Reconsidering the associations between self-reported alcohol use disorder and mental health problems in the light of co-occurring addictions in young Swiss men

PLoS One. 2019 Sep 30;14(9):e0222806. doi: 10.1371/journal.pone.0222806. eCollection 2019.

Abstract

Background: Alcohol use disorder (AUD) is known to co-occur with other addictions, as well as with mental health problems. However, the effects of other addictions co-occurring with AUD on mental health problems were rarely studied and not considering them may bias estimates of the association between AUD and mental health problems. This study investigated which role co-occurring addictions play for the cross-sectional associations between self-reported AUD and mental health problems.

Method: Participants were 5516 young Swiss men (73.0% of those that gave written informed consent) who completed a self-report questionnaire. Using short screening questionnaires, we assessed three substance use disorders (alcohol, cannabis and tobacco), seven behavioural addictions (internet, gaming, smartphone, internet sex, gambling, work, exercise) and four mental health problems (major depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and social anxiety disorder). Differences in the proportions of mental health problems were tested using logistic regressions between (1) participants with no AUD and AUD, (2) participants with no AUD and AUD alone and (3) participants with no AUD and AUD plus at least one co-occurring addiction.

Results: Overall, (1) participants with AUD had higher proportions of major depression (Odds ratio (OR [95% confidence interval]) = 3.51 [2.73, 4.52]; ADHD (OR = 3.12 [2.41, 4.03]); bipolar disorder (OR = 4.94 [3.38, 7.21]) and social anxiety (OR = 2.21 [1.79, 2.73])) compared to participants with no AUD. Considering only participants with AUD alone compared to participants with no AUD (2), differences in proportions were no longer significant for major depression (OR = 0.83 [0.42, 1.64]), bipolar disorder (OR = 1.69 [0.67, 4.22]), social anxiety (OR = 1.15 [0.77, 1.73]) and ADHD (OR = 1.65 [1.00, 2.72]) compared to participants with no AUD. In contrast, (3) proportions of mental health problems were considerably higher for participants with AUD plus at least one other addiction when compared to participants with no AUD, with OR's ranging from 2.90 [2.27, 3.70] for social anxiety, 4.03 [3.02, 5.38] for ADHD, 5.29 [4.02, 6.97] for major depression to 6.64 [4.44, 9.94] for bipolar disorder.

Conclusions: AUD was associated with all four measured mental health problems. However, these associations were mainly due to the high proportions of these mental health problems in participants with AUD plus at least one co-occurring addiction and only to a lesser degree due to participants with AUD alone (i.e. without any other co-occurring addictions). Hence, estimates of the association between AUD and mental health problems that do not consider other addictions may be biased (i.e. overestimated). These findings imply that considering addictions co-occurring with AUD, including behavioural addictions, is important when investigating associations between AUD and mental health problems, and for the treatment of AUD and co-morbid disorders.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Alcoholism / epidemiology*
  • Alcoholism / physiopathology
  • Alcoholism / psychology
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Attention Deficit Disorder with Hyperactivity / physiopathology
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Behavior, Addictive / epidemiology*
  • Behavior, Addictive / physiopathology
  • Behavior, Addictive / psychology
  • Bipolar Disorder / epidemiology*
  • Bipolar Disorder / physiopathology
  • Bipolar Disorder / psychology
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder, Major / epidemiology*
  • Depressive Disorder, Major / physiopathology
  • Depressive Disorder, Major / psychology
  • Humans
  • Logistic Models
  • Male
  • Marijuana Abuse / epidemiology*
  • Marijuana Abuse / physiopathology
  • Marijuana Abuse / psychology
  • Mental Health / statistics & numerical data
  • Odds Ratio
  • Phobia, Social / epidemiology*
  • Phobia, Social / physiopathology
  • Phobia, Social / psychology
  • Self Report
  • Surveys and Questionnaires
  • Switzerland / epidemiology
  • Tobacco Smoking / epidemiology*
  • Tobacco Smoking / physiopathology
  • Tobacco Smoking / psychology

Grants and funding

This work was supported by Grants FN 33CSC0-122679, FN 33CS30_139467 and FN 33CS30_148493 from the Swiss National Science Foundation (www.snf.ch) to GG. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.