Alcohol consumption and depressive symptoms over time: A longitudinal study of patients with and without HIV infection

Background: The impact of alcohol consumption on depressive symptoms over time among patients who do not meet criteria for alcohol abuse or dependence is not known. Objective: To evaluate the impact of varying levels of alcohol consumption on depressive symptoms over time in patients with and without HIV infection. Design: We used data from the Veterans Aging Cohort Study (VACS). We used generalized estimating equation models to assess the association of alcohol-related categories, as a fixed effect, on the time-varying outcome of depressive symptoms. Participants: VACS is a prospectively enrolled cohort study of HIV-infected patients and age-, race- and site-matched HIV uninfected patients. Main measures: Hazardous, binge drinking, alcohol abuse and alcohol dependence were defined using standard criteria. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9). Key results: Among the 2446 patients, 19% reported past but not current alcohol use, 50% non-hazardous drinking, 8% hazardous drinking, 14% binge drinking, and 10% met criteria for alcohol or dependence. At baseline, depressive symptoms were higher in hazardous and binge drinkers than in past and nonhazardous drinkers (OR = 2.65; CI = 1.50/4.69; p < .001) and similar to those with abuse or dependence. There was no difference in the association between alcohol-related category and depressive symptoms by HIV status (OR = 0.99; CI -.83/1.18; p = .88). Hazardous drinkers were 2.53 (95% CI = 1.34/4.81) times and binge drinkers were 2.14(95% CI = 1.49/3.07) times more likely to meet criteria for depression when compared to non-hazardous drinkers. The associations between alcohol consumption and depressive symptoms persisted over three years and were responsive to changes in alcohol-related categories. Conclusions: HIV-infected and HIV-uninfected hazardous and binge drinkers have depressive symptoms that are more severe than non-hazardous and non-drinkers and similar to those with alcohol abuse or dependence. Patients who switch to a higher or lower level of drinking experience a similar alteration in their depressive symptoms. Interventions to decrease unhealthy alcohol consumption may improve depressive symptoms. (C) 2011 Elsevier Ireland Ltd. All rights reserved.