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Alcohol use disorders and the course of depressive and anxiety disorders

  • Lynn Boschloo (a1), Nicole Vogelzangs (a1), Wim van den Brink (a2), Johannes H. Smit (a1), Dick J. Veltman (a3), Aartjan T. F. Beekman (a1) and Brenda W. J. H. Penninx (a4)...
Abstract
Background

Inconsistent findings have been reported on the role of comorbid alcohol use disorders as risk factors for a persistent course of depressive and anxiety disorders.

Aims

To determine whether the course of depressive and/or anxiety disorders is conditional on the type (abuse or dependence) or severity of comorbid alcohol use disorders.

Method

In a large sample of participants with current depression and/or anxiety (n = 1369) we examined whether the presence and severity of DSM-IV alcohol abuse or alcohol dependence predicted the 2-year course of depressive and/or anxiety disorders.

Results

The persistence of depressive and/or anxiety disorders at the 2-year follow-up was significantly higher in those with remitted or current alcohol dependence (persistence 62% and 67% respectively), but not in those with remitted or current alcohol abuse (persistence 51% and 46% respectively), compared with no lifetime alcohol use disorder (persistence 53%). Severe (meeting six or seven diagnostic criteria) but not moderate (meeting three to five criteria) current dependence was a significant predictor as 95% of those in the former group still had a depressive and/or anxiety disorder at follow-up. This association remained significant after adjustment for severity of depression and anxiety, psychosocial factors and treatment factors.

Conclusions

Alcohol dependence, especially severe current dependence, is a risk factor for an unfavourable course of depressive and/or anxiety disorders, whereas alcohol abuse is not.

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Copyright
Corresponding author
Lynn Boschloo, Department of Psychiatry, VU University Medical Centre, AJ Ernststraat 1187, 1081 HL Amsterdam, The Netherlands. Email: l.boschloo@ggzingeest.nl
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Declaration of interest

None.

Footnotes
References
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Alcohol use disorders and the course of depressive and anxiety disorders

  • Lynn Boschloo (a1), Nicole Vogelzangs (a1), Wim van den Brink (a2), Johannes H. Smit (a1), Dick J. Veltman (a3), Aartjan T. F. Beekman (a1) and Brenda W. J. H. Penninx (a4)...
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eLetters

Is alcohol consumption irrelevant to outcome in anxiety and depression?

John Bailey, Research Officer
11 July 2012

Boschloo and colleagues1 report that alcohol abuse is not a risk factor for unfavourable outcome in depression and anxiety disorders. This finding, which ostensibly conflicts with clinical experience, could easilybe misunderstood to imply that non-dependent alcohol use is irrelevant in these disorders. We do not believe this is a true finding of the study. The paper addresses DSM-IV alcohol use disorder (AUD) diagnosis at baseline as a risk factor for poor outcome. It does not address continuingalcohol abuse and its effects on depression and anxiety. Latest alcohol consumption statistics show that a substantial proportion of the population drink alcohol heavily. In England, the latest estimates are that 26% of men and 17% of women over the age of 16 drink at levels that are hazardous or harmful to health2. Clearly, only a small proportion of these receive a diagnosis of AUD and there is no reason to believe that the situation in the Netherlands is radically different. It would be expected that a significant proportion of the sample with no AUD diagnosiswould be drinking alcohol at hazardous or harmful levels. AUD is therefore a poor marker for alcohol consumption. AUD diagnosis cannot have an effect on the course of depressive or anxiety disorders as it is atheoretical construct. It is alcohol consumption that has an effect.The current data are extracted from a larger study with different aims3,4 and contain a number of flaws if used to examine the effects of alcohol ondepression and anxiety. There are no indications of levels of alcohol consumption other than AUD diagnosis and there are no data on alcohol diagnosis at follow up. There is no information about what treatments thesample patients received, although this is likely to have included advice to reduce alcohol consumption.Unsurprisingly, the study demonstrates that those with the poorest depression and anxiety outcomes are those with a baseline diagnosis of alcohol dependence, with a stronger effect with increasing severity of disorder. That is, those patients least likely to have reduced their alcohol consumption during the study had the poorest outcomes.There is a puzzling finding in relation to severity of alcohol diagnosis: there are more patients in the sample with the more severe diagnosis of alcohol dependence than with the less severe one of alcohol abuse disorder. The diagnostic criteria for alcohol abuse disorder are concerned largely with social dysfunction whilst those for alcohol dependence are concerned with physical dependence and social dysfunction. It may be that the gap between the onset of moderate social dysfunction and the onset of physical dependence or severe social dysfunction (as determined by the diagnostic criteria) represents a small part of the deterioration resulting from sustained heavy drinking, and therefore is a poor indicator of population harmful drinking.The paper does convincingly suggest that severe alcohol dependence at baseline is a risk factor for poor outcome in anxiety and depression. It does not demonstrate that continued drinking in other groups is irrelevantto outcome.

References

1 Boschloo, L., Vogelzangs, N., van den Brink, W., Smit, J.H., Veltman, D.J., Beekman, A.T.F. & Penninx, B.W.J.H. 2012, "Alcohol use disorders and the course of depressive and anxiety disorders", The BritishJournal of Psychiatry, vol. 200, no. 6, pp. 476-484.

2 Health and Social Care Information Centre 2012, Statistics on alcohol: England, 2012. http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/alcohol/statistics-on-alcohol-england-2012-%5Bns%5D (Accessed 27/06/2012).

3 Penninx, B.W.J.H., Beekman, A.T.F., Smit, J.H., Zitman, F.G., Nolen, W.A., Spinhoven, P., Cuijpers, P., De Jong, P.J., Van Marwijk, H.W.J., Assendelft, W.J.J., Van Der Meer, K., Verhaak, P., Wensing, M., DeGraaf, R., Hoogendijk, W.J., Ormel, J. & Van Dyck, R. 2008, "The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectivesand methods", International Journal of Methods in Psychiatric Research, vol. 17, no. 3, pp. 121-140.

4 Van Der Veen, W.J., Van Der Meer, K. & Penninx, B.W. 2009, "Screening for depression and anxiety: correlates of non-response and cohort attrition in the Netherlands Study of Depression and Anxiety (NESDA)", International Journal of Methods in Psychiatric Research, vol. 18, no. 4, pp. 229-239.

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Conflict of interest: None declared

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