Alcohol use disorder (AUD) is a risk factor for the long term persistence or recurrence of major depression, according to a study published in the Canadian Journal of Psychiatry. Recurrent depression may be linked to substance use disorders more broadly, and abstinence from alcohol or other addictive substances may play a role in the resolution of depressive symptoms.
Vivian N. Onaemo, MBBS, MPH, PhD, of the School of Public Health, University of Saskatchewan in Saskatoon, Canada, and colleagues obtained data from the longitudinal Canadian Population Health Survey (1994-1995 to 2010-2011), which consists of individuals ≥12 years of age from Canada (N=17,276). Participants of the survey were interviewed every 2 years for a total of 9 cycles. In this study, the researchers included a cohort of participants who met diagnostic criteria for a major depressive episode at baseline in the 12 months prior to survey participation (n=908).
A total of 124 participants met the criteria for a major depressive episode after cycle 4 (year 6), whereas 79 participants met the criteria after cycle 9 (year 16). The investigators examined whether alcohol dependence, AUD, or additional risk factors influenced the rate of major depression persistence or recurrence.
The presence of comorbid AUD was significantly associated with a 6-year persistence or recurrence of major depression (odds ratio [OR], 3.03; 95% CI, 1.68-5.48; P <.0001). Additionally, comorbid AUD was significantly associated with the persistence or recurrence of major depression at 16 years (OR, 3.17; 95% CI, 1.15-8.77; P =.003).
Other risk factors for the persistence or recurrence of major depression in this cohort included being a woman (relative ratio [RR], 1.53; 95% CI, 1.02-2.29; P ≤.05), childhood traumatic events (≥3 traumatic events: RR, 1.72; 95% CI, 1.04-2.83; P ≤.05), chronic pain restricting activities (RR, 1.70; 95% CI, 1.06-2.71; P ≤.05), daily smoking (RR, 1.58; 95% CI, 1.03-2.43; P ≤.05), and low self-esteem (P <.0001).
Limitations of the study included the loss of participants to follow-up, the lack of differentiation between persistent depression and recurrent depression, and the use of interviews to collect information on alcohol dependence and depression diagnoses.
Based on the overlap between AUD and major depression, the researchers of this study wrote, “It is imperative to treat both disorders simultaneously to improve treatment outcomes and reduce healthcare costs.”
Onaemo VN, Fawehinmi TO, D’Arcy C. Alcohol use disorder and the persistence/recurrence of major depression [published online May 4, 2020]. Can J Psychiatry. doi:10.1177/0706743720923065.