Latent alcohol use patterns and their link to depressive symptomatology in medical care patients

Abstract

Aims To investigate latent patterns of alcohol use and bingeing by gender and their association with depressive symptom severity and individual depressive symptoms. Design Cross‐sectional data were collected from January 2017 to March 2018 as part of a joint screening recruiting for different intervention studies. Setting Ambulatory practices and general hospitals from three sites in Germany. Participants A total of 5208 male and 5469 female proactively recruited alcohol users aged 18–64 years. Measurements Frequency and typical quantity of alcohol use, frequency of bingeing, alcohol‐related problems (assessed by the Alcohol Use Disorder Identification Test); depressive symptom severity, individual depressive symptoms (assessed with the Patient Health Questionnaire‐8); and socio‐demographics and health‐related variables. Findings Latent categorical analysis identified six patterns of alcohol use, with the majority of patients engaging in ‘light use plus no or occasional bingeing’ (males: 41.85%; females: 64.04%), followed by ‘regular use plus occasional bingeing’ (males: 34.03%; females: 16.17%). Multinomial logistic regression analyses (three‐step approach with correction for classification uncertainty, as implemented in the Mplus R3STEP command) controlling for socio‐demographics and health‐related variables revealed that severity of depressive symptoms was positively associated with ‘frequent use plus frequent bingeing’ when compared with ‘light use plus no or occasional bingeing’ [relative risk ratio (RRR)male = 1.07, 95% confidence interval (CI) = 1.03–1.11; RRRfemale = 1.09, 95% CI = 1.04–1.14]. Severity of depressive symptoms was negatively associated with ‘regular use plus occasional bingeing’ for males (RRRmale = 0.98, 95% CI = 0.95–1.00) and positively with ‘occasional use plus occasional bingeing’ for females (RRRfemale = 1.03, 95% CI = 1.01–1.05) when compared with ‘light use plus no or occasional bingeing’. Individual depressive symptoms were differentially associated with alcohol use patterns, with depressed mood, poor appetite or overeating, feelings of worthlessness or guilt and psychomotor agitation or retardation, being especially pronounced in the ‘frequent use plus frequent bingeing’ class (RRRsmale = 1.72–2.36; RRRsfemale = 1.99–2.17). Conclusions Patterns of ‘frequent alcohol use plus frequent bingeing’ and ‘occasional alcohol use plus occasional bingeing’ appear to have positive associations with depression when compared with ‘light alcohol use plus no or occasional bingeing’.

Commentary on Guertler et al.: Can latent class analysis methods develop our understanding of mental health and alcohol problem co‐occurrence at a symptom level?

“…Their study analysed data from more than 10 000 patients receiving care from ambulatory practices and general hospitals in Germany to understand how latent classes of alcohol use (defined by frequency and quantity of alcohol use and binge drinking frequency) were related to depression. As expected, those with severe depression scores were more likely to be in a class defined by frequent alcohol use and frequent binge drinking [1]. This, in itself, is not a new finding given that existing meta‐analyses have evidenced a strong association between common mental disorders (such as depression or anxiety) and alcohol use disorders (AUD) [2].…”

“…Guertler et al . [1] have taken a unique approach in developing our understanding of the association between mental health and alcohol use. Their study analysed data from more than 10 000 patients receiving care from ambulatory practices and general hospitals in Germany to understand how latent classes of alcohol use (defined by frequency and quantity of alcohol use and binge drinking frequency) were related to depression.…”

“…This, in itself, is not a new finding given that existing meta‐analyses have evidenced a strong association between common mental disorders (such as depression or anxiety) and alcohol use disorders (AUD) [2]. However, this study moved beyond purely establishing the co‐occurrence of specific disorders, by determining whether specific symptoms of depression were more likely to be endorsed in individuals with particular drinking profiles [1].…”

“…This new work has identified how specific symptoms of depression are more common in those with particular drinking patterns. For example, the association of the frequent use and frequent bingeing latent class with poor appetite or over‐eating [1] suggests that using alcohol to cope may not occur in isolation from other health behaviours, such as eating to cope [4]. This promotes a more holistic approach to understanding how a range of coping strategies may be used in individuals with a mental health problem.…”

“…Females with increased depression scores in the Guertler et al . study [1] were more likely to be in the class of occasional use and occasional bingers, suggesting that they used alcohol to cope in particular circumstances, but not on a frequent basis. Depression symptoms such as anhedonia, insomnia or hypersomnia and fatigue or loss of energy were also more common in individuals in the class defined by occasional use and occasional bingeing.…”