Abstract
BackgroundPrevious evidence indicates significant associations between depressive disorders and alcohol use disorder (AUD) and their strong links with social conditions. This study aims to investigate the association between major depressive episode (MDE) and AUD across various socio-economic groups.MethodsWe analysed data from the 2014 Thai National Health Examination Survey containing a random sample of 13,177 adults aged > 20 years from the general population. The Alcohol Use Disorder Identification Test was used to classify respondents into non-problem drinking (score 0–7), hazardous drinking (score 8–15), and harmful-dependent drinking (score 16–40). MDE was identified using questions based on the DSM-IV. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated using multinomial logistic regression to determine the strength of associations between MDE as a predictor and AUD as an outcome variable across different socio-economic levels.ResultsThe prevalence of MDE, hazardous, and harmful-dependent drinking was 2.5, 10.3, and 1.9%, respectively. The association between MDE and AUD was modified by wealth index, education level and area of residence. AORs for the association between MDE and harmful-dependent drinking were high among those in the highest (AOR = 8.68, 95% CI: 5.34, 14.11) and lowest (AOR = 7.14, 95% CI: 3.71, 13.73) levels of wealth index but not significant among those in the middle level (AOR = 1.78, 95% CI: 0.74, 4.25). Education had the strongest effect on the relationship between MDE and harmful-dependent drinking (AOR = 16.0, 95% CI: 10.30, 24.90 among those completing secondary school or higher and AOR = 1.44, 95% CI: 0.63, 3.33 among those completing primary school only). The association between MDE and harmful-dependent drinking was higher among people who lived in urban areas (AOR = 8.50, 95% CI: 5.50, 13.13) compared to those living in rural areas (AOR = 4.73, 95% CI: 3.31, 6.77).ConclusionSocio-economic factors modify the association between alcohol use disorder and major depressive disorder among Thai people.
Highlights
Previous evidence indicates significant associations between depressive disorders and alcohol use disorder (AUD) and their strong links with social conditions
57.8% had no formal education or had attained only a primary school level of education, 55.6% were employed in labor type work while 34.1% were employed in private or government work, and 10.3% were unemployed; 56.5% were living in rural areas
We found a significant association between major depressive episode (MDE) and either hazardous or harmful-dependent drinking in those with a secondary school or higher level of education but not in those with a primary school level of education, and a stronger association among those living in urban areas compared to those living in rural areas
Summary
Previous evidence indicates significant associations between depressive disorders and alcohol use disorder (AUD) and their strong links with social conditions. Alcohol use disorder (AUD) and depressive disorders are significant public health problems worldwide and both are strongly linked to social conditions [1, 2]. In terms of alcohol use disorder, people with a relatively low SES may consume similar amounts of alcohol to those with a relatively high SES, but those with a lower SES may have a higher-thanexpected burden of negative consequences of alcohol consumption [17]. Those with alcohol use disorder may suffer from loss of employment and income and eventual reduction in SES, the reverse causality cannot be precluded in the interpretation of the relationship. People with a lower SES tend to have a higher odds of being depressed than people with a higher SES, the presence and strength of this association varies according to contextual factors such as geographical region and historical period [19]
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