Rethinking gender differences: An investigation of comorbid psychopathology and alcohol use disorder in veterans

While men have been found to drink more alcohol and have higher rates of alcohol-related mortality, women tend to experience higher rates of alcohol-related consequences, including psychological comorbidities and worse alcohol use disorder (AUD) outcomes. However, gender differences in comorbid psychopathology and associations with AUD outcomes among veterans are less well understood.

Veterans (N = 126; 32 women) receiving inpatient treatment for AUD completed baseline clinical measures including the Beck Depression Inventory-II, Beck Anxiety Inventory, Early Life Stress Questionnaire, and PTSD Checklist for DSM-5. Alcohol use was assessed with the Timeline Followback for the 90 days prior to the baseline assessment and again at 1-, 3-, and 6-month follow-ups. Gender differences in baseline alcohol and psychopathology measures were examined using Fisher's exact test and Mann-Whitney U test. Linear/logistic regression was used to examine associations between comorbid psychopathology and alcohol relapse/use severity post-study.

Consistent with prior literature, statistically significant gender differences in psychopathology were observed, with women reporting higher anxiety (p < 0.001), depression (p = 0.001), early life stress (p < 0.001), and PTSD (p < 0.001) at baseline. Higher early life stress was also associated with higher anxiety, depression, and PTSD. Statistically significant gender differences were not observed for alcohol use in the 90 days prior to the study. Similarly, gender was not associated with relapse or severity of use at 1-, 3-, or 6-month follow ups (ps > 0.05). Psychopathology measures were not associated with relapse or severity of use at any time point (ps > 0.05).

Our study highlights that women veterans are drinking similar quantities of alcohol to men, supporting emerging evidence of a narrowing gender gap in alcohol use. Women also have a higher psychiatric burden than men; thus, identifying ways to mitigate comorbidity among women veterans should be a health priority.