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; RRR_female = 1.09, 95% CI = 1.04-1.14]. Severity of depressive symptoms was negatively associated with 'regular use plus occasional bingeing' for males (RRR_male = 0.98, 95% CI = 0.95-1.00) and positively with 'occasional use plus occasional bingeing' for females (RRR_female = 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 (RRRs_male = 1.72-2.36; RRRs_female = 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'.

Keywords: Alcohol use patterns; clustering; depressive symptoms; gender differences; latent categorical analysis; medical care.