Abstract
Studies from high-income countries report moderate-to-strong positive associations between alcohol use disorder (AUD) and other mental disorders, but there is little evidence about the comorbidity of AUD from low-and-middle-income countries. A sample of 74 752 adults from five provinces that account for >12% of China's adult population was screened using the General Health Questionnaire, and the Structured Clinical Interview for DSM-IV was administered by psychiatrists to a subsample of 9619 males. The associations between AUD and other mental disorders at each site and the characteristics of men with AUD with and without comorbid mental disorders were estimated using logistic regression and summarized across sites using meta-analysis. Generalized estimation equations estimated the associations between the clinical features of alcohol dependence and comorbidity. Robust inverse associations were found between current AUD and any mood disorder (adjusted OR = 0.6, 95% CI = 0.4-0.8) and any anxiety disorder (OR = 0.5, 95% CI = 0.3-1.0). Compared with men without AUD, men with AUD without comorbid disorders were more likely to be middle-aged, to be currently married, and to have higher family incomes. Men with comorbid AUD and other disorders were more likely to have the clinical features of alcohol dependence than men with AUD without comorbid disorders. Inverse associations between AUD and other mental disorders and the higher social status of men with AUD than men without AUD found in this large, representative sample of community-dwelling Chinese males highlight the importance of considering the local substance-use culture when designing clinical or preventive interventions for addictive conditions.
Highlights
Alcohol use disorder (AUD) is a common mental disorder that results in substantial disease burden worldwide, including in China (Yang et al 2013)
In a previous paper (Phillips et al 2017) we reported an inverse association between AUD and the presence of any non-AUD mental disorder diagnosed according to criteria specified in the 4th edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); that is, men with AUD were less likely to have another mental disorder than men without AUD
In contrast to a large body of literature from other countries indicating moderate to strong positive correlations between AUD and non-AUD mental disorders (Andrews et al 2002; Kessler et al 2005; Hasin et al 2007; Flensborg-Madsen et al 2009; Markon, 2010; Chou et al 2012), this large, representative study from China found that men with AUD were significantly less likely to have other mental disorders than men who do not have AUD
Summary
Alcohol use disorder (AUD) is a common mental disorder that results in substantial disease burden worldwide, including in China (Yang et al 2013). Comorbidity data are needed to adjust the estimates of AUD-related disease burden reported in the Global Burden of Disease studies. Most studies from high-income countries report a moderate-to-strong positive association between AUD and other mental disorders (Andrews et al 2002; Kessler et al 2005; Hasin et al 2007; FlensborgMadsen et al 2009; Markon, 2010; Chou et al 2012). Studies from high-income countries report moderate-to-strong positive associations between alcohol use disorder (AUD) and other mental disorders, but there is little evidence about the comorbidity of AUD from low-andmiddle-income countries
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