Alcohol Problems in Depression

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Arvo building, auditorium F115, address: Arvo Ylpön katu 34.

Jonna Levola

Doctoral defence of Lic.Med. Jonna Levola

Alcohol Problems in Depression: Screening, patterns of drinking and relationship with quality of life

The field of science of the dissertation is Addiction Medicine.

The opponent is docent Solja Niemelä (University of Turku). Professor Mauri Aalto acts as the custos.

The language of the dissertation defence is Finnish.

Alcohol, depression and quality of life

Alcohol problems and depression are common and they often co-occur. Co-morbid alcohol problems and depression can exacerbate one another and screening for one condition in the presence of the other is important. Alcohol use patterns, e.g. binge drinking, are widely known to cause many somatic symptoms and diseases. However, the role of alcohol use patterns in psychiatric disorders such as depression has not been as extensively studied. Alcohol problems as well as alcohol use patterns are known to be associated with quality of life in the general population. It is unclear what, if any, the associations between alcohol problems and alcohol use patterns and quality of life are among depressed individuals.

The aim of this study was to elucidate the relationship between alcohol problems and alcohol use patterns, depression and quality of life.
First, a systematic review was carried out in order to summarize what we know about quality of life among alcohol dependent individuals and how depression affects it. Alcohol dependence was associated with impaired quality of life as well as decrements in mental health. Depression was associated with more severely impaired quality of life. Treatment improved quality of life and mental wellbeing. Reduction or cessation of alcohol use was often linked to this improvement.

Using a Finnish general population sample (n = 4020), the validity of the ten question Alcohol Use Disorders Identification Test (AUDIT) -questionnaire and its abbreviated versions the AUDIT-C and AUDIT-3 in screening for at-risk drinking among depressed individuals was tested. The AUDIT and AUDIT-C performed well in screening for at-risk drinking among depressed men and women recognizing ca. 80 - 90% of at-risk drinkers. The AUDIT-3 performed well among men, but not women. Cut-offs for screening were different in men and women, but depression did not affect them.

In the same general population sample, the association between binge drinking and depression was evaluated, as were the associations between alcohol use variables and quality of life in depressed and non-depressed individuals. The men with weekly binge drinking in the past four weeks had a 2.6-fold risk for depression when compared to men with less frequent binge drinking. No such association was found among women. Depressed men and women drank more and engaged in binge drinking more often than their non-depressed counterparts did, had poorer quality of life and more severe alcohol problems. Frequency of binge drinking and alcohol problems were associated with impaired quality of life in depressed individuals. Mean alcohol consumption and abstinence were not associated with quality of life.

These results support the importance of screening for and treating alcohol problems among depressed individuals. Screening for at-risk drinking is simple and effective. Attention should also be paid to alcohol consumption patterns, specifically binge drinking. It is an encouraging finding that treatment of alcohol dependence was associated with improved quality of life.

The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2392, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1901, Tampere University Press 2018.

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