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Cited by 475Substance Abuse Treatment and OutcomesMental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional Development

Tests of Causal Links Between Alcohol Abuse or Dependence and Major Depression

Fergusson, David M., Boden, Joseph M., Horwood, L. John·2009·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2008.543
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Abstract

CONTEXT: There has been a great deal of research on the comorbidity between alcohol abuse or dependence (AAD) and major depression (MD). However, it is unclear whether AAD increases the risk of MD or vice versa. OBJECTIVE: To examine the associations between AAD and MD using fixed-effects modeling to control for confounding and using structural equation models to ascertain the direction of causality. DESIGN: Data were gathered during the course of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of children from New Zealand (635 boys, 630 girls). SETTING: General community sample. PARTICIPANTS: The analysis was based on a sample of 1055 participants with available data on AAD and MD at ages 17 to 18, 20 to 21, and 24 to 25 years. MAIN OUTCOME MEASURES: Symptom criteria for AAD and MD from the DSM-IV at ages 17 to 18, 20 to 21, and 24 to 25 years as well as measures of life stress, cannabis use, other illicit drug use, affiliation with deviant peers, unemployment, partner substance use, and partner criminality at ages 17 to 18, 20 to 21, and 24 to 25 years. RESULTS: There were significant (P < .001) pooled associations between AAD and MD. Controlling for confounding factors using conditional fixed-effects models and time-dynamic covariate factors reduced the magnitude of these associations, but they remained statistically significant. Structural equation modeling suggested that the best-fitting causal model was one in which AAD led to increased risk of MD. CONCLUSIONS: The findings suggest that the associations between AAD and MD were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD.

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  • Two reviews concluded that all three mechanisms are possible and probably existing, but the first mechanism-that alcohol use (especially heavy use and alcohol use disorders) causes depression-is stronger and more prevalent than the other pathways.

    “Two reviews on this topic came to the same conclusion: that all three mechanisms are possible and probably existing, but the first mechanism—that alcohol use (especially heavy use and alcohol use disorders) causes depression—is stronger and more prevalent than the other pathways (5, 219; see also 221, 222).”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [221]

  • The confounder-controlled risks from Fergusson and colleagues could be used, with odds ratio 1.66 (95% CI 1.08-2.55).

    “Alternatively, the confounder‐controlled risks from Fergusson and colleagues 221 could be used [odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.08–2.55].”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [221]

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Authors
Fergusson, D. M., Boden, J. M., & Horwood, L. J.
Affiliations
University of Otago (NZ)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2009-03-01
Volume
66
Issue
3
Pages
260
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2008.543
OpenAlex
W2090589978
Cited by
475
References
40
Citations by year
2026: 16 · 2025: 9 · 2024: 16 · 2023: 23 · 2022: 36 · 2021: 24 · 2020: 31 · 2019: 24 · 2018: 28 · 2017: 35 · 2016: 35 · 2015: 23 · 2014: 31 · 2013: 36 · 2012: 41
FWCI
23.81
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
alcohol abuse, alcoholism, major depressive disorder, comorbidities, causal direction, self-medication hypothesis, life events, deviant peer affiliation, cannabis use, illicit drug use, unemployment, Christchurch Health and Development Study
MeSH terms
Adolescent, Adult, Alcoholism, Major Depressive Disorder, Female, Humans, Life Change Events, Male, Surveys and Questionnaires, Cohort Studies, Incidence, Prevalence, Substance-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders, Young Adult

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