Socioeconomic status, alcohol use disorders, and depression: A population-based study

Aurélie M Lasserre,Sameer Imtiaz,Michael Roerecke,Markus Heilig,Charlotte Probst,Jürgen Rehm

doi:10.1016/j.jad.2021.12.132

Abstract

BackgroundDepressive disorders (DD) and alcohol use disorders (AUD) frequently co-occur. They are key to understanding the current increases in “deaths of despair” among individuals with lower socioeconomic status (SES). The aim of this study was to assess the prospective bidirectional associations between AUD and DD, as well as the effect of SES on these two conditions. MethodsThe National Epidemiologic Survey on Alcohol and Related Conditions is a cohort study representative of the US adult population, which began in 2001–2002, with follow-up interviews conducted 3 years later. SES was primarily operationalized as educational attainment. AUD, DD, and their levels of severity were defined according to the DSM-5 criteria. ResultsThe risk of developing an incident DD increased gradually with the recency and the severity of AUD at baseline, but the converse was not observed. Lower SES was an independent risk for incident AUD or DD. SES did not modify the prospective association between AUD and DD. LimitationsThe absence of interaction between SES and moderate or severe AUD for the incident DD must be considered with caution due to the limited number of DD cases reported in these AUD categories. ConclusionsThis result is consistent with a causal relationship between AUD and DD, and suggests that therapeutic interventions for AUD may also have beneficial effects to lower DD rates. The independent effects of a lower SES and AUD on DD may result in a vulnerable population cumulating disorders with heavy consequences on health and social well-being.

Highlights

In many societies, including in the United States (US), depressive disorders (DD) and alcohol use disorders (AUD) are among the most prevalent psychiatric disorders (Substance Abuse and Mental HealthServices Administration, 2019)
The risk for developing a DD during the 3 years prior to follow-up increased gradually among non-abstainer participants ac cording to the severity and the recency of their AUD at baseline (OR, 95% CI: 1.20, 1.01–1.41; 1.28, 1.04–1.57; 1.68, 1.22–2.32; 1.92, 1.31–2.81 and 2.35, 1.07–5.14 for participants without; with remitted; mild; moderate and severe AUD, respectively)
socioeconomic status (SES) did not modify the association between AUD and DD; comparing the high versus the low SES, we found no interaction between SES and AUD on a multiplicative, nor on an additive scale (Supplementary material, Table 1–3)

Summary

Introduction

In many societies, including in the United States (US), depressive disorders (DD) and alcohol use disorders (AUD) are among the most prevalent psychiatric disorders (Substance Abuse and Mental HealthServices Administration, 2019). Among US adults, 14.0 million qualified for an AUD in 2019 (SAMHSA Center for Behavioral Health Statistics and Quality, 2019) and more than 17.3 million experienced at least one depressive episode in 2017 (National Institutes of Mental Health, 2017). These disorders can co-occur; the presence of either disorder doubles the risk of the other disorder (Boden and Fergusson, 2011). Depressive disorders (DD) and alcohol use disorders (AUD) frequently co-occur They are key to understanding the current increases in “deaths of despair” among individuals with lower socioeconomic status (SES). The independent effects of a lower SES and AUD on DD may result in a vulnerable population cumulating disorders with heavy consequences on health and social well-being

Objectives

Methods

Results

Conclusion