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Depressed Patients With Co-Occurring Alcohol Use Disorders: A Unique Patient Population
Leo Sher, M.D.; Barbara H. Stanley, Ph.D.; Jill M. Harkavy-Friedman, Ph.D.; Juan J. Carballo, M.D.; Mikkel Arendt, M.S.; David A. Brent, M.D.; Dahlia Sperling, B.A.; Dana Lizardi, Ph.D.; J. John Mann, M.D.; and Maria A. Oquendo, M.D.
Objective: Alcohol use and depressive disorders are frequently comorbid. Few studies have assessed the impact of comorbid alcohol use disorders (AUDs) on clinical aspects of major depression. We compared depressed subjects with and without co-occurring AUDs with respect to demographic and clinical parameters.
Method: 505 individuals participated. 318 subjects had DSM-IV major depressive disorder (MDD) without a history of any alcohol or substance abuse/dependence (MDD only), and 187 individuals had MDD and a history of alcohol abuse/dependence (MDD/AUD). Demographic, clinical, and psychiatric history measures of patients in the 2 groups were examined and compared. The study was conducted from January 1990 to June 2005.
Results: MDD/AUD patients were younger at their first psychiatric hospitalization (p = .014), their first major depressive episode (p = .041), and their first suicide attempt (p = .001). They reported more previous major depressive episodes (p = .001), suicide attempts (p = .001), and recent life events (p = .001); and had higher lifetime aggression (p < .001), impulsivity (p < .001), and hostility (p < .001) scores. MDD/AUD patients were also more likely to report tobacco smoking (p < .001), a lifetime history of abuse (p = .004), and a history of AUD among first-degree relatives (p < .001) compared to MDD only patients. MDD/AUD individuals also had higher childhood (p < .001), adolescent (p < .001), and adult (p < .001) aggression scores and reported more behavioral problems during their childhood compared to their counterparts. Logistic regression analysis demonstrates that the number of previous depressive episodes, lifetime aggression, and smoking drive the difference between the groups.
Conclusion: Our findings suggest that comorbid MDD/AUD may result from worse antecedents and lead to early onset, more comorbidity, and a more severe course of illness.
(J Clin Psychiatry
2008;69:907-915. Online Ahead of Print April 15, 2008.)
Received July 5, 2007; accepted Oct. 25, 2007. From the Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, N.Y. (Drs. Sher, Stanley, Harkavy-Friedman, Carballo, Lizardi, Mann, and Oquendo, Mr. Arendt, and Ms. Sperling); and from the Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pa. (Dr. Brent).
This study was partly supported by grants MH62185 and MH59710 from the National Institute of Mental Health (NIMH), grant AA015630 from the National Institute on Alcohol Abuse and Alcoholism, and a grant to Dr. Sher from the American Foundation for Suicide Prevention.
Dr. Mann has received grant/research support from GlaxoSmithKline and Novartis. Dr. Oquendo has received grant/research support from the NIMH. Drs. Sher, Stanley, Harkavy-Friedman, Carballo, Brent, Lizardi, Mr. Arendt, and Ms. Sperling report no additional financial or other relationships relevant to the subject of this article.
Corresponding author and reprints: Leo Sher, M.D., Department of Psychiatry, Columbia University, 1051 Riverside Dr., Suite 2917, Box 42, New York, NY 10032 (e-mail: LS2003@columbia.edu).