Atypical Epidemiologic Finding in Association between Depression and Alcohol Use or Smoking in Korean Male: Korean Longitudinal Study of Aging

Associations of Changes in Alcohol Consumption on the Risk of Depression/Suicide Among Initial Nondrinkers

Although prior studies showed the association between the amount of alcohol ingestion and the risk of depression and suicide, there has been a lack of research considering changes in alcohol intake over time. This research aimed to assess the associations of alcohol consumption level changes and the risk of depression and suicide among initial nondrinkers. Using data from the National Health Insurance Service in South Korea between 2002 and 2019, a total of 129,446 subjects were included and monitored from January 1, 2011, to December 31, 2019, of which 102,721 were never drinkers and 26,725 were former drinkers. For depression, the follow-up periods ranged from 0.01 to 9.00 years (mean 8.65, median 9.00 years). Moreover, for suicide, the follow-up periods ranged from 0.03 to 9.00 years (mean 8.99, median 9.00 years). To ensure robust results, the model was adjusted for several confounders in three steps: Model 1 was adjusted for sociodemographic factors (age and sex), Model 2 included additional lifestyle factors (household income, smoking status, and physical activity) in addition to Model 1 variables, and Model 3 included all variables from Model 2 and incorporated further variables including body mass index (BMI), systolic blood pressure, fasting serum glucose, total cholesterol, and the Charlson Comorbidity Index (CCI). The Cox proportional hazard regression was utilized to estimate the adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) for depression and suicide risk after an increase in alcohol consumption. Individuals who increased alcohol consumption lightly up to one glass per day had a reduced risk of depression (aHR, 0.91; 95% CI, 0.84-0.98) compared with individuals who maintained their nondrinking status at the third medical checkup. Notably, stratified analyses indicated that the associations were only evident in those younger than 60 years and those physically active. Additionally, among former drinkers, those who increased their alcohol intake to four or more glasses per day had an increased risk of depression (aHR, 1.31; 95% CI, 1.04-1.66). However, individuals who initiated drinking between two and four glasses of alcoholic beverages per day were found to have a higher risk of suicide (aHR, 2.25; 95% CI, 1.31-3.87) relative to those who continued to abstain from drinking. Our findings suggest that small increases in alcohol intake among the initial nondrinkers are associated with a reduced risk of depression, whereas moderate-to-heavy increments in alcohol consumption are associated with a detrimental risk of suicide. This study has several limitations including the low number of suicide events, reliance on self-reported alcohol consumption which may introduce underreporting bias, and the exclusion of important confounding variables such as educational attainment and dietary factors. Furthermore, the study population was exclusively Korean, limiting the generalizability of the findings to other ethnic groups.

Socioeconomic disparities in alcohol-related depression: a national cohort study of low-income medical aid beneficiaries and national health insurance beneficiaries in Korea

OBJECTIVE

To examine the association between patterns of alcohol consumption in the past and the risk of depression among medical aid beneficiaries and National Health Insurance beneficiaries in Korea.

METHODS

We used data from the National Health Information Database (NHID) of 1,292,618 participants who underwent health checkups in 2015-16 and 2017-18. We categorized alcohol consumption into four groups: continuous high, increased, decreased, and non-consumers. We followed the participants from 2019 to 2021 and identified new episodes of depression. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for depression by alcohol consumption groups and socioeconomic status.

RESULTS

Medical aid beneficiaries had higher risks of depression than National Health Insurance beneficiaries across all alcohol consumption groups. The highest risk was observed among continuous high consumers (aOR, 2.31; 95% CI, 1.36-3.93), followed by increased (aOR, 1.51; 95% CI, 1.17-1.94), decreased (aOR, 1.48; 95% CI, 1.18-1.84), and non-consumers (aOR, 1.37; 95% CI, 1.22-1.54).

CONCLUSIONS

Socioeconomic status and patterns of alcohol consumption in the past are associated with the risk of depression. Public health interventions should consider both factors to reduce alcohol-related depression and health inequalities.

Comparison on the clinical features in patients with or without treatment-resistant depression: A National Survey on Symptomatology of Depression report

Patients with treatment-resistant depression (TRD) have fewer treatment options and worse prognoses than those without TRD. Although the etiology or pathophysiology of TRD remains unclear, certain clinical variables have been found to be related to its severity and prognosis. Therefore, 1151 patients with recurrent depression were recruited from the National Survey on Symptomatology of Depression (NSSD) and their depressive symptoms were assessed by using the doctor-rating assessment questionnaire. Then, the differences between patients with or without TRD were compared by parametric or nonparametric tests and the risk factors for TRD were explored by logistic regression. The results showed there were differences in clinical variables between patients with and without TRD. Additionally, we found depression with more somatic symptoms had a higher risk for TRD. Further analysis by stepwise logistic regression showed that age, gender, religious belief, drinking habit, the total course of depression, the number of hospitalizations, characteristics of seasonal episode remission, depressed mood, hypersexuality, emotionally incoherent psychotic symptoms, psychomotor agitation, respiratory system symptoms and history of suicide attempts were strongly associated with TRD. So, it is crucial for clinicians to identify these clinical features and adjust treatments timely.

Moderate alcohol consumption and depression prevention: A critical review

There is a clear consensus that alcohol use disorders are associated with poorer outcomes concerning depression, and that drinking alcohol shouldn`t be recommended because of the risk of dependence. Until recently, literature focused almost exclusively on patients with alcohol use disorders and excludes patients with moderate alcohol use (MAU). It’s has been shown that MAU can prevent or improve the evolution of chronic diseases such as cardiovascular diseases, but several researchers have suggested that there is no safe level of alcohol drinking due to other effects on health. Nevertheless, there is some evidence regarding the antidepressant effect of moderate alcohol consumption. This critical review aims to sum up the direction and tendency of current research on the effect of MAU on depression and relate the causal or confounders factors that might explain the results.

Comorbid Depressive and Anxiety Symptoms and Their Correlates Among 93,078 Multiethnic Adults in Southwest China

Background: Depressive symptoms and anxiety symptoms commonly coexist and severely increases the disease burden worldwide. Little is known about the patterns and correlates of comorbid depressive and anxiety symptoms among the multiethnic populations of China.

Methods: This population-based study investigated the comprehensive associations of comorbid depressive and anxiety symptoms with lifestyles, stressful life events, chronic diseases, and physical and mental well-being among 93,078 participants (37,193 men, 55,885 women) aged 30–79 years across seven ethnic groups in Southwest China. Multivariable logistic regression models were used to estimate associations.

Results: Overall, 2.9% (2.1% in men and 3.5% in women) participants had comorbid depressive and anxiety symptoms; there was considerable heterogeneity among multiethnic populations. Participants with chronic diseases were more likely to have comorbidity than those without them; people with rheumatic heart disease reported the highest risk, with an odds ratio (OR) of 6.25 and 95% confidence interval (CI) of 4.06–9.62. Having experienced 3 or more stressful life events (OR, 8.43, 95% CI: 7.27–9.77), very poor self-rated health status (OR, 33.60, 95%CI: 25.16–44.87), and very unsatisfied life (OR, 33.30, 95% CI: 23.73–46.74) had strong positive associations with comorbid depressive symptoms and anxiety symptoms, with a dose-response relationship (P < 0.05). High frequency of physical activity had negative associations. All the associations were stronger than depressive symptoms alone or anxiety symptoms alone.

Conclusions: Our findings emphasize the need to focus on the vulnerable ethnic groups with comorbid depressive and anxiety symptoms, ultimate for help early prevention and improvement of health equity in the underdevelopment and high urbanization areas.

Association between Alcohol Drinking Status and Depressive Symptoms in Korean Adults

We investigated the association between alcohol drinking status and depressive symptoms in a representative sample of South Korean adults using data from the 2017 Korea Community Health Survey (KCHS), which included 216,771 participants (99,845 men and 116,926 women). Depression was defined as a Patient Health Questionnaire-9 score of ≥10. Multivariate logistic regression using sampling weights was used to assess the relationship between alcohol drinking status and depression after adjusting for potential confounders. Alcohol intake was nonlinearly associated with depression; the risk of depression was the lowest in men who were moderate drinkers and women who were light drinkers. In men, heavy drinkers (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19–1.67), light drinkers (OR 1.13, 95% CI 0.94–1.36), infrequent drinkers (OR 1.31, 95% CI 1.00–1.73), and lifetime abstainers (OR 1.38, 95% CI 1.09–1.75) were at a higher risk of depression than moderate drinkers. In women, moderate drinkers (OR 1.19, 95% CI 1.02–1.40) and heavy drinkers (OR 1.56, 95% CI 1.33–1.84) were at a higher risk of depression than light drinkers; however, infrequent drinkers and lifetime abstainers were not at a high risk of depression. In both men and women, former drinkers were at a higher risk of depression (OR 1.61, 95% CI 1.34–1.93 and OR 1.25, 95% CI 1.09–1.43, respectively). In conclusion, the association between alcohol drinking status and depression was nonlinear in both sexes. Further investigation of age- and sex-specific factors related to the association between alcohol use and depression is needed.

Gender Differences in the Impact of Depression on Cognitive Decline Among Korean Older Adults

This study aimed to investigate whether (1) depression is associated with cognitive decline in Korean older adults and (2) the relationship between depression and cognitive function varies by gender. Using Korean Longitudinal Study of Aging data of 2006 to 2014, we studied 1787 adults aged 65 years or older who had normal cognitive function at baseline. This study examined the effects of depression on cognitive decline by using an interaction term of baseline depression and time, and compared relationships by gender. Among male participants, K-MMSE (Korean-Mini-Mental Status Examination) scores decreased with age, at an annual rate of approximately 0.465 points. Baseline depression was found to accelerate the decline in cognitive function, by approximately 0.184 points per year. Among female participants, K-MMSE scores decreased with age, at an annual rate of approximately 0.585 points. Baseline depression was not related to the decline in cognitive function. These results suggest the need for community-based programs to increase awareness of mental health problems need to be developed to encourage the use of health services to prevent or delay cognitive decline in older Korean males.

Smoking among adults with serious psychological distress: Analysis of anonymized data from a national cross-sectional survey in Japan

BACKGROUND

Smoking behavior among people with serious psychological distress (SPD) has not been fully investigated in Asia, although smoking has become a public health concern worldwide. Many Western population-based studies indicate that people with psychological distress are more likely to smoke.

METHODS

This study used a national representative data set from the 2010 Comprehensive Survey of Living Conditions of Japan. SPD was defined as scores ≥13 or greater on the Kessler Psychological Distress Scale (K6). Multivariate logistic regression analyses were conducted to analyze the association between SPD and current smoking in Japanese adults.

RESULTS

In both men (n = 27,937) and women (n = 30,786), SPD was significantly associated with current smoking (adjusted odds ratios [95% confidence intervals]: 1.169 [1.030-1.328] for men and 1.677 [1.457-1.931] for women). Among men, SPD was significantly associated with current smoking only in people aged ≥50 years (1.519 [1.232-1.874]) and married (1.456 [1.228-1.728]). SPD was significantly associated with current smoking in women of all ages. SPD had a greater impact on current smoking for women aged 20-49 years than for those aged ≥50 years (1.832 [1.552-2.162] and 1.445 [1.099-1.900], respectively).

LIMITATIONS

The cross-sectional design precludes assumptions about the direction of causality. In addition, smoking status was self-reported.

CONCLUSIONS

SPD was significantly associated with current smoking in Japan and the association was much stronger for younger women. Clinical strategies are needed to reduce the prevalence of smoking among people with SPD to reduce excess mortality in this population.

Depressive symptoms and their association with social determinants and chronic diseases in middle-aged and elderly Chinese people

Depression is one of the most prevalent mental disorders worldwide. Little information is available regarding association of depressive symptoms (DS) with cancer and chronic diseases among middle-aged and elderly Chinese in a population-based setting. In this study we evaluated the prevalence and examined correlates of DS in two population-based cohort studies. Included in the analyses were 103,595 people with a mean age of 61.8 years at the DS assessment. The prevalence of DS was 2.4% in men and 5.6% in women. We found elderly participants, those with lower BMI, or chronic diseases were more likely to experience DS. Having a history of stroke (odds ratio (OR) = 2.2 in men and 1.8 in women), cancer (OR = 3.3 in men and 1.9 in women), or Parkinson's disease (OR = 3.1 in men and 2.7 in women) was associated with high DS. In women, high income and high education levels were inversely related to DS. Being a single woman, long-term or heavy female smoker was associated with high prevalence of DS. High BMI was correlated with low prevalence of depression in men. Our data suggests a low prevalence of DS among middle-aged and elderly people in Shanghai, China. Age, education, income, marital status, smoking, BMI, and certain health conditions were associated with DS.

Clinical Significance of the Number of Depressive Symptoms in Major Depressive Disorder: Results from the CRESCEND Study

Our study aimed to establish the relationship between the number of depressive symptoms and the clinical characteristics of major depressive disorder (MDD). This would enable us to predict the clinical significance of the number of depressive symptoms in MDD patients. Using data from the Clinical Research Center for Depression (CRESCEND) study in Korea, 853 patients with DSM-IV MDD were recruited. The baseline and clinical characteristics of groups with different numbers of depressive symptoms were compared using the χ(2) test for discrete variables and covariance (ANCOVA) for continuous variables. In addition, the scores of these groups on the measurement tools were compared by ANCOVA after adjusting the potential effects of confounding variables. After adjusting the effects of monthly income and history of depression, a larger number of depressive symptoms indicated higher overall severity of depression (F [4, 756] = 21.458, P < 0.001) and higher levels of depressive symptoms (F [4, 767] = 19.145, P < 0.001), anxiety symptoms (F [4, 765] = 12.890, P < 0.001) and suicidal ideation (F [4, 653] = 6.970, P < 0.001). It also indicated lower levels of social function (F [4, 760] = 13.343, P < 0.001), and quality of life (F [4, 656] = 11.975, P < 0.001). However, there were no significant differences in alcohol consumption (F [4, 656] = 11.975, P < 0.001). The number of depressive symptoms can be used as an index of greater illness burden in clinical psychiatry.

Do Alcohol Misuse, Smoking, and Depression Vary Concordantly or Sequentially? A Longitudinal Study of HIV-Infected and Matched Uninfected Veterans in Care

We analyzed temporal patterns of alcohol misuse, smoking, and depression among veterans in care to determine whether these conditions vary concordantly or sequentially. Using the Veterans Aging Cohort Study, harmful alcohol use (AUDIT-C ≥ 4), current smoking, and depression (PHQ-9 ≥ 8), were measured. In regression analyses, predictors included each outcome condition at baseline, the other two conditions in the same survey, the other two conditions in the immediately preceding survey, number of years since enrollment, and HIV status. We found that current smoking and depression were more common among HIV infected individuals. Harmful alcohol use was more common among uninfected individuals. Temporal analyses suggested a concurrent pattern: each condition was associated with the other two conditions (p < 0.03, OR 1.12-1.66) as well as with the prior presence of the same condition (p < 0.0001; OR 6.38-22.02). Smoking was associated with prior depression after controlling for current depression (OR 1.16; p = 0.003). In conclusion, alcohol misuse, smoking, and depression were temporally concordant and persistent, raising the question of whether they constitute a common syndrome in HIV infected patients and others with chronic diseases.

Active smoking and exposure to secondhand smoke and their relationship to depressive symptoms in the Korea national health and nutrition examination survey (KNHANES)

BACKGROUND

The relationship between tobacco smoking, including secondhand smoking, and depression has been assessed. The purpose of this study was to evaluate the association between secondhand smoking among current, former and never smokers and depressive symptoms. For secondhand smoking, gender differences and sources of exposure were examined.

METHODS

Data from 34,693 participants from the fourth and fifth Korean Health and Nutritional Examination Survey (2007-2012) were analyzed in 2014. Self-reported exposure to active (current, former or never) and secondhand smoking and depressive symptoms experienced during the past year were analyzed using logistic regression. The dose-response relationship between duration of secondhand smoke exposure and depression was assessed with stratification by gender and sources of exposure (at home only, at the workplace only or both).

RESULTS

Regardless of their smoking status, all women who had secondhand smoke exposure at home reported more depressive symptoms than non-smoking women without any exposure to secondhand cigarette smoking (OR 1.43, 95 % CI 1.04-1.96 for current smokers; OR 2.32, 95 % CI 1.04-5.16 for former smokers; OR 1.25, 95 % CI 1.08-1.43 for never smokers). There was also a significant dose-response pattern (p-trend <0.001) for the duration of secondhand smoke exposure at home among women. No significant association was found between smoking and depressive symptoms in men.

CONCLUSIONS

There was a significant association between secondhand smoke exposure at home and depressive symptoms in women. Secondhand smoke exposure at home was associated with depressive symptoms in a dose-response manner.