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      The Association between Alcohol Dependence and Depression before and after Treatment for Alcohol Dependence

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          Abstract

          The presence of depression in alcohol-dependent persons is likely to influence treatment process and outcomes. Identification of depression is important though not every depressed alcohol-dependent person requires treatment with antidepressants. Understanding the association between depression and alcohol dependence is essential for proper management of alcohol dependence. Objectives. To determine the prevalence of depression among alcohol-dependent persons before and after alcohol detoxification and rehabilitation. Design. Clinical trial with pre-/postmeasurements. Method. The CIDI and WHO-ASSIST were administered to 188 alcohol-dependent persons at intake and after six months. A researcher-designed sociodemographic questionnaire was also administered at intake. Results. The prevalence of depression among alcohol-dependent persons is high (63.8%) with a significant association between depression and the mean AUDIT score. At posttest, depressed participants had a statistically significant craving for alcohol. Conclusion. Alcohol dependence is associated with major depression.

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          The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).

          R Kessler, T Ustün (2003)
          This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection.
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            Tests of causal links between alcohol abuse or dependence and major depression.

            J. Boden, David M. Fergusson, L John Horwood (2009)
            There has been a great deal of research on the comorbidity between alcohol abuse or dependence (AAD) and major depression (MD). However, it is unclear whether AAD increases the risk of MD or vice versa. To examine the associations between AAD and MD using fixed-effects modeling to control for confounding and using structural equation models to ascertain the direction of causality. Data were gathered during the course of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of children from New Zealand (635 boys, 630 girls). General community sample. The analysis was based on a sample of 1055 participants with available data on AAD and MD at ages 17 to 18, 20 to 21, and 24 to 25 years. Symptom criteria for AAD and MD from the DSM-IV at ages 17 to 18, 20 to 21, and 24 to 25 years as well as measures of life stress, cannabis use, other illicit drug use, affiliation with deviant peers, unemployment, partner substance use, and partner criminality at ages 17 to 18, 20 to 21, and 24 to 25 years. There were significant (P < .001) pooled associations between AAD and MD. Controlling for confounding factors using conditional fixed-effects models and time-dynamic covariate factors reduced the magnitude of these associations, but they remained statistically significant. Structural equation modeling suggested that the best-fitting causal model was one in which AAD led to increased risk of MD. The findings suggest that the associations between AAD and MD were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD.
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              Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions.

              James Bolton, Jennifer Robinson, Jitender Sareen (2009)
              Using alcohol or drugs to reduce emotional distress (self-medication) has been proposed as an explanation for the high comorbidity rates between anxiety and substance use disorders. Self-medication has been minimally studied in mood disorders despite equally high rates of alcohol and drug use. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large (n=43,093, age 18 years and older) nationally representative survey of mental illness in community-dwelling adults. Prevalence rates of self-medication were determined for DSM-IV mood disorders: dysthymia, major depressive disorder, bipolar I disorder, and bipolar II disorder. Multiple logistic regression generated odds ratios for the association between each category of self-medication and anxiety and personality disorders. Almost one-quarter of individuals with mood disorders (24.1%) used alcohol or drugs to relieve symptoms. The highest prevalence of self-medication was seen in bipolar I disorder (41.0%). Men were more than twice as likely as women to engage in self-medication (Adjusted Odds Ratio=2.18; 95% Confidence Interval 1.90-2.49). After controlling for the effects of substance use disorders, self-medication was associated with higher odds of comorbid anxiety and personality disorders when compared to individuals who did not self-medicate. Cross-sectional design. The use of alcohol and drugs to relieve affective symptoms is common among individuals with mood disorders in the general population, yet is associated with substantial psychiatric comorbidity. These findings may help clinicians identify a subgroup of people with mood disorders who suffer from a higher mental illness burden.
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                Author and article information

                Journal
                Journal ID (nlm-ta): ISRN Psychiatry
                Journal ID (iso-abbrev): ISRN Psychiatry
                Journal ID (publisher-id): ISRN.PSYCHIATRY
                Title: ISRN Psychiatry
                Publisher: International Scholarly Research Network
                ISSN (Electronic): 2090-7966
                Publication date Collection: 2012
                Publication date (Electronic): 26 January 2012
                Volume: 2012
                Electronic Location Identifier: 482802
                Affiliations
                1Department of Psychiatry, University of Nairobi, P.O. Box 74846-00200, Nairobi, Kenya
                2Department of Psychiatry, University of Nairobi, P.O. Box 48423-00100, Nairobi, Kenya
                3Department of Psychology, University of Uyo, P.O. Box 4230, Uyo, Nigeria
                4Department of Psychiatry, University of Nairobi, P.O. Box 59176-00200, Nairobi, Kenya
                5Crisis Pregnancy Ministry, Nairobi, Kenya
                6Harmony Psychological & Mental Health Consultancy, Nairobi, Kenya
                7Kitale District Hospital, Ministry of Health, P.O. Box 4463-300, Kitale, Kenya
                Author notes

                Academic Editor: A. K. Pandurangi

                Article
                DOI: 10.5402/2012/482802
                PMC ID: 3658562
                PubMed ID: 23738204
                SO-VID: 541b0cd3-8737-4d18-b6d8-741498501db5
                Copyright © Copyright © 2012 Mary W. Kuria et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 October 2011
                Date accepted : 20 November 2011
                Categories
                Subject: Research Article

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