Influence of comorbid alcohol use disorders on the clinical patterns of major depressive disorder: A general population-based study

Abstract

BackgroundTo compare the symptom patterns of major depressive disorder (MDD) among subjects with MDD and 1) no alcohol use disorder (AUD), 2) alcohol abuse and 3) alcohol dependence, respectively. MethodsIn a general population survey of 38,694 French individuals, MDD and AUDs were assessed using the Mini International Neuropsychiatric Interview 5.0.0 (MINI). A total of 4339 subjects (11.2%) in the sample met the criteria for MDD. Among them, 413 (9.5%) AUD subjects were identified: 138 (3.2%) for alcohol abuse and 275 (6.3%) for alcohol dependence. The associations of each of the ten MDD criteria of the MINI and psychiatric clinical features were compared among the three groups. The relative profiles of ‘MDD + AUD’ vs. ‘MDD alone’ were determined using a multivariable stepwise regression model. ResultsWith the noAUD group as the reference, sadness (OR = 0.46; 95%CI, 0.29–0.74) and anhedonia (OR = 1.66; 95%CI, 1.06–2.73) were only associated with alcohol abuse. Sleep disorders (OR = 2.07; 95%CI, 1.51–2.88), feelings of guilt (OR = 1.41; 95%CI, 1.05–1.90), diminished concentration/indecisiveness (OR = 1.52; 95%CI, 1.12–2.07) and thoughts of death (OR = 1.95; 95%CI 1.49–2.55) were only associated with alcohol dependence. Weight or appetite variations were both associated with alcohol abuse (OR = 1.7; 95%CI, 1.15–2.53) and dependence (OR = 1.41; 95%CI, 1.06–1.88). Bipolar disorder and PTSD were only associated with alcohol dependence. Psychotic features, previous suicide attempts, and panic disorder were more frequent in the MDD-AUD group. ConclusionMDD-AUD subjects displayed a more severe profile with specific symptomatology and comorbidity profiles compared to MDD-only subjects.