Alcohol abuse by mood disorder patients

Abuse of alcohol is associated with psychiatric disorders but requires updating of risks, outcomes, and associated factors, particularly for patients with co-occurring major mood disorders.

A total of 1768 consecutive, consenting adult patients (1070 women, 698 men, aged 47.0 [CI: 46.4-47.5] years) with information about alcohol abuse and with a DSM-5-TR mood disorder (897 bipolar disorder [BD: 466 BD1, 431 BD2], 871 major depressive disorder [MDD]), ill for a total of 19.2 [18.5-19.9] years, were evaluated extensively and followed prospectively for 4.61 [4.25-5.00] years.

Alcohol abuse was identified in 228/1768 subjects (12.9 % [11.4-14.5]); prevalence was greater with BD (18.8 % [16.3-21.6]) than MDD (6.77 % [5.20-8.65]), similar with BD1 (20.7 % [17.1-24.7]) and BD2 (17.0 % [13.5-20.9]), and 2.52-times greater among men (20.3 % [17.4-23.5]) than women (8.04 % [6.48-9.83]). Factors associated notably with alcohol abuse included: early sexual > physical abuse, earlier illness-onset, higher cyclothymic and irritable temperament ratings, unemployment, suicide attempt, separation or divorce and less marriage, fewer children, more smoking, less general medical morbidity, but not greater psychiatric morbidity (as depressive or [hypo]manic episodes/year, %-time-ill, -depressed, or-[hypo]manic, or hospitalizations/year). Multivariable logistic modeling found six factors to be significantly and independently associated with alcohol abuse, ranking: men > women, BD > MDD, suicide attempt, fewer children, early sexual abuse, and lack of somatic comorbidity.

Alcohol abuse, as expected, was associated with more adverse social measures and outcomes but surprisingly, not greater psychiatric, and even less general medical morbidity.