The prevalence and impact of alcohol problems in major depression: A systematic review
Abstract
Major depression and alcohol problems are common in primary care, yet little is known about the prevalence of alcohol problems in patients with depression or alcohol's effect on depression outcomes. We strove to answer the following questions: How common are alcohol problems in patients with depression? Does alcohol affect the course of depression, response to antidepressant therapy, risk of suicide/death, social functioning and health care utilization? In which alcohol categories and treatment settings have patients with depression and alcohol problems been evaluated? English language studies from MEDLINE, PsychINFO, and Cochrane Controlled Trial Registry were reviewed. Studies were selected using predefined criteria if they reported on the prevalence or effects of alcohol problems in depression. Thirty-five studies met criteria and revealed a median prevalence of current or lifetime alcohol problems in depression of 16% (range 5-67%) and 30% (range 10-60%), respectively. This compares with 7% for current and 16-24% for lifetime alcohol problems in the general population. There is evidence that antidepressants improve depression outcomes in persons with alcohol dependence. Alcohol problems are associated with worse outcomes with respect to depression course, suicide/death risk, social functioning, and health care utilization. The majority of the studies, 34 of 35 (97%), evaluated alcohol abuse and dependence, and 25 of 35 (71%) were conducted in psychiatric inpatients. We conclude that alcohol problems are more common in depression than in the general population, are associated with adverse clinical and health care utilization outcomes, and that antidepressants can be effective in the presence of alcohol dependence. In addition, the literature focuses almost exclusively on patients with alcohol abuse or dependence in psychiatric inpatient settings, and excludes patients with less severe alcohol problems and primary care outpatient settings.
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People with MDD are significantly more likely to engage in excessive alcohol and tobacco use.
“For instance, systematic reviews have found that people with MDD are significantly more likely to engage in excessive alcohol and tobacco use131,132, and have a higher total food intake and reduced diet quality133, higher levels of sedentary behavior134, and poorer sleep continuity and quality135, compared to non-depressed people.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [132]
Alcohol use has been associated with worsening the depression course, and worse outcomes such as suicide/death risk, social functioning and health care utilization.
“In addition to its role in the aetiology of depressive disorders, alcohol use has been associated with worsening the depression course, and worse outcomes such as suicide/death risk, social functioning and health care utilization (214; specifically for suicide, see section on injury below).”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [214]
Clinicians may attribute emerging somatic symptoms to the underlying psychiatric disorder, resulting in missed diagnoses, sometimes termed diagnostic overshadowing.
“One explanation for these disparities in care is that clinicians may attribute emerging somatic symptoms to the underlying psychiatric disorder resulting in missed diagnoses, sometimes termed 'diagnostic overshadowing'.124,125”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [124]
There is evidence that various healthcare providers have stigmatised views on people with mental illness.
“Although health care should be the one sector where challenging behaviour might be recognized as a symptom of illness, there is evidence that various healthcare providers have stigmatised views on people with mental illness.124,125”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [124]
Access to health care for people with mental illness may be compromised by financial costs, fragmentation of care and stigma.
“Finally, access may be compromised by financial costs, fragmentation of care and stigma.124,126,129”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [124]
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- Authors
- Sullivan, L. E., Fiellin, D. A., & O’Connor, P. G.
- Affiliations
- Yale University (US)
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2005-04
- Volume
- 118
- Issue
- 4
- Pages
- 330-341
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2015198281
- Cited by
- 489
- References
- 77
- Citations by year
- 2026: 6 · 2025: 25 · 2024: 26 · 2023: 25 · 2022: 36 · 2021: 26 · 2020: 33 · 2019: 34 · 2018: 30 · 2017: 30 · 2016: 26 · 2015: 26 · 2014: 30 · 2013: 25 · 2012: 23
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (K12 DA00167, K12DA000167)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- major depressive disorder, alcohol problems, alcoholism, alcohol abuse, prevalence, antidepressant treatment, suicide risk, social functioning, health care utilization, psychiatric inpatients, primary care
- MeSH terms
- Alcoholism, Antidepressive Agents, Depressive Disorder, Major, Major Depressive Disorder, Humans, Suicide, Prevalence, Randomized Controlled Trials as Topic
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