Abstract
Aims: To estimate the prevalence of major depressive disorder (MDD) among spouses of men who use alcohol in two rural areas in Sri Lanka, and to examine whether the severity of alcohol-related problems (ARPs) in men and presence of alcohol-related domestic violence are associated with MDD among these women.Method: In a cross-sectional study, ARPs among men were assessed using Alcohol Use Disorders Identification Test (AUDIT) questionnaire filled in by men, and domestic violence and husbands' drinking pattern data obtained from the women. MDD among the women was ascertained using the Structured Clinical Interview for DSM–IV Disorders for major depression. Using logistic regression we examined whether age, past history of depression, different indices of ARPs and domestic violence were associated with current MDD among the women.Results: Point prevalence of MDD in the sample was 33.3% (95% CI: 25.93, 40.73%). Once adjusted for other factors, morning drinking of the spouse (odds ratio = 4.11, 95% CI: 1.25, 13.47; P = 0.019) and increasing age (odds ratio = 1.05, 95% CI: 1.01, 1.09; P = 0.003) significantly increased the odds of MDD. Being subjected to domestic violence/arguments also had a trend to be associated with MDD among women, but was not significant (odds ratio = 2.29, 95% CI: 0.95, 5.48; P = 0.062).Conclusion: The prevalence of MDD among spouses of men who use alcohol is markedly higher than that has been observed among Sri Lankan women in previous studies. The prevalence of MDD in women seems to increase when their husbands are morning drinkers, and with increasing age.
Highlights
Alcohol-related problems in Sri LankaAccording to the ICD-10 Classification of Diseases, alcohol-related problems (ARPs) include harmful use and alcohol dependence syndrome
In addition to the Alcohol Use Disorders Identification Test (AUDIT) scores derived from interviewing husbands, we directly questioned the women whether their husbands are aggressive/argumentative or violent towards them, whether they consume alcohol in the morning (‘eye opener’). We considered these latter two indicators as two important and objective measures that can be obtained from an observer other than the alcohol consumer himself, which suggested domestic violence and alcohol dependence respectively
Village ARPs (AUDIT score ≥8) Depression in the past Age Domestic violence Morning drinking in spouse more) did not have a significant association with major depressive disorder (MDD) among women (OR = 2.22, 95% CI: 0.68–7.28, P = 0.185), but passed the cut of significant limit (i.e.
Summary
According to the ICD-10 Classification of Diseases, alcohol-related problems (ARPs) include harmful use and alcohol dependence syndrome. An early epidemiological survey reported the prevalence of ‘alcoholism’ among Sri Lankan men over 25 years of age to be 2.9% (Samarasinghe et al, 1987). This may have been an underestimate due to the tendency of these patients to under-report the extent and problems associated with their drinking especially in the presence of their family members as was the case in the above study. It is possible that the prevalence of ARPs has increased along with increased use of alcohol associated with change in cultural
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