Patterns of alcohol consumption in particular frequent use plus frequent bingeing have positive associations with symptoms of depression such as depressed mood, poor appetite or overeating, feelings of worthlessness or guilt and psychomotor agitation or retardation, a German study has found.

The study sample consisted of 10,677 patients, aged 18-64 years, who were receiving medical care from a range of hospital wards, outpatient departments and general practices, and reported some alcohol use.

Each participant was given an anonymous health risk screen which included a modified version of the Alcohol Use Disorder Identification Test (AUDIT) and three modified screening questions from the German version of the DSM-IV Composite International Diagnostic Interview (CIDI). The three questions related to feelings of sadness, lack of energy and loss of interest in things for two or more weeks.

Those who gave a positive response to any of the questions from the CIDI were additionally assessed using the eight-item Patient Health Questionnaire (PHQ-8). Major depression over the past year was defined as a PHQ-8 score ≥ 10.

Data analysis identified six patterns of alcohol use, with the majority of patients engaging in light use plus no or occasional bingeing, which was associated with the lowest overall alcohol intake; 41.85% of men and 64.04% of women, followed by regular use plus occasional bingeing 34.03% of men and 16.17% of women.

For both men and women, the 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) 1.07 (95% CI: 1.03-1.11) for men and 1.09 (95% CI: 1.04-1.14) for women.

The severity of depressive symptoms was negatively associated with regular use plus occasional bingeing for men, RRR 0.98 (95% CI: 0.95-1.00) and positively with occasional use plus occasional bingeing for women, RRR 1.03 (95% CI: 1.01-1.05) when compared with light use plus no or occasional bingeing.

Depressed mood, poor appetite or overeating, feelings of worthlessness or guilt and psychomotor agitation or retardation were significantly more likely in the frequent use plus frequent bingeing group: RRR 1.72-2.36 for men; 1.99-2.17 for women.

While extensive research has shown that depression is more prevalent in those who drink heavily, there has been little information about the relationship between mood disorder and the pattern of drinking. This study has provided information on individual depressive symptoms across a range of alcohol use patterns, with additional analysis by gender.

The authors have demonstrated an association between certain patterns of alcohol use and the symptoms of depression, with frequent use plus frequent bingeing associated with a higher prevalence of symptoms compared with light alcohol use plus no or occasional bingeing. This information is likely to be of value to GPs when they are advising patients with depression who drink alcohol.

Dr Jez Thompson