Mental disorders and total mortality after 20 years in an adult general population sample

[Long-term courses of alcohol dependence]

BACKGROUND

Descriptions of long-term histories of alcohol dependence provide insight into the etiology, prevention and care.

OBJECTIVE

Report of empirical findings about the development into and remission from alcohol dependence.

METHOD

Narrative literature review, analysis of findings from cohort studies in the general population.

RESULTS

Risk factors provide the opportunity to estimate increased probabilities of developing an alcohol dependence. Adolescents disclosed symptoms of alcohol dependence within 8 years after the first alcohol consumption. Alcohol dependence is related to a life expectancy 17.6 years fewer than in the general population. Data of a general population sample revealed a risk of early death 2.8 times higher than among people without mental disorders. The severity of alcohol dependence was shown to be a predictor of premature death. Nicotine dependence can add to the shortening of life in addition to alcohol dependence. Among the alcohol dependent residents in a general population sample, 90.2% did not have utilized detoxification treatment that included motivational treatment and 78.4% did not have utilized standard detoxification treatment in a psychiatric treatment facility. Remission without formal help has been proven. It is the main route of remission.

CONCLUSION

To reduce unfavorable courses of alcohol dependence, prevention and treatment should be focused more on the needs in the general population. In psychiatric and other medical routine care, screening and an appropriate brief intervention should be carried out.

Behavior-related risk factors and time to death among persons with alcohol consumption versus persons without: A general population study with mortality follow-up after 20 years

BACKGROUND

Evidence shows that low to moderate alcohol consumers seem to live longer than abstainers. Insufficient consideration of subgroups among abstainers and of further behavior-related risk factors for death might be reasons. The aim of this study was to compare alcohol lifetime abstainers, former drinkers, and current consumers with regard to mortality considering tobacco smoking, body overweight, and physical inactivity.

METHODS

A general adult population sample of residents aged 18 to 64 had been drawn at random in northern Germany. Among eligible persons, 4093 (70.2%) participated. Assessments included alcohol consumption by the Alcohol Use Disorders Identification Test Consumption in addition to lifetime alcohol abstinence and former drinking. A score of behavior-related risk factors was built from tobacco smoking, body overweight, and physical inactivity. Twenty years later, a mortality follow-up was conducted. Data of 4028 study participants were analyzed.

RESULTS

At baseline, former alcohol consumers but not current low to moderate alcohol drinkers had more behavior-related risk factors than lifetime abstainers. At follow-up, former alcohol drinkers with two or more behavior-related risk factors had a shorter time to death than lifetime abstainers with 0 or one behavior-related risk factor (hazard ratio 3.43, 95% confidence interval: 1.63-7.20). Low to moderate alcohol drinkers did not survive longer than lifetime alcohol abstainers with 0 or one behavior-related risk factor.

CONCLUSION

The results provide evidence against the assumption that alcohol consumption has a beneficial effect on health and longevity.

Alcohol and Nicotine Dependence and Time to Death in a General Adult Population: A Mortality Cohort Study

INTRODUCTION

Findings from general population studies are lacking in regard to the co-occurrence of alcohol and nicotine dependence in relation to later mortality. The aim of this study was to analyze potential interactions of risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and time until the first cigarette is smoked in the morning after awakening in the prediction of mortality.

METHODS

This study analyzed a random sample of the general population in Northern Germany, which comprised adults aged 18-64 years. Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning after awakening were assessed for the period of 1996-1997 by applying the Munich-Composite International Diagnostic Interview. Data about all-cause mortality were gathered for the period of 2017-2018 and analyzed using Cox proportional hazards models.

RESULTS

Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning were associated with each other and predicted the time to death. Among participants with a former alcohol dependence, 29.59% had a current nicotine dependence. Participants who had ever been dependent on alcohol at some point in their life before and currently smoked their first cigarette in the morning within 30 min or less after awakening had a hazard ratio of 5.28 (95% confidence interval: 3.33-8.38) for early death compared to low-risk alcohol consumers who had never smoked.

CONCLUSION

Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning may have a cumulative impact on time to death. The findings suggest that it could be beneficial to provide support for quitting both risky alcohol drinking and tobacco smoking among nondependent individuals in addition to supporting remission from dependence.

Behavior-related health risk factors, mental disorders and mortality after 20 years in a working aged general population sample

Mortality is predicted by the sum of behavior-related health risk factors (BRFs: tobacco smoking, alcohol drinking, body overweight, and physical inactivity). We analyzed degrees and combinations of BRFs in their relation to mortality and adjusted for mental disorders. In a random sample of the general population in northern Germany aged 18-64, BRFs and mental disorders had been assessed in 1996-1997 by the Munich Composite International Diagnostic Interview. A sum score including eight ranks of the behavior-related health risk factors was built. Death and its causes were ascertained 2017-2018 using residents' registration files and death certificates. Relations of the sum score and combinations of the BRFs at baseline with all-cause, cancer, and cardiovascular mortality 20 years later were analyzed. The sum score and combinations predicted all-cause, cardiovascular and cancer mortality. The odds ratio of the sum score was 1.38 (95% confidence interval 1.31-1.46) after adjustment for age, gender, and mental disorder. In addition to the BRFs, mood, anxiety or somatoform disorders were not related to mortality. We concluded that the sum score and combinations of behavior-related health risk factors predicted mortality, even after adjustment for mental disorders.

The Alcohol Use Disorders Identification Test and Mortality 20 Years later

The objective was to test whether Alcohol Use Disorders Identification Test (AUDIT) results may predict mortality after 20 years. An observational study was conducted. It included an interview of a general population sample aged 18 to 64 in northern Germany in the years 1996 − 1997 (baseline) and a mortality-follow-up in the years 2017 − 2018. Study participants were 3581 persons who had consumed alcohol during the last 12 months prior to the baseline assessment. It included the AUDIT which was filled in by study participants. At follow-up, death cases were ascertained including the date of death. Official records and death certificates from local health authorities were used. Cox proportional hazards regression revealed that the AUDIT predicted time to death. The hazard ratio was 1.70 (95% confidence interval: 1.43 − 2.02) with the lowest AUDIT zone of values as the reference group. Competing risks regression analysis for diagnosis-specific mortality data revealed that the AUDIT predicted cardiovascular mortality (subhazard ratio, 1.84; 95% confidence interval, 1.49 − 2.27). It is concluded that the alcohol screening predicted total and cardiovascular mortality in this adult general population sample.

Excess mortality in a cohort of Brazilian patients with a median follow-up of 11 years after the first psychiatric hospital admission

PURPOSE

To estimate the mortality rates of a cohort of Brazilian patients after their first psychiatric admission and determine the possible risk factors associated with excess mortality.

METHODS

The study included a cohort of psychiatric patients hospitalised from Jan 1, 2002 to Dec 31, 2007 in the catchment area of Ribeirão Preto, São Paulo state, Brazil. Data were linked to deaths that occurred between Jan 1, 2002 and Dec 31, 2016 from the SEADE Foundation (state data analysis system of São Paulo). The mortality rate (MR), age-sex-standardised mortality ratio (SMR), life expectancy at birth, and years of life lost (YLL) were computed. The factors associated with mortality were analysed by survival analysis using a Cox proportional hazards regression model.

RESULTS

Of 4019 patients admitted (54.76% male), 803 died (69.74% male) during the follow-up (median = 11.25 years). Mortality rates were approximately three-fold higher than expected (SMR = 2.90, 95% CI 2.71-3.11). The highest mortality rate was noted in men with alcohol-related disorders (SMR = 5.50, 95% CI 4.87-6.19). Male sex (adjusted hazard ratio (aHR) = 1.62, 95% CI 1.37-1.92), higher age (aHR = 21.47, 95% CI 13.48-34.17), and unemployment (aHR = 1.22, 95% CI 1.05-1.43) significantly increased the mortality risk from all causes. The average YLL was 27.64 years with the highest YLL noted in nonalcohol substance-related disorders (39.22 years). The life expectancy at birth in this cohort was 47.27 years. Unnatural causes of death were associated with nonwhite skin colour and substance-related disorders.

CONCLUSION

An excess of mortality and a significant reduction in life expectancy of mentally disordered patients who were first admitted to psychiatric beds was noted, particularly patients admitted for substance-related disorders, which should represent a priority in mental health policies.

Severity of alcohol dependence and mortality after 20 years in an adult general population sample

OBJECTIVES

To estimate mortality on grounds of the severity of alcohol dependence which has been assessed by two approaches: the frequency of alcohol dependence symptoms (FADS) and the number of alcohol dependence criteria (NADC).

METHODS

A random sample of adult community residents in northern Germany at age 18 to 64 had been interviewed in 1996. Among 4075 study participants at baseline, for 4028 vital status was ascertained 20 years later. The FADS was assessed by the Severity of Alcohol Dependence Scale among the 780 study participants who had one or more symptoms of alcohol dependence or abuse and vital status information. The NADC was estimated by the Munich Composite International Diagnostic Interview among 4028 study participants with vital status information. Cox proportional hazard models were used.

RESULTS

The age-adjusted hazard ratio for the FADS (value range: 0-79) was 1.02 (95% confidence interval, CI: 1.016-1.028), for the NADC (value range: 0-7) it was 1.25 (CI: 1.19-1.32).

CONCLUSIONS

The FADS and NADC predicted time to death in a dose-dependent manner in this adult general population sample.

Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study

BACKGROUND

Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts. However, little is known about factors that might be causal for this finding. The objective was to analyze former alcohol or drug use disorders, risky drinking, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol drinking in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later.

METHODS AND FINDINGS

A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018. We found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers. Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or drug dependence or abuse, alcohol risky drinking, or had tried to cut down or to stop drinking, were daily smokers, or self-rated their health as fair to poor. Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or risky alcohol consumption in their history. Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers. The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption. The Cox proportional hazard ratio (HR) was 2.44 (95% confidence interval (CI), 1.68 to 3.56) for persons who had one or more criteria for an alcohol or drug use disorder fulfilled in their history and after adjustment for age and sex. The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality. Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 (CI 0.72 to 3.77) compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking. Main limitations of this study include its reliance on self-reported data at baseline and the fact that only tobacco smoking was analyzed as a risky behavior alongside alcohol consumption.

CONCLUSIONS

The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons.