Associations Between Psychiatric Disorders and Alcohol Consumption Levels in an Adult Primary Care Population

Abstract

Background: Unhealthy alcohol use frequently co-occurs with psychiatric disorders; however, little is known about the relationship between psychiatric disorders and alcohol consumption levels. Understanding varying levels of unhealthy alcohol use among individuals with a variety of psychiatric disorders in primary care would provide valuable insight for tailoring interventions. Methods: We conducted a cross-sectional study of 2,720,231 adult primary care patients screened for unhealthy alcohol use between 2014 and 2017 at Kaiser Permanente Northern California, using electronic health record data. Alcohol consumption level was classified as no reported use, low-risk use, and unhealthy use, per National Institute on Alcohol Abuse and Alcoholism guidelines. Unhealthy use was further differentiated into mutually exclusive groups: exceeding only daily limits, exceeding only weekly limits, or exceeding both daily and weekly limits. Multivariable multinomial logistic regression models were fit to examine associations between 8 past-year psychiatric disorders (depression, bipolar disorder, anxiety disorder, obsessive-compulsive disorder, schizophrenia, schizoaffective disorder, anorexia nervosa, and bulimia nervosa) and alcohol consumption levels, adjusting for sociodemographic and health characteristics. Results: In the full sample [53% female, 48% White, mean (SD) age = 46 (18) years], patients with psychiatric disorders (except eating disorders), compared to those without, had lower odds of reporting low-risk and unhealthy alcohol use relative to no use. Among patients who reported any alcohol use (n = 861,427), patients with depression and anxiety disorder, compared to those without, had higher odds of exceeding only weekly limits and both limits; patients with bulimia nervosa were also more likely to exceed both limits. Conclusions: Findings suggest that patients with anxiety disorder, depression, and bulimia nervosa who drink alcohol are more likely to exceed recommended limits, increasing risk of developing more serious problems. Health systems and clinicians may wish to consider implementing more robust screening, assessment, and intervention approaches to support these vulnerable subgroups in limiting their drinking.

Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

“…To adjust for patients' medical comorbidities, we used the Charlson comorbidity score, which estimates the 1year mortality risk based on a weighted score of 17 medical conditions (Charlson et al, 1987;Deyo et al, 1992). We also identified whether individuals had an alcohol use disorder diagnosis, drug use disorder diagnosis, mental health condition (Palzes et al, 2020a(Palzes et al, , 2020b; depression, bipolar disorder, schizophrenia, schizoaffective disorder, anxiety disorder, panic disorder, obsessive-compulsive disorder, pervasive developmental disorder, anorexia nervosa, and bulimia nervosa), or substance abuse-related medical condition (SAMC; Weisner et al, 2001) in the year prior to index date, based on ICD-9 and ICD-10 codes. We used the NDI as a proxy for individual socioeconomic status (SES) and divided patients into quartiles based on the overall distribution (Messer et al, 2006).…”

“…Unhealthy alcohol use is a significant public health problem associated with many common medical and mental health conditions (Palzes et al, 2020b;Sterling et al, 2020), and is often a precursor to alcohol use disorder and related medical problems (Mertens et al, 2003). A recent large-scale combined analysis found a positive and curvilinear association between the level of alcohol consumption and all-cause mortality, with the minimum mortality risk around or below 100 g per week (Wood et al, 2018).…”

Characterization of benzodiazepine misuse and comorbidities in patients with alcohol use disorder

“…Studies shown that patients with AUD have higher prevalence of comorbid psychiatric disorders including schizophrenia, mood disorders, anxiety disorders and personality disorders [25,26]. In addition, insomnia is frequent in this population and may contribute to anxiety and depressive symptoms and cognitive impairment [27].…”

Alcohol Use Among Young Adults in Northern California During the COVID-19 Pandemic—An Electronic Health Records-Based Study

“…KPNC provides care to a population insured through employer-based plans, Medicare, Medicaid, and health insurance exchanges. KPNC has 21 medical centers, 233 medical offices, and 2,147 adult primary care physicians and providers, and provides specialty psychiatry and addiction treatment as a covered benefit ( 23 ).…”