Abstract
Background: It has been suggested that alcohol problems negatively affect therapeutic interventions for depression. This study examines the patterns of change in depressive symptoms following an intervention for depression, in participants with or without comorbid unhealthy alcohol use.Methods: Depressive symptoms (BDI–II), perceived control of depressive symptoms (UNCONTROL) and unhealthy alcohol use (AUDIT) were assessed in 116 patients before and after attending a cognitive behavioral psychoeducational intervention for depression. At pretest the mean score of AUDIT was 8.1, indicating a, on average, risk of harmful level of alcohol abuse. At pretest the majority of the total sample had a moderate degree of depressive symptoms, with a mean BDI–II score of 25.1 and 36.2% had a risky use of alcohol as measured with AUDIT score at 8 points or above. To assess the relationship between depressive symptoms, perceived uncontrollability of depression and alcohol use across time, a cross-lagged panel model was estimated.Results: A clinical significant reduction of depressive symptoms, and a parallel and statistically significant increase in the perceived control of depressive symptoms, was identified after attending a cognitive behavioral psychoeducational intervention for depression. At posttest, the mean BDI–II score was 17.8, demonstrating a statistically significant decrease of 7.3 points in depressive symptoms from before starting the course to 6 months later. The effect size (d-value) of 0.83 can be interpreted as a large decrease in depressive symptoms. In this sample alcohol use and depressive symptoms seemed to be unrelated. The cross-lagged correlation panel analysis indicated that a high degree of perceived control of depressive symptoms leads to a reduction in depressive symptoms, and not vice versa.Conclusion: We found that this intervention for depression were effective in reducing depressive symptoms. The patterns of change seemed to be independent of risky use of alcohol, although leaving the study was systematically associated with higher AUDIT-scores. As participants with or without unhealthy alcohol use show the same patterns of change regarding reduction of depressive symptoms and perceived control of depression, both groups could be offered the same cognitive behavioral psychoeducational interventions for depression.
Highlights
Depression is a highly prevalent and recurrent disorder, often comorbid with alcohol-related problems (Ostacher, 2007; Palfai et al, 2007; Seignourel et al, 2008)
This study examines the patterns of change in depressive symptoms following an outpatient cognitive behavioral, psychoeducational intervention for depression, in participants with or without comorbid unhealthy alcohol use
*p < 0.001. aLogarithmic transformed Alcohol Use Disorders Identification Test (AUDIT)-scores used in the correlation analyses, mean, and standard deviation estimated on the basis of raw AUDIT-scores
Summary
Depression is a highly prevalent and recurrent disorder, often comorbid with alcohol-related problems (Ostacher, 2007; Palfai et al, 2007; Seignourel et al, 2008). A majority of patients seeking treatment for alcohol problems show clinically significant levels of depressive symptoms (Brown et al, 1997). Theories of causality in dual diagnosis do share the intention of finding the best way to understand and treat patients with comorbid mental illness and alcohol or substance abuse disorders. This study examines the patterns of change in depressive symptoms following an intervention for depression, in participants with or without comorbid unhealthy alcohol use
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