Depressive Symptoms and Subsequent Alcohol Use and Problems: A Prospective Study of Medical Inpatients with Unhealthy Alcohol Use *.
THERE IS CONSIDERABLE EVIDENCE to suggest that patients in medical settings have a higher prevalence of alcohol-use disorders and exhibit more risky drinking behavior than the general population (Maisto and Saitz, 2003). This “unhealthy drinking,” which includes the spectrum of drinking patterns that place one at risk for harm to alcohol dependence (Saitz, 2005), is also observed among those who use medical services more frequently (Chou et al., 1996; Curtis et al., 1986; Moore et al., 1989). The prevalence of unhealthy drinking appears to be particularly high among hospitalized medical patients. These patients are more likely to report problems associated with their drinking (Jarman and Kellett, 1979; Moore et al., 1989) and meet criteria for alcohol-use disorders (Booth et al., 1998) than those in the community. Medical patients who are unhealthy drinkers are also more likely to exhibit clinical depression and elevated depressive symptoms (Alati et al., 2004; Amodei et al., 1994; Kim et al., 2003; Roeloffs et al., 2002). Amodei et al., for example, found that, of those who met criteria for an alcohol-use disorder in an urban primary care center, 38% experienced significant depressive symptoms within the past 30 days, compared with 13% of people without an alcohol-use disorder. Similarly, Alati et al. found that both male and female harmful drinkers in the emergency room, defined by cutoff scores on the Alcohol Use Disorder Identification Test (AUDIT; Saunders et al., 1993), showed higher levels of depressive symptoms compared with those with lower AUDIT scores. The co-occurrence of unhealthy alcohol use and elevated depressive symptoms may be of particular concern for medical patients given their significant negative effects on physical health outcomes (Aneshensel et al., 1984) and mortality risk (Greenfield et al., 2002).