Alcohol Depression Research Articles

Validity and reliability of the Neilands sexual stigma scale among Kenyan gay, bisexual, and other men who have sex with men

BackgroundWe evaluated the validity and reliability of the Neilands sexual stigma scale administered to 871 gay, bisexual, and other men who have sex with men (GBMSM) at two research locations in Kenya.MethodsUsing cross-validation, exploratory factor analysis (EFA) was performed on a randomly selected subset of participants and validated using confirmatory factor analysis (CFA) on the remaining participants. Associations of the initial and final stigma scale factors with depressive symptoms, alcohol use, and other substance use were examined for the entire dataset.ResultsEFA produced a two-factor scale of perceived and enacted stigma. The CFA model fit to the two-factor scale was improved after removing three cross-loaded items and adding correlated errors (chi-squared = 26.5, df 17, p = 0.07). Perceived stigma was associated with depressive symptoms (beta = 0.34, 95% CI 0.24, 0.45), alcohol use (beta = 0.14, 95% CI 0.03, 0.25) and other substance use (beta = 0.19, 95% CI 0.07, 0.31), while enacted stigma was associated with alcohol use (beta = 0.17, 95% CI 0.06, 0.27).ConclusionsOur findings suggest enacted and perceived sexual stigma are distinct yet closely related constructs among GBMSM in Kenya and are associated with poor mental health and substance use.

Protective behavioral strategies as a protective factor against suicidal ideation among college student drinkers

Objective: Research shows that alcohol use is linked to suicidal ideation (SI), while depression is strongly associated with SI. Protective behavioral strategies (PBS) are safe drinking strategies. PBS are broadly protective across alcohol-related problems; however, it is unclear if these effects extend to those at risk for SI. We hypothesized that alcohol use and depressive symptoms would be risk factors for SI, and that these factors would moderate the effects of PBS. PBS was hypothesized to be protective for individuals with elevated depressive symptoms and alcohol use. Participants: College student drinkers (n = 990; M age = 19.97, SD = 3.75) from a Southeastern University. Methods: Participants completed an online survey inquiring about demographics, depressive symptoms, SI, alcohol use, and PBS use. Results: Depressive symptoms were associated with an increased likelihood of SI; however, alcohol use was not. PBS were most protective for individuals with high levels of alcohol use and/or depressive symptoms. Conclusions: PBS may be protective for heavier drinkers who are at heightened risk for SI.

The role of alcohol use and adiposity in serum levels of IL-1RA in depressed patients

BackgroundThe role of Interleukin-1 Receptor antagonist (IL-1Ra), an innate antagonist to pro-inflammatory cytokine IL-1, has attracted increasing attention due to its potential pathogenic and therapeutic implications in depression. However, the role of alcohol and adiposity in modulating IL-1Ra cytokine pathway in depressed patients has remainned unknown. The aim of this study was to follow the changes in IL-1Ra serum levels in depressed patients with or without simultaneous alcohol use disorder (AUD) and different degrees of adiposity during 6 months of follow-up.Materials and methodsA total of 242 patients with depression were followed for 6 months. At baseline 99 patients had simultaneous AUD. Levels of serum IL-1Ra and common mediators of inflammation (IL-6, hs-CRP) were measured. Clinical assessments included Body Mass Index (BMI), Montgomery-Asberg Depression Rating Scale (MADRS) and Alcohol Use Disorders Identification Test (AUDIT) scores.ResultsSignificant reductions in clinical symptoms and IL-1Ra were observed during 6-month follow-up. In hierarchical linear regression analysis, the effect of MADRS score, age, gender, and smoking had a combined effect of 2.4% in the model. The effect of AUDIT score increased the effect to 4.2% of variance (p = 0.08), whereas adding BMI increased the effect to 18.5% (p < 0.001).ConclusionAdiposity may influence the IL-1Ra anti-inflammatory response in depressed patients, whereas the effect of alcohol consumption in these patients seems insignificant. These findings should be considered in studies on the role of IL-1Ra in depression.Trial registrationOstrobothnia Depression Study in ClinicalTrials.gov , Identifier NCT02520271.

Does breastfeeding account for the association between maternal sensitivity and infant cognitive development in a large, nationally representative cohort?

BackgroundPrevious research has established that exposure to high maternal sensitivity is positively associated with advances in infant cognitive development. However, there are many fixed and modifiable factors that influence this association. This study investigates whether the association between maternal sensitivity and infant cognitive development in the first year of life is accounted for by other factors, such as breastfeeding, maternal depressive symptoms, maternal alcohol use, infant birth weight or demographic covariates.MethodsUsing data from the Early Childhood Longitudinal Study-Birth (ECLS-B) Cohort, a nationally representative sample of U.S. born children, multi-variable regression analyses was used to examine whether breastfeeding, maternal depressive symptoms and alcohol use were associated with maternal sensitivity, as measured by the Nursing Child Assessment Teaching Scale (NCATS), and with infant cognitive development, as measured by the Bayley Scales of Infant Development, Short Form, Research Edition, after controlling for demographic covariates (infant sex, maternal age, education, race/ethnicity, income, parity, family structure) and infant birth weight.ResultsBreastfeeding, depressive symptoms and alcohol use were not associated with maternal sensitivity scores after controlling for demographic covariates and infant birth weight. However, breastfeeding (β = .079, p < .001), depressive symptoms (β = −.035, p < .05), and maternal sensitivity (β = .175, p < .001) were each significantly associated with infant cognitive development scores, even after controlling for demographic covariates and birthweight (R2 = .053, p < .001). The association between maternal sensitivity and infant cognitive development did not attenuate after adjusting for breastfeeding. Instead, both sensitivity and breastfeeding independently contributed to higher infant cognitive development scores.ConclusionMaternal sensitivity and breastfeeding are separate means to advancing infant cognitive development. This study is significant because it is the first to examine breastfeeding, maternal depressive symptoms and alcohol use together, upon the association between maternal sensitivity and infant cognitive development, after adjusting for demographic covariates and infant birthweight. Maternal sensitivity, a measurable quality, advances infants’ cognitive development. Moreover, sensitivity and breastfeeding had independent effects upon cognitive development after controlling for multiple fixed and modifiable covariates. Understanding factors impacting the association between sensitivity and infant cognitive development provide avenues for developing more effective parenting interventions.

A Cross-sectional Study of the Patterns and Impact of Socio-demographic Factors in Anxious and Depressed Alcohol Dependent Patients

Introduction: Socio-demographic factors may play a pivotal role in anxious and depressed alcohol dependent patients. Identifying the patterns and impact of these factors may be important in the successful management of Alcohol Use Disorders (AUDs). Aim: To assess the patterns and impact of socio-demographic factors in anxious and depressed alcohol dependent patients. Materials and Methods: This cross-sectional study was conducted at Rama Medical College Hospital and Research Center Hapur, Uttar Pradesh, India, from August 2018 to January 2020. Patients with history of substance dependence, gross brain damage, severe medical complications, or evidence of drinking during the hospital stay were excluded. Severity of Alcohol Dependence Questionnaire (SADQ) was used to rate the extent of alcohol dependence and Hamilton Depression Rating Scale (HAM-D or HDRS) to rate depression. Sociodemographic data was recorded in each patient which included age, gender, background, education level, employment status, occupation, marital status, and family type. The severity of anxiety symptoms was measured on Hamilton Anxiety Rating Scale (HAM-A). Independent t-tests, Chi-square tests, oneway Analysis of Variance (ANOVA) and Pearson’s correlation analysis were used for statistical analysis. A p-value &lt;0.05 was considered statistically significant. Results: The total of 90 alcohol dependent patients with mean age of 37.6±9.3 years and mean HDRS score was 8.5±4.3. The overall prevalence of depression cohort was. Out of these 30 (33.3%) had mild and 6 (6.7%) had moderate depression, respectively. The mean Hamilton anxiety scale score was 18.6±5.2. Patients who had a lower Socio-economic Status (SES) (p-value= 0.049 and 0.004), were martially separated (p-value&lt;0.001 and 0.027), living in a nuclear family (p-value=0.005 and &lt;0.001) and were unemployed (p-value&lt;0.001 and p-value&lt;0.001) had significantly higher depression and anxiety scores, respectively. Conclusion: In anxious and depressed alcohol dependent patients, lower SES, martial separation, living as a single family and unemployment significantly influenced depression and anxiety

Impact of resilience on college student mental health during COVID-19

Objective The aim of this study was to investigate how the COVID-19 pandemic impacted college student mental health and alcohol use and to determine how resilience could alleviate negative outcomes. Participants Students attending an Appalachian university during spring 2020 were surveyed shortly after on-campus activities stopped. Methods Survey items included resilience, demographics, self-rated health, and depression symptoms, anxiety symptoms, and alcohol use before and since COVID-19. Results There was a significant increase in prevalence of severe depression, severe anxiety, and high stress, and a significant decrease in prevalence high risk for problem drinking before and since COVID-19. Four separate standard least squares regression models were conducted with each of the dependent variables. Self-rated health was the strongest predictor for changes in depression, anxiety, and stress in each of the models, displaying a negative relationship. Conclusions Universities should prepare students using resilience training and provide employment and other resources to mitigate effects of stressful situations.

Cannabis Consumption Onset and Addiction: Data from the Second Brazilian Drugs and Alcohol Survey (BNADS)

ABSTRACT The objective of this study was to provide rates of cannabis use and dependence and risk factors, proposing a conditional path model for cannabis addiction. A subsample of adult participants from a Brazilian household survey was analyzed to estimate cannabis dependence. Estimation of prevalence rates and association between dependence and age of cannabis use initiation were performed. The conditional model was applied to investigate the mediation of depressive symptoms and alcohol consumption in the association of early cannabis use and dependence. Lifetime and last year cannabis use were 6.47% and 2.81%, respectively. Moderate and severe cannabis dependence were 0.74% and 0.18% in the population, and 26.47% and 6.38% among last year’s cannabis users. A Parallel Multiple Mediator Model revealed strong association between cannabis use initiation age and dependence, when depressive symptoms or alcohol consumption mediate this association. The proportion of cannabis users displaying dependence symptoms is elevated and it is associated with the age of cannabis use initiation. The results show the importance of primary prevention interventions, prioritizing the delay of cannabis and alcohol experimentation. Our findings can enrich the debate on drugs policies and legislation, reinforcing the need for stronger restrictions of adolescent drug access and ensuring its enforcement.

Alcohol intake in relation to suicidal ideation and behavior among university students

ObjectiveHeavy alcohol use has been clearly linked to risk for suicidal behaviors and is also prevalent on many American college campuses. This report uses a large sample of college students to explore relationships between alcohol use, depressive symptoms, and suicidality. Methods: A brief suicide screen was completed by 40,335 university students at four pariticipating sites. Assessments quantified recent depressive symptoms, alcohol use, suicidal ideation, and suicide attempts. Results: Problems from alcohol use were consistently associated with suicidal thoughts and attempts in the previous month, and in the previous year, but the quantity of alcohol used was not. Alcohol related problems exerted effects on the likelihood of both suicide ideation and attempts beyond those explained by their relationship with depressive symptoms. Conclusions: Screens for individuals at increased risk for suicidal ideation and behavior should emphasize alcohol-related problems over quantification of alcohol intake.

“Take Care of You” – Efficacy of integrated, minimal-guidance, internet-based self-help for reducing co-occurring alcohol misuse and depression symptoms in adults: Results of a three-arm randomized controlled trial

BackgroundDepression and harmful alcohol use are two of the top five leading causes of years of life lost to disability in high-income countries. Integrated treatment targeting both at the same time is often considered more complicated and difficult and, therefore, more expensive. Consequently, integrated internet-based interventions could be a valuable addition to traditional care. MethodsA three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an integrated, minimal-guidance, adherence-focused self-help intervention designed to reduce both alcohol use and depression symptoms (AFGE-AD); (2) a similar intervention designed to reduce alcohol use only (AFGE-AO), and (3) internet access as usual (IAU) as a control condition, in at least moderately depressed alcohol misusers from February 2016—March 2020. We recruited 689 alcohol misusers (51.6 % males, mean age = 42.8 years) with at least moderate depression symptoms not otherwise in treatment from the general population. Six months after baseline, 288 subjects (41.8 %) were reachable for the final assessment. ResultsAll interventions yielded reduced alcohol-use after six months (AFGE-AD: -16.6; AFGE-AO: -19.8; IAU: -13.2). Those who undertook active-interventions reported significantly fewer standard drinks than controls (AFGE-AD: p = .048, d=0.10; AFGE-AO: p = .004, d=0.20). The two active-intervention groups also reported significantly less severe depression symptoms than controls (AFGE-AD: p = .006, d=0.41; AFGE-AO: p = .008, d=0.43). Testing revealed noninferiority between the two interventions. ConclusionsThis study documented sustained effectiveness of the first integrated, fully internet-based self-help intervention developed for the reduction of both alcohol use and depression symptoms in at least moderately depressed adult alcohol misusers recruited from the general population.

Effectiveness of a digital alcohol moderation intervention as an add-on to depression treatment for young adults: study protocol of a multicentre pragmatic randomized controlled trial

BackgroundDepressive disorders and problematic drinking often co-occur, also among young adults. These co-occurring conditions are associated with various negative health outcomes compared to both conditions alone. Early intervention by addressing alcohol use and depressive symptoms simultaneously in the same treatment might improve both conditions. However, evidence on the (cost-) effectiveness of digital combined depression and alcohol interventions for young adults is currently insufficient. We therefore developed an add-on digital alcohol moderation adherence-focussed guided intervention to complement treatment as usual (TAU) for depressive disorders. The digital intervention is a web-app, including 6 modules based on motivational interviewing and cognitive behavioural therapy. This study aims to evaluate the (cost-)effectiveness of a digital alcohol moderation intervention + TAU compared to TAU on alcohol and depression outcomes among young adults with co-occurring depressive disorders and problematic alcohol use.MethodsOne hundred fifty-six participants, aged 18–35 years, with problematic alcohol use and a diagnosed depressive disorder will participate in a pragmatic multicentre two-arm randomized controlled trial. Problematic alcohol use is operationalised as scoring ≥5 for women and ≥ 8 for men on the Alcohol Use Disorder Identification Test (AUDIT). Participants will be randomized to either the experimental group (digital alcohol intervention + TAU) or control group (TAU only). Participants will be recruited at three Dutch mental health care centres and through social media. Assessments take place at baseline and after 3, 6 and 12 months post-randomization. The primary outcome is treatment response at 6-month follow-up, operationalized as a composite score that combines alcohol use and depression measures and indicates whether treatment has been successful or not. Secondary outcomes are depressive symptoms and alcohol use (i.e. number of weekly standard drinks and AUDIT score). An economic evaluation will be conducted alongside the trial.DiscussionThis study evaluates the (cost-) effectiveness of an add-on digital alcohol moderation intervention for young adults who are in treatment for depressive disorders. If proven effective, the digital intervention could be implemented in mental health care and improve treatment for people with co-occurring depressive disorders and problematic alcohol use.Trial registrationPre-registered on October 29, 2019 in The Netherlands Trial Register (NL8122).

Understanding co-occurring depression symptoms and alcohol use symptoms among cisgender sexual minority women

Sexual minority women (SMW; e.g., lesbian, bisexual) experience depression and alcohol use disorder at approximately twice the rates of heterosexual women. Though discrimination is a common explanation for these disparities, little is known about the mechanisms through which discrimination contributes to these disparities. Past research has found that the strategies that individuals use to regulate their emotions in response to discrimination may influence their depression symptoms and alcohol use symptoms. The current study proposes and validates a model to test whether alcohol use, suppression of emotion expression, and social support explain the relationships between discrimination and depression/alcohol use symptoms of cisgender SMW. A national sample of 1,782 cisgender SMW completed an online survey in 2017 through The PRIDE Study. Structural equation modeling was used to test model hypotheses. Discrimination was associated with lower levels of social support, but discrimination was not associated with higher levels of alcohol use or suppression. Social support, alcohol use, suppression, and discrimination were all significantly associated with depression symptoms. This study makes an important contribution to the literature by evaluating mechanisms that may potentially drive depression and alcohol use symptoms among cisgender SMW, focusing on mechanisms that can be intervened upon using existing evidence-based practices.

Abstract PO-137: The association between modifiable lifestyle behaviors and depression among Asian Americans with chronic hepatitis B by medication status

Abstract Background: Although Asian Americans only make up about 6% of the total U.S. population, they comprise almost 60% of individuals living with chronic hepatitis B (CHB). Asian Americans are disproportionately affected by CHB; and are more likely to develop Hepatitis B Virus (HBV)-related cirrhosis and hepatocellular carcinoma (HCC). Mental health may impact patient adherence to long-term management and treatment of chronic conditions such as CHB. Increased likelihood to report depressive symptoms and lower health-related quality of life (HRQOL) has been established among patients with CHB compared to the general population. Physical inactivity and smoking have also been associated with lower HRQOL among U.S. adults with depression. This study aims to examine the association between modifiable lifestyle behaviors (physical activity, smoking, alcohol use) and depression among Asian Americans with CHB by medication status. Methods: Chinese- and Vietnamese-Americans with CHB were recruited through outpatient clinics and community-based organizations to participate in an in-person assessment at baseline, as part of an ongoing intervention trial aimed at improving long-term adherence to monitoring/treatment. Participants were asked to report on their socio-demographic characteristics, health-related behaviors, depression symptoms, and modifiable lifestyle behaviors, among others. Bivariate analyses (two sample t- test, chi square test of independence) and multivariable logistic regression were conducted to examine association between exposures to modifiable lifestyle behaviors and outcomes of depression. Results: The study analysis sample consists of 289 participants (219 Chinese- and 70 Vietnamese-Americans). Bivariate analyses showed that there is no statistically significant difference in mean depression scores among those on CHB medication vs. those not (4.73 vs. 4.78, p 0.94), with 38.71% and 39.39% reporting mild to severe depression, respectively. In terms of lifestyle behaviors, when controlling for socio-demographic factors, multivariable logistic regression showed that while none of the three lifestyle behaviors (physical activity, smoking, alcohol use) were significantly associated with depression (p &amp;gt; 0.05) among participants not on medication, being physically inactive was significantly associated with a higher risk of depression (OR = 5.10, 95% CI = 1.72-15.10, p &amp;lt; 0.01) among participants currently on CHB medications, with other covariates held constant. Conclusion: Our study found a significant association between physical inactivity and depression among Asian Americans currently on CHB medication. Our findings suggest a need to incorporate physical activity, as part of a mental health intervention for patients with CHB, particularly for those on medication. Larger studies are needed to determine the association between depression and smoking and/or alcohol use among Asian Americans with CHB. Citation Format: Winterlyn Gamoso, Lin Zhu, Timmy R. Lin, Yin Tan, Grace X. Ma. The association between modifiable lifestyle behaviors and depression among Asian Americans with chronic hepatitis B by medication status [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-137.

Why Do I Smoke Pot when I’m Pregnant? A National Study Examining Social Correlates to Marijuana Use during Pregnancy

This study examined depression, legal involvement and social correlates to marijuana use among pregnant females in the US. The National Survey on Drug Use and Health data was examined. Unadjusted odds ratios were computed to determine if marijuana use duringpregnancy differed based on demographic variables, depression, legal involvement and smoking and alcohol use. Results from the unadjusted odds ratios indicated that marijuana use during pregnancy differed significantly based on age, race, health status, past year participation in governmental assistance, past year major depressive episode, past year legal involvement, and past month cigarette smoking, alcohol use and binge drinking. Multivariable logistic regression models revealed that those at highest risk for prenatal marijuana use were those who reported their health status was poor/fair/good health and those who drank alcohol in the past month. Past year majordepressive episode or legal involvement were not associated with marijuana use during pregnancy. Medical care providers and public health educators are encouraged to educate females of reproductive age regarding the adverse effects of marijuana use during pregnancy. Continued awareness campaigns, educational interventions and comprehensive substance abuse prevention programs addressing prenatal marijuana use are needed. Recommendations for future research are offered.

Management of work-related common mental disorders in general practice: a cross-sectional study

BackgroundGeneral practitioners (GPs) often manage individuals with work-related common mental disorders (CMD: depressive disorders, anxiety and alcohol abuse). However, little is known about the ways in which they proceed. The aim of this study is to analyze GPs’ management and patterns of referral to other health professionals of patients with work-related CMD and associated factors.MethodWe used data from a cross-sectional study of 2027 working patients of 121 GPs in the Nord – Pas-de-Calais region in France (April – August 2014). Statistical analyses focused on patients with work-related CMD detected by the GP and examined the ways in which GPs managed these patients’ symptoms. Associations between patient, work, GP and contextual characteristics and GPs’ management were explored using modified Poisson regression models with robust variance.ResultsAmong the 533 patients with work-related CMD in the study, GPs provided psychosocial support to 88.0%, prescribed psychotropic treatment to 82.4% and put 50.7% on sick leave. Referral rates to mental health specialists and occupational physicians were respectively 39.8 and 26.1%. Several factors including patients’ characteristics (occupational and sociodemographic), GPs’ characteristics and environmental data were associated with the type of management used by the GP.ConclusionOur study emphasizes the major and often lonesome role of the GP in the management of patients with work-related CMDs. Better knowledge of the way GPs manage those patients could help GPs in their practice, improve patients care and be a starting point to implement a more collaborative care approach.

Depressive and Anxiety Symptoms Predict Obsessive and Compulsive Cravings among Depressed Alcoholics.

Alcohol craving is often associated with mood symptoms and predicts alcohol use in individuals with alcohol dependence. However, little is known about the impact of mood symptoms on alcohol craving in comorbid mood disorders and alcohol dependence. This study examines the predictive value of depressive and anxiety symptoms for obsessive and compulsive aspects of alcohol craving in adults with comorbid Major Depressive Disorder (MDD) and Alcohol Dependence. Fifty-five adults (47% female; mean age of 39.35 (SD=8.80)) with DSM-IV diagnoses of comorbid MDD and alcohol dependence were prospectively assessed over a six-month period. They completed the Hamilton Rating Scales for Depression and Anxiety, the Alcohol Timeline Followback, the Obsessive Compulsive Drinking Scale (OCDS), the Alcohol Dependence Scale (ADS), and the Addiction Severity Index (ASI). The linear mixed model analyses for repeated measures was used to test weather depressive and anxiety symptoms predict OCDS subscale scores. Depressive and anxiety symptoms were strongly associated with obsessive and compulsive subscales of the OCDS. Baseline ASI-alcohol scores were associated with both the obsessive and compulsive and with the obsessive subscale scores in the predictive model including depressive symptoms, and that including anxiety symptoms respectively. Results suggest that depressive and anxiety symptoms predict obsessive and compulsive aspects of alcohol craving in adults with comorbid MDD and alcohol dependence. Assessing the severity of depressive and anxiety symptoms and alcohol use in this population may identify those more likely to experience intense alcohol craving states and at increased risk of relapse.

Depression and alcohol use disorders as precursors to death by suicide

The combined presence of depression with alcohol abuse can increase suicide risk. We used psychological autopsy to evaluate 101 individuals who died by suicide, to understand relationships between stressful life events, alcohol abuse, and depression. As compared to suicidal adults with depression only, individuals meeting criteria for both a depressive disorder and alcohol use disorder tended to be younger and experienced higher rates of stressful life events during the six months prior to death. Alcohol abuse likely influences interpersonal conflict, financial distress, and legal problems. Interventions focusing on managing life problems may help to reduce suicide risk.

Impact of mental disorders and chronic physical conditions on quality-adjusted life years in Singapore

The current study aims to evaluate the burden of disease in Singapore by estimating the quality-adjusted life years (QALYs) lost due to mental disorders and chronic physical conditions. The second Singapore Mental Health Study (SMHS-2016) was conducted in 2016 among 6126 respondents aged 18 years and above. The World Health Organization Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0) and a modified version of the CIDI chronic medical disorders checklist were used to assess the 12-month diagnoses of mental and chronic physical disorders while the SF-6D scores derived from the 12-item Short Form Health Survey instrument was used to estimate the QALYs lost. The mean SF-6D score in this population was 0.87. The largest reduction in SF-6D scores among people with mental disorders was observed in Generalized Anxiety Disorder (GAD), followed by Major Depressive Disorder (MDD), alcohol abuse, bipolar disorder and Obsessive Compulsive Disorder (OCD) while the largest reduction in SF-6D score among people with chronic physical conditions was observed in ulcer, followed by lung disease, chronic pain and cardiovascular disease. At the population level, chronic pain was associated with the greatest QALY loss followed by MDD (14,204 and 6,889 respectively). Lung disease was associated with the smallest QALY loss (376). These findings highlight chronic pain, MDD, OCD, cardiovascular disease and GAD as the five leading contributors of QALYs lost in the general population which deserve prioritisation in public health prevention programmes.

Disclosure of suicidal thoughts during an e-mental health intervention: relational ethics meets actor-network theory

ABSTRACT The technological revolution has created enormous opportunities for the provision of affordable, accessible, and flexible mental healthcare. Yet it also creates complexities and ethical challenges. While some of these challenges may be similar to face-to-face care, their nuance in the online milieu is different, as relationships, identities and boundaries in this setting are fluid, and there is an absence of physical presence. In this paper we consider the specific ethical complexities involved in the provision of a social networking intervention for depression and problematic alcohol use involving providers and peers. We present a case in which clinicians encountered a participant who repeatedly expressed suicidal thoughts in this online forum, and reflect on how this situation was managed. In analyzing this case, we use relational ethics—which proposes that interpersonal relationships are the fulcrum for ethical decision-making and action—together with actor-network theory—which highlights the power of technology to transform and mediate social and ethical relationships. Our analysis demonstrates the need to move beyond human-centric approaches, to recognize the role of both human and non-human actors in shaping moral decisions and behavior in the provision of e-mental healthcare.

They must be sick: consensual nonmonogamy through the eyes of psychotherapists

This study examined current and prospective psychotherapists’ attitudes toward different relationship types (monogamy, polyamory, swinging, and cheating). The sample consisted of 324 participants who were presented with hypothetical vignettes of couples involved in each type of relationship and seeking the help of a psychologist due to symptoms of depressive disorders, alcohol abuse, erectile dysfunction, or marital conflicts. The participants rated relationship satisfaction, the morality-, and competence-related abilities of the clients, hypothesized about the source and possible solutions to the problem, and assessed the possibility of finding a therapeutic solution. People in nonmonogamous relationships were rated lower than monogamous ones on scales related to relationship satisfaction, morality, and cognitive abilities. Moreover, the participants often associated the source of nonmonogamous clients’ problems with their lack of sexual exclusivity, while the source of problems in the case of monogamous clients was usually assessed as being unrelated to any aspects of the relationship. A qualitative analysis of the hypotheses and solutions points to strong pathologization of consensual nonmonogamy: it was assumed harmful to the relationship, and people who engage in it were attributed numerous psychologically negative qualities. A distinct tendency to persuade clients to stop pursuing the open relationship format was also visible.

Do outcomes of cognitive-behaviour therapy for co-occurring alcohol misuse and depression differ for participants with symptoms of posttraumatic stress?

Background Although post-traumatic stress disorder (PTSD) often co-occurs with depression and alcohol use disorder (AUD), treatment settings may not screen for PTSD symptoms. Aims To explore the effects of PTSD symptoms in participants seeking treatment for depression and alcohol misuse by capitalising on the DAISI (Depression and Alcohol Integrated and Single focussed Interventions) project. Methods Participants (N = 220) with current depressive symptoms and alcohol misuse were recruited from the DAISI project, a randomised controlled trial with four treatment arms. PTSD symptoms were assessed at baseline by the Posttraumatic Stress Diagnostic Scale and again at the 3-month assessment. Results McNemars t-test assessed for changes in PTSD symptom severity and PTSD symptom clusters at the 3-month assessment. Repeated measures multivariate analysis of variance assessed for changes in PTSD symptoms, by DAISI treatment allocation. At the 3-month assessment, participants with PTSD reported significant reductions in PTSD symptoms (except intrusion) and a lower rate of PTSD, and responded better to integrated depression-alcohol misuse CBT than to the alcohol/depression single-focussed or brief interventions. Conclusion Integrated depression and alcohol misuse CBT may be effective for PTSD symptoms, but intrusions may need to be addressed specifically.