Alcohol Use Predicts 10-Year Depressive Symptom Trajectories in the Health and Retirement Study

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.

Do symptoms of depression and anxiety contribute to heavy episodic drinking? A 3-wave longitudinal study of adult community members

Heavy episodic drinking (or binge drinking) is a significant public health concern. Self-medication using alcohol is often thought to explain the co-occurrence of heavy episodic drinking with depression and anxiety. Yet, there is little longitudinal work examining both depressive and anxiety symptoms and how they are independently related to heavy episodic drinking in adult community samples. To this end, we invited adult community members (N = 102) to come to the lab to complete validated measures of depressive symptoms (composite of CES-D-SF, SCL-90-D, and DASS-21-D), anxiety symptoms (DASS-21-A), and heavy episodic drinking (composite of frequency, severity, and perceptions) at baseline, and again three and six months later. Using a three-wave cross-lagged panel model, we tested reciprocal relations between heavy episodic drinking and each internalizing symptom. We found strong temporal stability in our study variables. Depressive symptoms were associated with increases in heavy episodic drinking, and anxiety symptoms were associated with decreases in heavy episodic drinking. In contrast, heavy episodic drinking did not predict either internalizing symptom over time. Results are consistent with the notion that individuals with greater depressive symptoms use alcohol to self-medicate, and that anxiety symptoms (particularly autonomic arousal) may be potentially protective against future heavy episodic drinking.

Social capital and alcohol risks among older adults (50 years and over): analysis from the Drink Wise Age Well Survey

Although there has been significant research on the relationship between alcohol consumption and demographic and psychological influences, this does not consider the effect of social influence among older drinkers and if these effects differ between men and women. One aspect of social influence is social capital. The aim of this paper is to examine whether relational and cognitive social capital are associated with higher or lower risk of alcohol use among adults aged 50 years or older and to assess the extent to which this relationship differs between men and women. To investigate this, data were collected from a cross-sectional questionnaire survey of adults over the age of 50 in the United Kingdom who were recruited from general practitioners. The sample consisted of 9,984 individuals whose mean age was 63.87 years. From these data, we developed proxy measures of social capital and associate these with the respondent's level of alcohol consumption as measured on the Alcohol Use Disorders Identification Test (AUDIT-10) scale. In the sample, just over 20 per cent reported an increasing risk or dependency on alcohol. Using two expressions of social capital – relational (social relationships) and cognitive (knowledge acquisition and understanding) – we found that greater levels of both are associated with a reduced risk of higher drinking risk. Being female had no significant effect when combined with relational capital but did have a significant effect when combined with cognitive capital. It is argued that interventions to enhance social relations among older people and education to help understand alcohol risks would be helpful to protect older people from the damaging effects of excessive alcohol consumption.

History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND

OBJECTIVE

To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18 years later.

METHOD

A longitudinal Health and Retirement Study cohort (n = 4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18 years later.

RESULTS

Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND.

CONCLUSIONS

For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.

Pandemic-related mental health risk among front line personnel

The mental health of frontline workers is critical to a community's ability to manage crises and disasters. This study assessed risks for mental health problems (traumatic stress, depression, anxiety, alcohol use, insomnia) in association with pandemic-related stressors in a sample of emergency and hospital personnel (N = 571). Respondents completed self-report surveys online from April 1st to May 7th, 2020 in the Rocky Mountain region of the United States. Results showed that roughly fifteen to thirty percent of respondents screened positive for each disorder. Odds of screening positive were similar between groups for probable acute traumatic stress, depressive disorder, anxiety disorder, and alcohol use disorder; emergency personnel reported significantly higher rates of insufficient sleep than healthcare workers. Logistic regressions showed that respondents who reported having an immunocompromised condition had higher odds of acute traumatic stress, anxiety, and depression. Having an immunocompromised household member was associated with higher odds of insufficient sleep and anxiety. Being in a direct care provision role was associated with higher odds of screening positive for risky alcohol use. Being in a management role over direct care providers was associated with higher odds of screening positive for anxiety, risky alcohol use, and insufficient sleep. There was an inverse relationship between number of positive COVID-19 cases and anxiety, such that as positive cases went up, anxiety decreased. Overall, the mental health risks that we observed early in the COVID-19 pandemic are elevated above previous viral outbreaks (SARS) and comparable to rates shown in disasters (9/11 attacks; Hurricane Katrina).

Low-to-Moderate Alcohol Intake Associated with Lower Risk of Incidental Depressive Symptoms: A Pooled Analysis of Three Intercontinental Cohort Studies

BACKGROUND

The existing findings of the longitudinal impact of low-to-moderate drinking on symptomatic depression were controversial, as results ranged from finding no association to finding both a protective and adverse association.

METHODS

The present study examined the association between low-to-moderate alcohol consumption and incident depressive symptoms by pooled analysis of three European, American and Chinese representative samples of middle-aged and older adults.

RESULTS

A total of 29,506 participants (55.5% female) were included. During 278,782 person-years of follow-up, we found that subjects with low-to-moderate drinking had a significantly lower incidence of depressive symptoms compared to never-drinking subjects, with pooled hazard ratios of 0.87 (95% confidence interval [CI]: 0.79-0.96) for men and 0.87 (95% CI: 0.80-0.95) for women, whereas heavy drinkers failed to show significantly higher risk of depressive symptoms. Furthermore, a J-shaped relation between alcohol consumption and incident depressive symptoms was identified in Chinese men, US men, and UK men and women.

LIMITATIONS

The classification of depressive symptoms based on the Center for Epidemiologic Studies Depression Scale may not be completely comparable to diagnosis from a clinical setting.

CONCLUSIONS

Low-to-moderate alcohol consumption was significantly associated with a lower risk of depressive symptoms on a long-term basis compared to never drinking. Our results support the threshold of moderate drinking in current US guidelines. However, caution should be exercised in engaging in guideline-concordant drinking habits, for even moderate drinkers are at risk of developing heavy drinking habits and experiencing future alcohol-related problems.

Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom

Background

Racism has been linked with poor health in studies in the United States. Little is known about prospective associations between racial discrimination and health outcomes in the United Kingdom (UK).

Methods

Data were from 4883 ethnic minority (i.e. non-white) participants in the UK Household Longitudinal Study. Perceived discrimination in the last 12 months on the basis of ethnicity or nationality was reported in 2009/10. Psychological distress, mental functioning, life satisfaction, self-rated health, physical functioning and reports of limiting longstanding illness were assessed in 2009/10 and 2011/12. Linear and logistic regression analyses adjusted for age, sex, income, education and ethnicity. Prospective analyses also adjusted for baseline status on the outcome being evaluated.

Results

Racial discrimination was reported by 998 (20.4%) of the sample. Cross-sectionally, those who reported racial discrimination had a greater likelihood on average of limiting longstanding illness (odds ratio (OR) = 1.78, 95% confidence interval (CI) 1.49; 2.13) and fair/poor self-rated health (OR = 1.50; 95% CI 1.24; 1.82) than those who did not report racial discrimination. Racial discrimination was associated with greater psychological distress (B = 1.11, 95% CI 0.88; 1.34), poorer mental functioning (B = − 3.61; 95% CI -4.29; − 2.93), poorer physical functioning (B = − 0.86; 95% CI -1.50; − 0.27), and lower life satisfaction (B = − 0.40, 95% CI -0.52; − 0.27). Prospectively, those who reported racial discrimination had a greater likelihood on average of limiting longstanding illness (OR = 1.31, 95% CI 1.01; 1.69) and fair/poor self-rated health (OR = 1.30; 95% CI 1.00; 1.69), than those who did not report racial discrimination. Racial discrimination was associated increased psychological distress (B = 0.52, 95% CI 0.20; 0.85) and poorer mental functioning (B = − 1.77; 95% CI -2.70; − 0.83) over two-year follow-up, adjusting for baseline scores.

Conclusions

UK adults belonging to ethnic minority groups who perceive racial discrimination experience poorer mental and physical health than those who do not. These results highlight the need for effective interventions to combat racial discrimination in order to reduce inequalities in health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09792-1.

Interactive Effects of Quality of Life and Related Factors on Alcohol Use Outcomes

This investigation derives its impetus from public health concerns around detecting, mitigating, and preventing the deleterious effects that alcohol use can cause particularly in advanced age. We aim to complement gerontological research by exploring the interactive effects of quality of life and related factors on alcohol use outcomes assessed by the Drinking Problem Index. The study is based on cross-sectional data collected from questionnaires mailed to a randomly drawn sample of 6,000 Norwegian adults aged 62 and older (participation rate: 32%). According to the Chi-square Automatic Interaction Detection (CHAID) analysis, constellations of interactive factors emerged differently for women and men, and, between non-problem and problem drinkers. For women, drinking outcomes were related to intra-psychic functioning, and for men, to physical health and social situation. An ongoing quality-of-life assessment may be very important in the comprehensive assistance provided to those older people who are vulnerable to undergoing alcohol-related harms.

Risky drinking and dual diagnosis in older people under a UK community old age psychiatry service

Purpose

The assessment of patterns in risky drinking and its association with dual diagnosis in community services for older people remains under-explored. The paper aims to discuss this issue.

Design/methodology/approach

Drinking risk using the Alcohol Use Disorders Identification Test (AUDIT) and the presence of co-existing mental disorders was examined in 190 people aged 65 and over.

Findings

In total, 24 per cent of drinkers drank above lower risk levels and 22 per cent reported binge drinking over the past 12 months. Those scoring 1 or more on the AUDIT were more likely to be male and to have greater cognitive impairment than non-drinkers and those reporting no past problems with alcohol.

Research limitations/implications

Given the limitations of the Mini Mental State Examination in the detection of alcohol related cognitive impairment (ARCI), the use of other cognitive screening instruments in larger study populations is also warranted.

Practical implications

Greater attention needs to be paid to the assessment of risky drinking in older male drinkers and those with cognitive impairment.

Originality/value

There is considerable scope for the routine detection of cognitive impairment and dementia in older people with alcohol use within mainstream mental health services, particularly in those with binge drinking. As ARCI is associated with loss of function and independence, early detection and intervention can improve health and social outcomes.

Depression and alcohol misuse among older adults: exploring mechanisms and policy impacts using agent-based modelling

PURPOSE

To: (1) explore how multi-level factors impact the longitudinal prevalence of depression and alcohol misuse among urban older adults (≥ 65 years), and (2) simulate the impact of alcohol taxation policies and targeted interventions that increase social connectedness among excessive drinkers, socially isolated and depressed older adults; both alone and in combination.

METHODS

An agent-based model was developed to explore the temporal co-evolution of depression and alcohol misuse prevalence among older adults nested in a spatial network. The model was based on Los Angeles and calibrated longitudinally using data from the Multi-Ethnic Study of Atherosclerosis.

RESULTS

Interventions with a social component targeting depressed and socially isolated older adults appeared more effective in curbing depression prevalence than those focused on excessive drinkers. Targeting had similar impacts on alcohol misuse, though the effects were marginal compared to those on depression. Alcohol taxation alone had little impact on either depression or alcohol misuse trajectories.

CONCLUSIONS

Interventions that improve social connectedness may reduce the prevalence of depression among older adults. Targeting considerations could play an important role in determining the success of such efforts.

Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

Moderate alcohol drinking is not associated with risk of depression in older adults

The scarce research on the effects of moderate alcohol consumption on mental health among older adults suggests a protective effect against depression. We prospectively examined the association between patterns of moderate alcohol consumption, depression and psychological distress, using information from 5,299 community-dwelling older adults from the ELSA and Seniors-ENRICA cohorts. A Mediterranean drinking pattern (MDP) was defined as moderate alcohol intake (<40 g/day for men; <24 g/day for women) with a preference for wine and drinking only with meals. Depression was ascertained with the 10-item Geriatric Depression Scale (GDS-10), a self-report of clinically-diagnosed depression, or being on anti-depressant medication (Seniors-ENRICA); and with the 8-item Center for Epidemiologic Studies Depression Scale (CES-D) (ELSA). Psychological distress was assessed with the General Health Questionnaire-12 (GHQ-12). Compared to never drinkers, moderate drinkers showed comparable scores on the ENRICA-GDS-10 (PRR (95%CI): 1.03 (0.84–1.26)), the ENRICA-GHQ-12 (0.88 (0.73–1.06)), the ELSA-CES-D (0.92 (0.79–1.06)) and the ELSA-GHQ-12 (0.75 (0.55–1.01). The MDP was not associated with the GDS-10 or GHQ-12 scores, or with clinically-diagnosed depression; however drinkers with a preference for wine showed an increased number of psychological distress symptoms (1.31 (1.03–1.66)). In conclusion, we found no consistent protective association between moderate alcohol consumption and depression in older adults.

The relationship between moderate alcohol consumption, depressive symptomatology, and C-reactive protein: the Health and Retirement Study

OBJECTIVE

Moderate alcohol use has been broadly associated with health benefits among older adults, including improved mood. Aims of this study were to evaluate the relationship of moderate alcohol use and depressive symptomatology over a period of eight years, and to examine inflammation, indicated by C-reactive protein (CRP), as one mechanism by which this relationship functions.

METHODS

The study included 3177 community-dwelling participants over the age of 65 in 2008 drawn from the Health and Retirement Study. Data from the 2006, 2008, 2012, and 2014 waves were used. Alcohol use was measured via self-report and was dichotomized as abstinent (0 drinks per week) and moderate (1-14 drinks per week). Inflammation was measured using CRP, which was collected using an enzyme-linked immunosorbent assay and provided in units of μg/mL. Control variables included gender, age, body mass index (BMI), and medical burden.

RESULTS

A latent growth curve model with full information maximum likelihood was used, with results revealing that moderate drinkers endorsed fewer depressive symptoms at baseline and a steeper rate of change over time. Abstinent respondents' depressive symptomatology was characterized by a more linear change rate. Further, moderate drinkers had lower CRP levels suggesting that inflammation partially mediates the relationship between moderate alcohol use and depressive symptomatology.

CONCLUSIONS

Moderate alcohol use predicts fewer depressive symptoms among older adults. This relationship is partially moderated by CRP and is eroded by the passage of time. Future research should identify additional mechanisms relating alcohol to positive health outcomes and less depressive symptomatology. Copyright © 2017 John Wiley & Sons, Ltd.