Aetiology of secondary depression in male alcoholics

The Role Of Alcohol Use Disorder And Alcohol Consumption In Suicide Attempts-A Secondary Analysis Of 1921 Suicide Attempts

Background

It is not known how characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts.

Methods

Data on 1921 suicide attempts was gathered in a major German city over a 5-year period. Suicide attempts were categorised according to a diagnosis of alcohol use disorder and acute alcohol consumption at the time of the attempt. Group comparisons and multinomial logistic regression were used for statistical analysis.

Results

In 331 suicide attempts (17%) an alcohol use disorder was diagnosed. Six hundred and twenty-two suicide attempts (32%) were committed with acute alcohol consumption. Suicide attempts by individuals with alcohol use disorder were more often committed by men, older individuals and as a recurrent attempt, independently of alcohol consumption at the time of the attempt. When alcohol was consumed in suicide attempts by individuals with alcohol use disorder, low-risk methods were used most often.

Conclusions

Individuals with a diagnosis of alcohol use disorder are a high-risk group for multiple suicide attempts and should be a target group for suicide prevention. Screening for suicidality should be a regular part of the clinical assessment in individuals with alcohol use disorder.

Drinking Behavior and Mental Illness Among Evacuees in Fukushima Following the Great East Japan Earthquake: The Fukushima Health Management Survey

Background

Recent evidence from alcohol and trauma studies suggests that disasters are associated with increases in the consumption of alcohol. The Great East Japan Earthquake and the associated nuclear disaster have continued to affect the mental health of evacuees from Fukushima. This study aimed to extend these findings by examining the relationship between drinking behaviors and the risk of mental illness after the compound disaster.

Methods

We conducted the Mental Health and Lifestyle Survey with 56,543 evacuees. Kessler's K6 was used to assess the risk of mental illness, and logistic regression models were applied to analyze how drinking behavior patterns influence the risk of serious mental illness after adjustment for confounding variables.

Results

Logistic regression analysis evidenced that beginning heavy and light drinkers had the highest and a higher risk of serious mental illness, respectively. Individuals who were nondrinkers pre‐ and postdisaster had the lowest proportional risk of mental illness. Abstainers also had some risk to their mental health after the compound disaster.

Conclusions

The results of this study highlight that beginning drinkers have a high risk of serious mental illness. Thus, mental health professionals should pay attention to the drinking behaviors of evacuees, which might predict increased risk of serious mental illness and consequently indicate a need for psychological intervention.

THE ASSOCIATION BETWEEN ALCOHOL MISUSE AND SUICIDAL BEHAVIOUR

AIMS

Despite recent small reductions in overall suicide rates, rates among those aged 25-44 have remained high. The aim of this paper was to examine the evidence for a link between alcohol misuse/consumption and suicidal behaviour, explore the reasons for this association, and consider the implications for reducing rates of suicidal behaviour.

METHODS

A medline search was performed to find relevant research evidence.

RESULTS

There is evidence to suggest alcohol misuse predisposes to suicidal behaviour through its depressogenic effects and promotion of adverse life events, and both behaviours may share a common genetic predisposition. Acute alcohol use can also precipitate suicidal behaviours through induction of negative affect and impairment of problem-solving skills, as well as aggravation of impulsive personality traits, possibly through effects on serotonergic neurotransmission.

CONCLUSIONS

Effective interventions for problem drinking may help reduce suicide rates. At a public health level, reducing overall alcohol consumption may be beneficial, and the measures shown to be most effective in this regard are those that aim to restrict availability of alcohol.

Psychometrische Eigenschaften des Beck-Depressionsinventars (BDI) bei Alkoholabhängigen

Zusammenfassung. Theoretischer Hintergrund: Eine standardisierte Erfassung von Depressivität wird bei Alkoholabhängigen dadurch erschwert, dass Alkohol bzw. Alkoholentzug zu depressiven Verstimmungen und vegetativer Symptomatik führen kann. Gängige Messinstrumente zur Depression sind außerdem nicht für Alkoholikergruppen entwikkelt und an diesen bisher kaum überprüft worden. Fragestellung: Die Studie untersucht die psychometrischen Eigenschaften des Beck-Depressionsinventars (BDI) bei Alkoholikern. Methode: Es wurde eine unausgelesene Stichprobe von 665 Alkoholikern (143 Frauen, 522 Männer) in stationärer Behandlung analysiert. Ergebnisse: Die interne Konsistenz des BDI war mit 0,90 hoch. Analysen mit dem ordinalen Rasch-Modell ergaben jedoch, dass die Kategorie 3 in drei Items nicht den theoriekonformen Schweregrad abbildet. Bedeutsame Geschlechtsunterschiede waren nicht zu verzeichnen. Verkürzte Skalen mit sieben bzw. neun Items, die aufgrund inhaltlicher und empirischer Vorgaben gebildet wurden, weisen ebenfalls noch hohe Reliabilität auf, ebenso eine nur aus drei Items bestehende Kernsymptom-Skala. Schlussfolgerung: Die Reliabilität des BDI ist hoch, doch wird wegen insgesamt besserer psychometrischer Eigenschaften der Gebrauch der Subskalen empfohlen. Deren prognostische Validität zur frühzeitigen Differenzierung von Alkoholpatienten mit und ohne zusätzliche depressive Störung muss jedoch noch bestätigt werden.

Nefazodone treatment of major depression in alcohol-dependent patients: a double-blind, placebo-controlled trial

Depression is the most common comorbid psychiatric illness in patients with alcohol dependence. This double-blind study tested the efficacy of nefazodone versus placebo for the treatment of depression in actively drinking alcohol-dependent patients who were also participating in weekly group treatment for alcoholism. Sixty-four subjects with major depression disorder and alcohol dependence with a history of at least one prior episode of depression when not drinking were randomly assigned to receive 12 weeks of either nefazodone or placebo and participated in a weekly psychoeducational group on alcoholism. Subjects were assessed every 2 weeks for depression, anxiety, side effects, and drinking frequency. Subjects taking nefazodone were significantly more likely to complete the study (62%) than those taking placebo (34%). Analyses of covariance using drinks per week as a time-dependent covariate showed lower Hamilton Rating Scale for Depression scores at week 8 for end-point analysis and at weeks 8 and 12 for completers. The endpoint analysis demonstrated a significantly greater response in the nefazodone group (48%) than in the placebo group (16%). Both groups showed a similarly significant decrease in the average number of alcoholic drinks consumed per day over the course of the study. Although the number of adverse effects was significantly greater for the nefazodone group, there were no severe adverse events, and nefazodone was well tolerated. Nefazodone is a safe and effective antidepressant to use in a population of alcohol-dependent patients with depression who have a high degree of comorbidity. Nefazodone treatment was superior to placebo in alleviating depression in these patients but did not add any advantage over the psychoeducational group in terms of drinking outcomes.

Childhood trauma and depression in alcoholics: relationship to hostility

OBJECTIVE

To examine for a relationship between childhood trauma and depression in alcoholics.

METHODS

Euthymic depressed alcoholics (N = 23) were compared with never depressed alcoholics (N = 20) for their scores on the Childhood Trauma Questionnaire (CTQ). Subjects also completed the Hostility and Direction of Hostility Questionnaire (HDHQ).

RESULTS

Euthymic depressed alcoholics had significantly higher scores on the CTQ for childhood emotional abuse, physical abuse, sexual abuse, and emotional neglect. They also had significantly higher hostility scores on the HDHQ. There were significant correlations between adult hostility scores and CTQ scores for childhood emotional neglect, physical neglect, sexual abuse and total childhood trauma.

CONCLUSION

A history of childhood trauma was correlated with adult depression in male alcoholics: a hostile personality dimension might be a mediating variable.

LIMITATION

Subjects were queried on their memories of childhood traumas. Prospective studies are needed.

Neuroticism and depression in alcoholics

BACKGROUND

To examine neuroticism as a possible determinant of depression in alcoholics.

METHOD

24 euthymic depressed alcoholics and 18 never-depressed alcoholic controls completed the Eysenck Personality Questionnaire.

RESULT

Euthymic depressed alcoholics had significantly higher neuroticism scores than alcoholic controls.

LIMITATION

No women alcoholics were studied.

CONCLUSION

Neuroticism may be a risk factor for depression in alcoholics.

Placebo-controlled study of sertraline in depressed recently abstinent alcoholics

BACKGROUND

Depression is common among recently abstinent alcoholics; however, its treatment has been little studied.

METHODS

Thirty-six depressed recently abstinent alcoholics were randomized in a 6-week double-blind placebo-controlled trial of sertraline 100 mg daily.

RESULTS

There was a significant group x time interaction for both the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI). For the HDRS there were significant differences between the sertraline and placebo groups at weeks 3 and 6 and for the BDI at week 3. Also, patients receiving sertraline had significantly lower mean posttreatment HDRS and BDI scores than patients receiving placebo. Furthermore, significantly more of the patients receiving sertraline obtained a Clinical Global Impression rating of "very much improved."

CONCLUSIONS

Depressed recently abstinent alcoholics benefit from antidepressant medication.