A Longitudinal study of the order of onset of alcohol dependence and major depression (Gilman and Abraham, 2001)

by Andrew MCGovern

Journal presentation:

Points covered:

• The relationship between alcohol dependence and depression.

• A summary of the subject paper.

• Discussion of the methodsand results.

Introduction

• Alcohol dependence and major depression commonly occur together. (Deykin et al., 1987, Regier et al., 1990)

• The prevalence of one condition is significantly higher if the other condition is present, when compared to the general population. (Kessler et al., 1996, Kessler et al., 1997)

• Rates of both conditions are increasing at younger ages. (Helzer et al., 1990, Wittchen et al., 1994)

Alcohol dependence and depression

A Longitudinal study of the order of onset of alcohol dependence and major depression.

• Objective: to examine the temporal relationship between depression and alcohol dependence.

• Hypothesis: diagnosis of depression or alcohol dependence increases risk of developing the other disorder.

The study

Data from the Epidemiological Catchment Area community survey (ECA) was used.

The ECA was conducted at 5 locations in the United States between 1980 and 1985.

The suitable population consisted of 18,571 (78%) subjects who were re-interviewed after 1 year.

The data

The subjects were interviewed using the Diagnostic Interview Schedule (DIS).

It is designed for non-clinician interviewers to estimate psychiatric diagnosis.

DIS kappa (κ) values for predicting:• Alcohol dependence κ = 0.68 (Heltzer et al.,

1985)

κ = 0.86 (Robins et al., 1981)

• Depression κ = 0.63 (Heltzer et al., 1985)

κ = 0.33 (Robins et al., 1981)

• Depression test-retest κ = 0.66 (Semler et al.,

1987) κ = 0.41 (Vandiver and Sher, 1991)

Data collection

Prevalent cases of the outcome disorder at baseline were excluded from each group.

Groups were controlled for age, gender, socio-economic status, ethnicity and ECA site.

Sampling weights were used to standardise the study population to the age, race and sex distribution of the United States according to the 1980 census.

Analytical procedures

For both sexes there was no significant association between depression at baseline and alcohol dependence after one year.

For females there is a correlation between alcohol dependence and number of depressive symptoms at baseline.

There is a marginally significant relationship in males.

Results: Risk of alcohol dependence

For both sexes there were increased odds of depression associated with alcohol dependence at baseline.

Results: Risk of major depression

DIS diagnosis is imperfect:• Inaccuracies at first and second interviews.• Lifetime cases misclassified as incident cases at

second interview.

Self reported symptoms are inconsistent.

Interview technique may be gender biased.

Population sample may not be geographically universal.

Data was recorded 1980-1985.

Study limitations

Alcohol dependence and major depression commonly occur together.

There is correlation between the number of depressive symptoms and the onset of alcoholism in women only.

Alcoholism is an independent risk factor for developing depression in both women and men.

Conclusion

DEYKIN, E. Y., LEVY, J. C. & WELLS, V. (1987) Adolescent depression, alcohol and drug abuse. American Journal of Public Health, 77 (2), pp. 178-182.

GILMAN, S. E. & ABRAHAM, H. D. (2001) A longitudinal study of the order of onset of alcohol dependence and major depression. Drug and Alcohol Dependence, 63 pp. 277-286.

HELZER, J. E., CANINO, G. J., YEH, E. K., BLAND, R. C., LEE, C. K., HWU, H. G. & NEWMAN, S. (1990) Alcoholism - North America and Asia. A comparison of population surveys with the Diagnostic Interview Schedule. Archives of General Psychiatry, 47 (4), pp. 313-319.

HELZER, J. E., ROBINS, L. N., MCEVOY, L. T., SPITZNAGEL, E. L., STOLTZMAN, R. K., FARMER, A. & BROCKINGTON, I. F. (1985) A comparison of clinical and diagnostic interview schedule diagnoses. Physician reexamination of lay-interviewed cases in the general population. Archives of General Psychiatry, 42 (7), pp. 657-666.

KESSLER, R. C., CRUM, R. M., WARNER, L. A., NELSON, C. B., SCHULENBERG, J. & ANTHONY, J. C. (1997) Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Archives of General Psychiatry, 54 (4), pp. 313-321.

KESSLER, R. C., NELSON, C. B., MCGONAGLE, K. A., LIU, J., SWARTZ, M. & BLAZER, D. G. (1996) Comorbidity of DSM-III-R major depressive disorder in the general population : Results from the US National Comorbidity Survey. British journal of psychiatry. Supplement, pp. 17-30.

REGIER, D. A., FARMER, M. E., RAE, D. S., LOCKE, B. Z., KEITH, S. J., JUDD, L. L. & GOODWIN, F. K. (1990) Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. The Journal of the American MEdical Association, 264 (19), pp. 2511-2518.

ReferencesROBINS, L. N., HELZER, J. E., CROUGHAN, J. & RATCLIFF, K. S.

(1981) National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of General Psychiatry, 38 (4), pp. 381-389.

SEMLER, G., WITICHEN, H.-U., JOSCHKE, K., ZAUDIG, M., GEISO, T. V., KAISER, S., CRANACH, M. V. & PFISTER, H. (1987) Test-Retest Reliability of a standardized psychiatric interview (DIS/CIDI). European Archives of Psychiatry and Clinical Neuroscience, 236 (4), pp. 214-222.

VANDIVER, T. & SHER, K. J. (1991) Temporal stability of the Diagnostic Interview Schedule. Psychological Assessment, 3 pp. 277-281.

WITTCHEN, H. U., KNÄUPER, B. & KESSLER, R. C. (1994) Lifetime risk of depression. British journal of psychiatry. Supplement, 26 pp. 16-22.

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