scale (K6) to measure symptoms of psychological distress, and data on socio-demographics, behavioral and psychosocial factors. Multivariable analyses were used to identify factors associated with distress.

RESULTS

The prevalence of high psychological distress symptoms among patients with substance use disorder was 51.1 %. The mean score found on the K6 was 12.22 (SD = 5.87). Outcomes of multivariable analyses demonstrated various factors associated with symptoms of psychological distress, including age (β = -0.122, 95 % CI = -0.218; -0.026), education (β =2.694, 95 % CI = 0.274; 5.115), severity of drug abuse (Drug Abuse Screening Test-10-DAST10)(β = 0.262, 95 % CI = 0.022;0.502), and family functioning (Adaptability, Partnership, Growth, Affection and Resolve-APGAR) (β = -0.525, 95 % CI = -0.787; -0.264).

CONCLUSIONS

High psychological distress symptoms are common in patients with substance use disorder in Nepal. Demographics (age, education), behavioral (drug abuse severity), and psychosocial factors (family functionality) were associated with psychological distress symptoms. If confirmed by future longitudinal studies such characteristics may assist in identifying groups at risk for co-morbid psychological distress symptoms among patients with substance use disorders. Future treatment approaches for substance use disorders should address co-existing mental illness in Nepal.

Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies

BACKGROUND

Alcohol-induced blackouts, or memory loss for all or portions of events that occurred during a drinking episode, are reported by approximately 50% of drinkers and are associated with a wide range of negative consequences, including injury and death. As such, identifying the factors that contribute to and result from alcohol-induced blackouts is critical in developing effective prevention programs. Here, we provide an updated review (2010 to 2015) of clinical research focused on alcohol-induced blackouts, outline practical and clinical implications, and provide recommendations for future research.

METHODS

A comprehensive, systematic literature review was conducted to examine all articles published between January 2010 through August 2015 that focused on vulnerabilities, consequences, and possible mechanisms for alcohol-induced blackouts.

RESULTS

Twenty-six studies reported on alcohol-induced blackouts. Fifteen studies examined prevalence and/or predictors of alcohol-induced blackouts. Six publications described the consequences of alcohol-induced blackouts, and 5 studies explored potential cognitive and neurobiological mechanisms underlying alcohol-induced blackouts.

CONCLUSIONS

Recent research on alcohol-induced blackouts suggests that individual differences, not just alcohol consumption, increase the likelihood of experiencing an alcohol-induced blackout, and the consequences of alcohol-induced blackouts extend beyond the consequences related to the drinking episode to include psychiatric symptoms and neurobiological abnormalities. Prospective studies and a standardized assessment of alcohol-induced blackouts are needed to fully characterize factors associated with alcohol-induced blackouts and to improve prevention strategies.

Who seeks treatment for alcohol problems? Demography and alcohol-use characteristics of patients in taboo and non-taboo drinking groups attending professional alcohol services in Nepal

INTRODUCTION

Only few individuals with alcohol problems seek help; those who do have not been described adequately. Here, we summarize the demographic and alcohol-related features of inpatients attending professional alcohol services in Nepal and examine differences between patients with and without social taboos about drinking.

METHODS

Fully structured interviews including the Composite International Diagnostic Interview and the Alcohol Use Disorder Identification Test were administered to 177 men and 21 women consecutively admitted to eight alcohol treatment centres in Kathmandu.

RESULTS

Altogether, 164 patients (83%) had alcohol dependence and 24 patients (12%) had alcohol abuse. The sample had a mean age of 35.3 years (SD 10.1) with a time lag of 16.8 years (SD 9.8) from start of habitual drinking to first entry into treatment. Most (62%) were married, lived in urban areas (72%), had above-average income (57%), received adequate social support (71%), and belonged to social groups in which drinking is taboo (57%). Individuals in non-taboo group more often lived in urban areas, had lower socioeconomic status, more often reported parental problem drinking and started drinking at a younger age, whereas individuals in the taboo group more often had late onset, risky drinking, and waited longer before seeking treatment (P<0.05).

CONCLUSION

Traditionally alcohol non-using castes and people with higher socioeconomic status over-represent professional alcohol services in Kathmandu. This, and high levels of hazardous and harmful alcohol use, indicate changing trends concerning social tolerance towards alcohol in Nepalese society in recent times and a heavy burden associated with alcohol disorders.

High frequency and intensity of drinking may attenuate increased inflammatory cytokine levels of major depression in alcohol-use disorders

AIMS

As major depression (MD) is often comorbid with alcohol-use disorders (AUD) and alcohol itself modulates the immune system, we examined serum levels of interleukin (IL)-6, IL-10, tumor necrosis factor (TNF), and interferon (IFN)-γ in AUD patients with and without MD. Putative interactions between alcohol variables and MD on cytokine levels were also assessed.

METHODS

A consecutive sample of inpatients with AUD (N = 176) from eight alcohol treatment centers in Kathmandu, Nepal, was assessed for alcohol use and depression by administering fully structured psychiatric interviews. Serum cytokine levels were determined using multiplex technology.

RESULTS

Alcohol-use disorders patients with a positive history of MD had higher levels of the inflammatory cytokines IL-6 (P = 0.019), TNF (P = 0.020), and IFN-γ (P = 0.001), but not of IL-10 (P = 0.853). AUD patients with MD had higher concentrations of cytokines compared with those without, regardless of the severity of the alcohol problem, but the difference was greater among those drinking in lower frequency and intensity.

CONCLUSION

These findings provide evidence for altered functioning of the immune system in AUD patients with comorbid MD. However, frequent and intense drinking may attenuate the difference in the cytokine profiles between AUD patients with and without MD.

Risk of depressive disorder following non-alcoholic cirrhosis: a nationwide population-based study

BACKGROUND & AIMS

To evaluate the risk of depressive disorders among non-alcoholic patients by using the Taiwan National Health Insurance Research Database (NHIRD).

METHODS

We conducted a retrospective study of a matched cohort of 52 725 participants (10 545 non-alcoholic cirrhotic patients and 42 180 control patients) who were selected from the NHIRD. Patients were observed for a maximum of 11 years to determine the rates of newly onset depressive disorders, and Cox regression was used to identify the risk factors associated with depressive disorders in cirrhotic patients.

RESULTS

During the 11-year follow-up period, 395 (3.75%) non-alcoholic cirrhotic patients and 1 183 (2.80%) control patients were diagnosed with depressive disorders. The incidence risk ratio of depressive disorders between non-alcoholic cirrhotic patients and control patients was 1.76 (95% CI, 1.57-1.98, P<.001). After adjusting for age, sex, and comorbidities, non-alcoholic cirrhotic patients were 1.75 times more likely to develop depressive disorders (95% CI, 1.56-1.96, P<.001) compared with the control patients. The hazard ratios for patients younger than 60 years old (1.31) and female (1.25) indicated that each is an independent risk factor for depressive disorders in non-alcoholic cirrhotic patients.

CONCLUSIONS

The likelihood of developing depressive disorders is greater among non-alcoholic cirrhotic patients than among patients without cirrhosis. Symptoms of depression should be sought in patients with cirrhosis.

Vitamin D deficiency in alcohol-use disorders and its relationship to comorbid major depression: a cross-sectional study of inpatients in Nepal

BACKGROUND

Mounting evidence suggests that deficiency of vitamin D may be associated with major health problems, including alcohol-use disorders (AUD) and major depression (MD). This study aimed to identify the vitamin D status of Nepalese inpatients with an AUD. We explored socio-demographic and alcohol-use related correlates and the relationship between vitamin D deficiency and comorbid MD.

METHODS

A cross-sectional study was conducted on AUD inpatients (N=174) at eight alcohol/drug treatment centres around Kathmandu. Structured questionnaires were administered to assess the socio-demographic and alcohol-use parameters and to establish DSM-IV diagnoses of AUD and MD. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25(OH)D) concentration of <50 nmol/L.

RESULTS

The prevalence of vitamin D deficiency was 64%. Higher age, having a stable job or business, shorter time since last alcohol intake and winter serum samples were related to having lower 25(OH)D levels. Several features of AUD severity were associated with low vitamin D levels: guilt about drinking, using alcohol as eye-opener, and history of relapse after alcohol treatment (p ≤ 0.03). Patients with a comorbid major depression, in particular secondarily depressed cases, were less likely to have vitamin D deficiency (X(2)=6.8; p=0.01).

CONCLUSIONS

This study confirms high rates of vitamin D deficiency in alcohol treatment sample and shows a positive association between vitamin D deficiency and severity of alcohol-use disorders. Competing risk and other confounders may help explain the vitamin D status among patients with alcohol-use disorders and comorbid major depression.