Alcohol Use Disorder and Depression Among Community-Based Clinic Patients Before and During the COVID-19 Public...

The clustering of smoking, alcohol use disorder, and depression is associated with increased health risks and mortality. The COVID-19 pandemic caused significant disruption, with unknown implications for alcohol use disorder and depression diagnoses among patients who smoke. This study assessed changes in the prevalence of alcohol use disorder and depression diagnoses in patients at community-based healthcare organizations before and during the COVID-19 public health emergency, by smoking status and sex.

A retrospective cohort study was conducted using electronic health record data from community-based primary care and behavioral health clinics (n=766 clinics in 19 states) in the U.S. Outcomes included the covariate-adjusted probability of alcohol use disorder diagnosis, depression diagnosis, and comorbid diagnoses in 2019 and 2022, stratified by smoking status and sex.

In both years, alcohol use disorder and depression diagnoses were higher among patients who were smoking (n=57,351 patients) than among those who were not (n=304,405 patients). The likelihood of alcohol use disorder, depression, or co-occurring alcohol use disorder and depression diagnoses increased from 2019 to 2022 among both sexes and all smoking statuses, with larger increases seen among patients who were smoking. The largest change was in depression among currently smoking females, rising from 35.2% to 41.7% (absolute difference=6.4%, 95% CI=5.8%, 7.1%).

The COVID-19 pandemic was associated with a greater burden of alcohol use disorder and depression diagnoses among patients seen in community-based clinics, with larger differences among those who currently smoke than among those who do not. Males had the largest increase in alcohol use disorder diagnoses, and females had the largest increase in depression diagnoses. These results support the need for a coordinated, integrated healthcare approach addressing the clustering of smoking, alcohol use, and depression in populations already facing elevated social and health risks, particularly during times of high stress, such as pandemics and other public health emergencies.