The prevalence and impact of alcohol problems in major depression: A systematic review

doi:10.1016/j.amjmed.2005.01.007

The American Journal of Medicine

Volume 118, Issue 4, April 2005, Pages 330-341

https://doi.org/10.1016/j.amjmed.2005.01.007 Get rights and content

Abstract

Major depression and alcohol problems are common in primary care, yet little is known about the prevalence of alcohol problems in patients with depression or alcohol’s effect on depression outcomes. We strove to answer the following questions: How common are alcohol problems in patients with depression? Does alcohol affect the course of depression, response to antidepressant therapy, risk of suicide/death, social functioning and health care utilization? In which alcohol categories and treatment settings have patients with depression and alcohol problems been evaluated? English language studies from MEDLINE, PsychINFO, and Cochrane Controlled Trial Registry were reviewed. Studies were selected using predefined criteria if they reported on the prevalence or effects of alcohol problems in depression. Thirty-five studies met criteria and revealed a median prevalence of current or lifetime alcohol problems in depression of 16% (range 5–67%) and 30% (range 10–60%), respectively. This compares with 7% for current and 16–24% for lifetime alcohol problems in the general population. There is evidence that antidepressants improve depression outcomes in persons with alcohol dependence. Alcohol problems are associated with worse outcomes with respect to depression course, suicide/death risk, social functioning, and health care utilization. The majority of the studies, 34 of 35 (97%), evaluated alcohol abuse and dependence, and 25 of 35 (71%) were conducted in psychiatric inpatients. We conclude that alcohol problems are more common in depression than in the general population, are associated with adverse clinical and health care utilization outcomes, and that antidepressants can be effective in the presence of alcohol dependence. In addition, the literature focuses almost exclusively on patients with alcohol abuse or dependence in psychiatric inpatient settings, and excludes patients with less severe alcohol problems and primary care outpatient settings.

Section snippets

Search strategy

We identified English language studies by searching the following databases: MEDLINE (1980 to September 2002), PsychINFO (1984 to September 2002), and the Cochrane Central Register of Controlled Trials (through 4^th quarter of year 2002). Specific medical subject headings and text words in MEDLINE are listed in Table 1.

Publications were limited to clinical trials, consensus development conferences, editorials, guidelines, journal articles, meta-analyses, multicenter studies, reviews, twin

Literature search results

The search identified 2027 abstracts. After excluding duplicates (n = 448), 1579 abstracts remained (900 from MEDLINE and 679 from PsychINFO). Review of the Cochrane databases produced no additional articles. Of the 1579 studies, 151 (10%) were excluded because they did not focus on adult subjects, 1259 (80%) because the subjects did not meet criteria for current depression, 113 (7%) because they did not assess alcohol problems or use, 21 (1%) because of the presence of polysubstance use, and

Discussion

Our review reveals that alcohol problems are prevalent in patients with depression, with median rates of 16% for current alcohol problems and 30% for lifetime alcohol problems. The studies that compared these rates with those of nondepressed patients or of the general population found higher rates of current and lifetime alcohol problems in depressed patients. The identified literature supports the efficacy of antidepressant therapy in patients with depression and alcohol problems. It also

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: Dr. Sullivan is supported by the National Institute on Drug Abuse Physician Scientist Award (NIDA # K12 DA00167), and Dr. Fiellin is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. Funding for this project was made possible through grants from the Robert Wood Johnson Foundation’s Program of Research Integrating Substance Use Issues into Mainstream Healthcare (PRISM), the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.

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Review The prevalence and impact of alcohol problems in major depression: A systematic review

Abstract

Section snippets

Search strategy

Literature search results

Discussion

J Substance Abuse

Drug Alcohol Depend

Addict Behav

J Affect Disord

J Affect Disord

Control Clin Trials

Compr Psychiatry

J Affect Disord

Am J Geriatr Psychiatry

Addict Behav

Am J Geriatr Psychiatry

J Affect Disord

Environ Res

Compr Psychiatry

Compr Psychiatry

Gen Hosp Psychiatry

J Affect Disord

J Affect Disord

Psychosomatics

J Affect Disord

Compr Psychiatry

One-year prevalence of depressive disorders among adults 18 and over in the U.S.: NIMH ECA prospective data. Population estimates based on U.S. Census estimated residential population age 18 and over on July 1, 1998

Depression in Primary Care: Volume 1, Detection and Diagnosis

Recognition, management, and outcomes of depression in primary care

Arch Fam Med

Collaborative management to achieve treatment guidelines. Impact on depression in primary care

JAMA

A multifaceted intervention to improve treatment of depression in primary care

Arch Gen Psychiatry

Medication management of depression in the United States and Ontario

J Gen Intern Med

The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services

Arch Gen Psychiatry

Prescribing trends in psychotropic medicationsprimary care, psychiatry, and other medical specialties

JAMA

The Physicians’ Guide to Helping Patients with Alcohol Problems

Diagnostic criteria for use in psychiatric research

Arch Gen Psychiatry

Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV)

Prevalence of Alcohol Abuse and Alcohol Dependence

At-risk drinking in an HMO primary care sampleprevalence and health policy implications

Am J Public Health

What if Americans drank less? The potential effect on the prevalence of alcohol abuse and dependence

Am J Public Health

ICD-10 harmful use of alcohol and the alcohol dependence syndromeprevalence and implications

Addiction

Drinking patterns and drinking problems in 1984results from a general population survey

Alcohol Clin Exp Res

Review
The prevalence and impact of alcohol problems in major depression: A systematic review